hospital_name last_updated_on version hospital_location hospital_address license_number|TN "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "Cumberland Behavioral Health, LLC" 5/31/2024 2.0.0 "Nashville, Tennessee" 300 Great Circle Road license_ L00000032043 | TN TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AARP SUPPLEMENT]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AARP SUPPLEMENT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AARP SUPPLEMENT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AARP SUPPLEMENT]|[plan_COMMERCIAL] standard_charge|[payer_AARP SUPPLEMENT]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AARP SUPPLEMENT]|[Plan_COMMERCIAL] standard_charge|[payer_ACS BENEFIT SERVICES- CIG]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ACS BENEFIT SERVICES- CIG]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ACS BENEFIT SERVICES- CIG]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ACS BENEFIT SERVICES- CIG]|[plan_HMO/PPO] standard_charge|[payer_ACS BENEFIT SERVICES- CIG]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ACS BENEFIT SERVICES- CIG]|[Plan_HMO/PPO] 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 BETTER HEALTH OF KY]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH OF KY]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH OF KY]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH OF KY]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER HEALTH OF KY]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA BETTER HEALTH OF KY]|[Plan_MANAGED MEDICARE] 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_AETNA SENIOR SUPPLEMENTAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_COMMERCIAL] standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AETNA SENIOR SUPPLEMENTAL]|[Plan_COMMERCIAL] standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AITHER HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AITHER HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_ALL SAVERS- UHC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALL SAVERS- UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALL SAVERS- UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALL SAVERS- UHC]|[plan_HMO/PPO] standard_charge|[payer_ALL SAVERS- UHC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALL SAVERS- UHC]|[Plan_HMO/PPO] standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALLEGIANCE BENEFIT- CIGNA]|[plan_HMO/PPO] standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALLEGIANCE BENEFIT- CIGNA]|[Plan_HMO/PPO] standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLIED BENEFIT SYSTEMS]|[plan_COMMERCIAL] standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_ALLIED BENEFIT SYSTEMS]|[Plan_COMMERCIAL] standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AMBETTER]|[plan_COMMERCIAL] standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AMBETTER]|[Plan_COMMERCIAL] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ANTHEM MEDIBLUE GA MDCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ANTHEM MEDIBLUE GA MDCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OF TENNESSEE]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE]|[Plan_BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS]|[Plan_HMO/PPO] standard_charge|[payer_BHS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BHS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BHS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BHS]|[plan_COMMERCIAL] standard_charge|[payer_BHS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BHS]|[Plan_COMMERCIAL] standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BLUECARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BLUECARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BLUECARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BLUECARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_BLUECARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BLUECARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUECARE PLUS]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BRIGHT HEALTH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BRIGHT HEALTH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BRIGHT HEALTH MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BRIGHT HEALTH MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CARELON BEHAVIORAL HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_CARELON BEHAVIORAL HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_CBH]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_CBH]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_CBH]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_CBH]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_CBH]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_CBH]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMPVA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMPVA]|[Plan_VETERANS