hospital_name last_updated_on version hospital_location hospital_address license_number|AR "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." "Conway Behavioral Health, LLC" 5/31/2024 2.0.0 "Conway, Arkansas" 2255 Sturgis Road license_ 5367| AR TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AETNA HEALTHCARE ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA HEALTHCARE ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA HEALTHCARE ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA HEALTHCARE ]|[plan_HMO/PPO] standard_charge|[payer_AETNA HEALTHCARE ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AETNA HEALTHCARE ]|[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_ALASKA MEDICAID ]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_ALASKA MEDICAID ]|[Plan_MEDICAID: CBS OOS] standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_ALASKA MEDICAID ]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_ALASKA MEDICAID ]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_ALLWELL ]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALLWELL ]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALLWELL ]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALLWELL ]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL ]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ALLWELL ]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AMBETTER COMMERCIAL ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER COMMERCIAL ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AMBETTER COMMERCIAL ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMBETTER COMMERCIAL ]|[plan_HMO/PPO] standard_charge|[payer_AMBETTER COMMERCIAL ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AMBETTER COMMERCIAL ]|[Plan_HMO/PPO] standard_charge|[payer_AMBETTER MCD MNGD ]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMBETTER MCD MNGD ]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMBETTER MCD MNGD ]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMBETTER MCD MNGD ]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMBETTER MCD MNGD ]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMBETTER MCD MNGD ]|[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_APC PASSE SUMMIT COMM CARMANAGED ]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_APC PASSE SUMMIT COMM CARMANAGED ]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_APC PASSE SUMMIT COMM CARMANAGED ]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_APC PASSE SUMMIT COMM CARMANAGED ]|[plan_MEDICAID] standard_charge|[payer_APC PASSE SUMMIT COMM CARMANAGED ]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_APC PASSE SUMMIT COMM CARMANAGED ]|[Plan_MEDICAID] standard_charge|[payer_AR DHS ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_AR DHS ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_AR DHS ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_AR DHS ]|[plan_LOCAL GOVT] standard_charge|[payer_AR DHS ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_AR DHS ]|[Plan_LOCAL GOVT] standard_charge|[payer_ARK MEDICAID ]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_ARK MEDICAID ]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_ARK MEDICAID ]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_ARK MEDICAID ]|[plan_MEDICAID] standard_charge|[payer_ARK MEDICAID ]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_ARK MEDICAID ]|[Plan_MEDICAID] standard_charge|[payer_ARKANSAS ADULT MEDICAID ]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_ARKANSAS ADULT MEDICAID ]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_ARKANSAS ADULT MEDICAID ]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_ARKANSAS ADULT MEDICAID ]|[plan_MEDICAID] standard_charge|[payer_ARKANSAS ADULT MEDICAID ]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_ARKANSAS ADULT MEDICAID ]|[Plan_MEDICAID] standard_charge|[payer_ATC INC AR TOTAL CARE ]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ATC INC AR TOTAL CARE ]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ATC INC AR TOTAL CARE ]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ATC INC AR TOTAL CARE ]|[plan_MANAGED MEDICAID] standard_charge|[payer_ATC INC AR TOTAL CARE ]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ATC INC AR TOTAL CARE ]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BLUE CROSS MARKETPLACE AR ]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BLUE CROSS MARKETPLACE AR ]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BLUE CROSS MARKETPLACE AR ]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BLUE CROSS MARKETPLACE AR ]|[plan_MANAGED MEDICAID] standard_charge|[payer_BLUE CROSS MARKETPLACE AR ]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BLUE