ADMIN] standard_charge|[payer_CIGNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA]|[plan_HMO/PPO] standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA]|[Plan_HMO/PPO] standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTHSPRING]|[Plan_MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH PLAN]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_DEVOTED HEALTH PLAN]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_DEVOTED HEALTH PLAN]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_DEVOTED HEALTH PLAN]|[plan_MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH PLAN]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_DEVOTED HEALTH PLAN]|[Plan_MANAGED MEDICARE] standard_charge|[payer_GEHA- UHC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GEHA- UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GEHA- UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GEHA- UHC]|[plan_HMO/PPO] standard_charge|[payer_GEHA- UHC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_GEHA- UHC]|[Plan_HMO/PPO] standard_charge|[payer_GTL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GTL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GTL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GTL]|[plan_COMMERCIAL] standard_charge|[payer_GTL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_GTL]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTHY BLUE MISSOURI]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HEALTHY BLUE MISSOURI]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HEALTHY BLUE MISSOURI]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HEALTHY BLUE MISSOURI]|[plan_MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE MISSOURI]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HEALTHY BLUE MISSOURI]|[Plan_MANAGED MEDICAID] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_KAISER PERMANENTE]|[Plan_COMMERCIAL] standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_KY ANTHEM MEDIBLUE ACCESS]|[plan_MANAGED MEDICARE] standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_KY ANTHEM MEDIBLUE ACCESS]|[Plan_MANAGED MEDICARE] standard_charge|[payer_KY UHC COMMUNITY PLAN]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_KY UHC COMMUNITY PLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_KY UHC COMMUNITY PLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_KY UHC COMMUNITY PLAN]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_KY UHC COMMUNITY PLAN]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_KY UHC COMMUNITY PLAN]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_LUCENT HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN]|[Plan_HMO/PPO] standard_charge|[payer_MEDICAID KY]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MEDICAID KY]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MEDICAID KY]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MEDICAID KY]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID KY]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MEDICAID KY]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID TN]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID TN]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID TN]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID TN]|[plan_MEDICAID ] standard_charge|[payer_MEDICAID TN]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID TN]|[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_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_MUTUAL OF OMAHA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MUTUAL OF OMAHA]|[Plan_COMMERCIAL] standard_charge|[payer_OHIO STATE HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_OHIO STATE HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_OHIO STATE HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_OHIO STATE HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_OHIO STATE HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_OHIO STATE HEALTH PLAN]|[Plan_COMMERCIAL] standard_charge|[payer_OOS MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OOS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OOS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OOS MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OOS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OOS MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM BEHAVIORAL H HEALTH]|[plan_HMO/PPO] standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM BEHAVIORAL H HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_OSCAR- CIGNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OSCAR- CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OSCAR- CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OSCAR- CIGNA]|[plan_HMO/PPO] standard_charge|[payer_OSCAR- CIGNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OSCAR- CIGNA]|[Plan_HMO/PPO] standard_charge|[payer_SISCO BENEFITS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_SISCO BENEFITS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_SISCO BENEFITS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SISCO BENEFITS]|[plan_COMMERCIAL] standard_charge|[payer_SISCO BENEFITS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_SISCO BENEFITS]|[Plan_COMMERCIAL] standard_charge|[payer_TN MEDICAID - SLMB]|[plan_SELF PAY CHARITY]|negotiated_dollar standard_charge|[payer_TN MEDICAID - SLMB]|[plan_SELF PAY CHARITY] |negotiated_percentage standard_charge|[payer_TN MEDICAID - SLMB]|[plan_SELF PAY CHARITY] |negotiated_algorithm estimated_amount|[payer_TN MEDICAID - SLMB]|[plan_SELF PAY CHARITY] standard_charge|[payer_TN MEDICAID - SLMB]|[plan_SELF PAY CHARITY] |methodology additional_payer_notes |[payer_TN MEDICAID - SLMB]|[Plan_SELF PAY CHARITY] standard_charge|[payer_TRICARE EAST]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST]|[Plan_TRICARE] standard_charge|[payer_TRICARE 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_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_UHC AARP ADVAN]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC AARP ADVAN]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC AARP ADVAN]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC AARP ADVAN]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC AARP ADVAN]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC AARP ADVAN]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC ADVANTAGE]|[Plan_MANAGED MEDICARE] 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 SHARED SERVICES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC SHARED SERVICES]|[Plan_HMO/PPO] 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_UPMC HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UPMC HEALTH PLAN]|[Plan_COMMERCIAL] standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA CCN OPTUM]|[Plan_VETERANS ADMIN] standard_charge|[payer_VA COMMUNITY CARE NETWORK]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA COMMUNITY CARE NETWORK]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA COMMUNITY CARE NETWORK]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA COMMUNITY CARE NETWORK]|[plan_VETERANS ADMIN] standard_charge|[payer_VA COMMUNITY CARE NETWORK]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA COMMUNITY CARE NETWORK]|[Plan_VETERANS ADMIN] standard_charge|[payer_WELLCARE HEALTH PLANS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE HEALTH PLANS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE HEALTH PLANS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE HEALTH PLANS]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE HEALTH PLANS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE HEALTH PLANS]|[Plan_MANAGED MEDICARE] additional_generic_notes ROOM AND BOARD ADULT UNIT 1 124 RC facility inpatient 2700 1000 700 2700 2700 per diem 1224 per diem 1269 per diem 2700 per diem 1269 per diem 2700 per diem 2700 per diem 1000 per diem 1224 per diem 2700 per diem 2700 per diem 700 per diem 2600 per diem 1075 per diem 1075 per diem 1075 per diem 1075 per diem 1100 per diem 1100 per diem 1075 per diem 725 per diem 725 per diem 1240 per diem 1100 per diem 2700 per diem 2700 per diem 1224 per diem 2400 per diem 2400 per diem 1000 per diem 2700 per diem 1082 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1400 per diem 2700 per diem 2700 per diem 876 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1224 per diem 2700 per diem 2700 per diem 1087 per diem 2700 per diem 1087 per diem 1235 per diem 1235 per diem 750 per diem 1000 per diem 1000 per diem 1000 per diem 2700 per diem 2700 per diem 2700 per diem 937 per diem ROOM AND BOARD GERI UNIT 1 124 RC facility inpatient 2700 1000 700 2700 2700 per diem 1224 per diem 1269 per diem 2700 per diem 1269 per diem 2700 per diem 2700 per diem 1000 per diem 1224 per diem 2700 per diem 2700 per diem 700 per diem 2600 per diem 1075 per diem 1075 per diem 1075 per diem 1075 per diem 1100 per diem 1100 per diem 1075 per diem 725 per diem 725 per diem 1240 per diem 1100 per diem 2700 per diem 2700 per diem 1224 per diem 2400 per diem 2400 per diem 1000 per diem 2700 per diem 1082 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1400 per diem 2700 per diem 2700 per diem 876 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1224 per diem 2700 per diem 2700 per diem 1087 per diem 2700 per diem 1087 per diem 1235 per diem 1235 per diem 750 per diem 1000 per diem 1000 per diem 1000 per diem 2700 per diem 2700 per diem 2700 per diem 937 per diem ELECTROCONVULSIVE THERAPY - INPATIENT 901 RC facility outpatient 2600 1600 460 