CROSS MARKETPLACE AR ]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BLUE CROSS OF ARKANSAS MP ]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE CROSS OF ARKANSAS MP ]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE CROSS OF ARKANSAS MP ]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE CROSS OF ARKANSAS MP ]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUE CROSS OF ARKANSAS MP ]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUE CROSS OF ARKANSAS MP ]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BLUE CROSS OF ARKANSAS ]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE CROSS OF ARKANSAS ]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE CROSS OF ARKANSAS ]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE CROSS OF ARKANSAS ]|[plan_BLUE CROSS] standard_charge|[payer_BLUE CROSS OF ARKANSAS ]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE CROSS OF ARKANSAS ]|[Plan_BLUE CROSS] standard_charge|[payer_BLUE CROSS OOS ]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE CROSS OOS ]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE CROSS OOS ]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE CROSS OOS ]|[plan_BLUE CROSS] standard_charge|[payer_BLUE CROSS OOS ]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE CROSS OOS ]|[Plan_BLUE CROSS] standard_charge|[payer_CARESOURCE ARKANSAS ]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CARESOURCE ARKANSAS ]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CARESOURCE ARKANSAS ]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CARESOURCE ARKANSAS ]|[plan_MANAGED MEDICAID] standard_charge|[payer_CARESOURCE ARKANSAS ]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CARESOURCE ARKANSAS ]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CENTERS FOR YOUTH & FAMIL ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CENTERS FOR YOUTH & FAMIL ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_CENTERS FOR YOUTH & FAMIL ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_CENTERS FOR YOUTH & FAMIL ]|[plan_LOCAL GOVT] standard_charge|[payer_CENTERS FOR YOUTH & FAMIL ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_CENTERS FOR YOUTH & FAMIL ]|[Plan_LOCAL GOVT] standard_charge|[payer_CIGNA HEALTH SPRING ]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTH SPRING ]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTH SPRING ]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTH SPRING ]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTH SPRING ]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTH SPRING ]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA ]|[plan_HMO/PPO] standard_charge|[payer_CIGNA ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA ]|[Plan_HMO/PPO] standard_charge|[payer_COUNSELING ASSOCIATES ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_COUNSELING ASSOCIATES ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_COUNSELING ASSOCIATES ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_COUNSELING ASSOCIATES ]|[plan_LOCAL GOVT] standard_charge|[payer_COUNSELING ASSOCIATES ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_COUNSELING ASSOCIATES ]|[Plan_LOCAL GOVT] standard_charge|[payer_COUSELING CLINIC INC ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_COUSELING CLINIC INC ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_COUSELING CLINIC INC ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_COUSELING CLINIC INC ]|[plan_LOCAL GOVT] standard_charge|[payer_COUSELING CLINIC INC ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_COUSELING CLINIC INC ]|[Plan_LOCAL GOVT] standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI ]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI ]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI ]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EMPOWER HEALTHCARE SOLUTI ]|[plan_MANAGED MEDICAID] standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI ]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EMPOWER HEALTHCARE SOLUTI ]|[Plan_MANAGED MEDICAID] standard_charge|[payer_FEDERAL BLUE CROSS ]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_FEDERAL BLUE CROSS ]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_FEDERAL BLUE CROSS ]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_FEDERAL BLUE CROSS ]|[plan_BLUE CROSS] standard_charge|[payer_FEDERAL BLUE CROSS ]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_FEDERAL BLUE CROSS ]|[Plan_BLUE CROSS] standard_charge|[payer_GOLDEN RULE ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GOLDEN RULE ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GOLDEN RULE ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GOLDEN