5200 2600 per diem 1588 per diem 2600 per diem 1588 per diem 2600 per diem 2600 per diem 1134 per diem 721 per diem 2600 per diem 5200 per diem 760 per diem 2600 per diem 788 per diem 1576 per diem 1576 per diem 1576 per diem 773 per diem 700 per diem 1576 per diem 950 per diem 950 per diem 1045 per diem 773 per diem 2600 per diem 2600 per diem 1442 per diem 460 per diem 1134 per diem 5200 per diem 1700 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem 1700 per diem 2600 per diem 5200 per diem 460 per diem 5200 per diem 2600 per diem 2600 per diem 773 per diem 1442 per diem 2600 per diem 2600 per diem 5200 per diem 2600 per diem 2600 per diem 1174 per diem 1174 per diem 940 per diem 1134 per diem 1134 per diem 1134 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem ELECTROCONVULSIVE THERAPY - OUTPATIENT 901 RC facility outpatient 2600 1600 460 5200 2600 per diem 1588 per diem 2600 per diem 1588 per diem 2600 per diem 2600 per diem 1134 per diem 721 per diem 2600 per diem 5200 per diem 760 per diem 2600 per diem 788 per diem 1576 per diem 1576 per diem 1576 per diem 773 per diem 700 per diem 1576 per diem 950 per diem 950 per diem 1045 per diem 773 per diem 2600 per diem 2600 per diem 1442 per diem 460 per diem 1134 per diem 5200 per diem 1700 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem 1700 per diem 2600 per diem 5200 per diem 460 per diem 5200 per diem 2600 per diem 2600 per diem 773 per diem 1442 per diem 2600 per diem 2600 per diem 5200 per diem 2600 per diem 2600 per diem 1174 per diem 1174 per diem 940 per diem 1134 per diem 1134 per diem 1134 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem INTENSIVE OUTPATIENT PROGRAM OP PROGRAM 905 RC facility outpatient 650 250 130 788 276 per diem 276 per diem 250 per diem 600 per diem 130 per diem 600 per diem 274 per diem 274 per diem 274 per diem 258 per diem 788 per diem 160 per diem 160 per diem 258 per diem 256 per diem 250 per diem 600 per diem 300 per diem 350 per diem 600 per diem 600 per diem 256 per diem 600 per diem 250 per diem 250 per diem 140 per diem 250 per diem 250 per diem 250 per diem 600 per diem 600 per diem PARTIAL HOSPITAL PROGRAM OP PROGRAM 912 RC facility outpatient 865 500 250 800 566 per diem 566 per diem 350 per diem 800 per diem 250 per diem 800 per diem 412 per diem 550 per diem 412 per diem 425 per diem 350 per diem 800 per diem 450 per diem 600 per diem 800 per diem 800 per diem 425 per diem 800 per diem 350 per diem 350 per diem 260 per diem 350 per diem 350 per diem 350 per diem 800 per diem 800 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GRP 1 915 RC facility outpatient 217 242 550 550 per diem 242 per diem 242 per diem Integrated Biopsychosocial Assessment 90791 RC facility inpatient 300 150 71 144 125 fee schedule 105 fee schedule 126 fee schedule 134 fee schedule 142 fee schedule 86 fee schedule 118 fee schedule 144 fee schedule 144 fee schedule 116 fee schedule 114 fee schedule 119 fee schedule 71 fee schedule Psychiatric Diagnostic Evaluation with Medical Services 90792 RC facility inpatient 350 150 119 234 163 fee schedule 234 fee schedule 119 fee schedule 124 fee schedule 159 fee schedule 156 fee schedule 128 fee schedule 159 fee schedule 74 fee schedule 183 fee schedule 166 fee schedule Initial Inpatient Consultation 99223 RC facility inpatient 280 140 103 223 161 fee schedule 157 fee schedule 191 fee schedule 145 fee schedule 108 fee schedule 223 fee schedule 161 fee schedule 161 fee schedule 172 fee schedule 153 fee schedule 103 fee schedule Initial Hospital Inpatient or Observation Care 99231 RC facility inpatient 140 70 21 54 27 fee schedule 53 fee schedule 45 fee schedule 29 fee schedule 33 fee schedule 54 fee schedule 37 fee schedule 32 fee schedule 39 fee schedule 43 fee schedule 42 fee schedule 32 fee schedule 39 fee schedule 35 fee schedule 21 fee schedule 48 fee schedule Level 2 Hospital Subsequent Care 99232 RC facility inpatient 160 80 34 140 74 fee schedule 84 fee schedule 140 fee schedule 56 fee schedule 59 fee schedule 66 fee schedule 63 fee schedule 34 fee schedule 53 fee schedule 72 fee schedule 80 fee schedule 74 fee schedule 41 fee schedule 64 fee schedule Level 3 Hospital Subsequent Care 99233 RC facility inpatient 180 90 70 115 111 fee schedule 100 fee schedule 70 fee schedule 115 fee schedule 111 fee schedule 111 fee schedule 109 fee schedule 82 fee schedule Observation Discharge Services 92238 RC facility inpatient 160 80 40 109 80 fee schedule 109 fee schedule 56 fee schedule 60 fee schedule 61 fee schedule 65 fee schedule 57 fee schedule 68 fee schedule 76 fee schedule 72 fee schedule 59 fee schedule 72 fee schedule 88 fee schedule 40 fee schedule Hospital Inpatient or Observation Discharge Day Management 99239 RC facility inpatient 160 80 72 85 72 fee schedule 85 fee schedule