RULE ]|[plan_HMO/PPO] standard_charge|[payer_GOLDEN RULE ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_GOLDEN RULE ]|[Plan_HMO/PPO] standard_charge|[payer_HEALTH ADVANTAGE BC ]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_HEALTH ADVANTAGE BC ]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_HEALTH ADVANTAGE BC ]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_HEALTH ADVANTAGE BC ]|[plan_BLUE CROSS] standard_charge|[payer_HEALTH ADVANTAGE BC ]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_HEALTH ADVANTAGE BC ]|[Plan_BLUE CROSS] standard_charge|[payer_HUMANA GOLD CHOICE ]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD CHOICE ]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA GOLD CHOICE ]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA GOLD CHOICE ]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD CHOICE ]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA GOLD CHOICE ]|[Plan_MANAGED MEDICARE] 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_MAINECARE ]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MAINECARE ]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_MAINECARE ]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_MAINECARE ]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MAINECARE ]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_MAINECARE ]|[Plan_MEDICAID: CBS OOS] standard_charge|[payer_MEDICAID PENDING ]|[plan_PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_MEDICAID PENDING ]|[plan_PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_MEDICAID PENDING ]|[plan_PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDICAID PENDING ]|[plan_PENDING MEDICAID] standard_charge|[payer_MEDICAID PENDING ]|[plan_PENDING MEDICAID] |methodology additional_payer_notes |[payer_MEDICAID PENDING ]|[Plan_PENDING 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_MID SOUTH HEALTH SYSTEMS ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MID SOUTH HEALTH SYSTEMS ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MID SOUTH HEALTH SYSTEMS ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MID SOUTH HEALTH SYSTEMS ]|[plan_LOCAL GOVT] standard_charge|[payer_MID SOUTH HEALTH SYSTEMS ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_MID SOUTH HEALTH SYSTEMS ]|[Plan_LOCAL GOVT] standard_charge|[payer_MUNICIPAL HEALTH BENEFIT ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MUNICIPAL HEALTH BENEFIT ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MUNICIPAL HEALTH BENEFIT ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MUNICIPAL HEALTH BENEFIT ]|[plan_HMO/PPO] standard_charge|[payer_MUNICIPAL HEALTH BENEFIT ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MUNICIPAL HEALTH BENEFIT ]|[Plan_HMO/PPO] standard_charge|[payer_OUACHITA BEHAVIORAL HEALT ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OUACHITA BEHAVIORAL HEALT ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_OUACHITA BEHAVIORAL HEALT ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_OUACHITA BEHAVIORAL HEALT ]|[plan_LOCAL GOVT] standard_charge|[payer_OUACHITA BEHAVIORAL HEALT ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_OUACHITA BEHAVIORAL HEALT ]|[Plan_LOCAL GOVT] standard_charge|[payer_OZARK GUIDANCE ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OZARK GUIDANCE ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_OZARK GUIDANCE ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_OZARK GUIDANCE ]|[plan_LOCAL GOVT] standard_charge|[payer_OZARK GUIDANCE ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_OZARK GUIDANCE ]|[Plan_LOCAL GOVT] standard_charge|[payer_PROF COUNSELING ASSOCIAT ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_PROF COUNSELING ASSOCIAT ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_PROF COUNSELING ASSOCIAT ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_PROF COUNSELING ASSOCIAT ]|[plan_LOCAL GOVT] standard_charge|[payer_PROF COUNSELING ASSOCIAT ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_PROF COUNSELING ASSOCIAT ]|[Plan_LOCAL GOVT] standard_charge|[payer_QUALCHOICE PPO ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_QUALCHOICE PPO ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_QUALCHOICE PPO ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_QUALCHOICE PPO ]|[plan_HMO/PPO] standard_charge|[payer_QUALCHOICE PPO ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_QUALCHOICE PPO ]|[Plan_HMO/PPO] 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_UHC MEDICARE ]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC MEDICARE ]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC MEDICARE ]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC MEDICARE ]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE ]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC MEDICARE ]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UMR ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR ]|[plan_HMO/PPO] standard_charge|[payer_UMR ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UMR ]|[Plan_HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE ]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE ]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE ]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE ]|[plan_HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE ]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE ]|[Plan_HMO/PPO] standard_charge|[payer_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] standard_charge|[payer_WESTERN ARK COUNSELING ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_WESTERN ARK COUNSELING ]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_WESTERN ARK COUNSELING ]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_WESTERN ARK COUNSELING ]|[plan_LOCAL GOVT] standard_charge|[payer_WESTERN ARK COUNSELING ]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_WESTERN ARK COUNSELING ]|[Plan_LOCAL GOVT] additional_generic_notes ACUTE PSY ROOM AND BOARD 124 RC facility inpatient 2200 800 400 1400 922 per diem 896 per diem 663 per diem 663 per diem 924 per diem 840 per diem 663 per diem 850 per diem 663 per diem 663 per diem 663 per diem 798 per diem 876 per diem 876 per diem 663 per diem 475 per diem 1070 per diem 400 per diem 480 per diem 663 per diem 876 per diem 960 per diem 876 per diem 924 per diem 1400 per diem 663 per diem 400 per diem 800 per diem 465 per diem 400 per diem 400 per diem 1063 per diem 989 per diem 989 per diem 485 per diem ADULT DTX ROOM AND BOARD 126 RC facility inpatient 2200 800 400 1400 922 per diem 896 per diem 663 per diem 663 per diem 924 per diem 840 per diem 663 per diem 850 per diem 663 per diem 663 per diem 663 per diem 798 per diem 876 per diem 876 per diem 663 per diem 475 per diem 1070 per diem 400 per diem 480 per diem 663 per diem 876 per diem 960 per diem 876 per diem 924 per diem 1400 per diem 663 per diem 400 per diem 654 per diem 465 per diem 400 per diem 400 per diem 1063 per diem 989 per diem 989 per diem 485 per diem TRANSCRANIAL MAGNETIC STIMULATION INITIAL TREAT 9001 RC facility outpatient 1000 234 315 266 per diem 239 per diem 239 per diem 243 per diem 243 per diem 243 per diem 243 per diem 234 per diem 243 per diem 239 per diem 315 per diem 239 per diem 239 per diem 239 per diem 239 per diem TRANSCRANIAL MAGNETIC STIMULATION SUBSEQ TREAT 9002 RC facility outpatient 850 128 315 244 per diem 239 per diem 239 per diem 133 per diem 133 per diem 133 per diem 133 per diem 128 per diem 133 per diem 239 per diem 315 per diem 239 per diem 239 per diem 239 per diem 239 per diem TRANSCRANIAL MAGNETIC STIMULATION REMAPPING 9003 RC facility outpatient 1000 128 315 222 per diem 239 per diem 239 per diem 133 per diem 133 per diem 133 per diem 133 per diem 128 per diem 133 per diem 239 per diem 315 per diem 239 per diem 239 per diem 239 per diem 239 per diem INTENSIVE OUTPATIENT PROGRAM 905 RC facility outpatient 480 200 126 236 234 per diem 139 per diem 126 per diem 162 per diem 162 per diem 162 per diem 162 per diem 189 per diem 200 per diem 229 per diem 200 per diem 236 per diem 159 per diem 229 per diem 229 per diem 229 per diem TH INTENSIVE OUTPATIENT PROGRAM COMMERCIAL 905 RC facility outpatient 480 200 126 236 234 per diem 139 per diem 126 per diem 162 per diem 162 per diem 162 per diem 162 per diem 189 per diem 200 per diem 229 per diem 200 per diem 236 per diem 159 per diem 229 per diem 229 per diem 229 per diem PARTIAL HOSPITALIZATION PROGRAM PROGRAM 912 RC facility outpatient 800 300 150 492 492 per diem 347 per diem 315 per diem 286 per diem 286 per diem 286 per diem 286 per diem 439 per diem 150 per diem 330 per diem 451 per diem 300 per diem 347 per diem 398 per diem 451 per diem 451 per diem 451 per diem TH PARTIAL HOSPITALIZATION PROGRAM COMMERCIAL 912 RC facility outpatient 800 300 150 492 492 per diem 347 per diem 315 per diem 286 per diem 286 per diem 286 per diem 286 per diem 439 per diem 150 per diem 330 per diem 451 per diem 300 per diem 347 per diem 398 per diem 451 per diem 451 per diem 451 per diem "INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 1, 2, 3" 915 RC facility outpatient 480 206 206 206 per diem 206 per diem 206 per diem 206 per diem 206 per diem 206 per diem 206 per diem 206 per diem "PARTIAL HOSPITALIZATION PROGRAM MCR PROC GRP 1, 2, 3, 4" 915 RC facility outpatient 160 239 239 239 per diem 239 per diem 239 per diem 239 per diem 239 per diem 239 per diem 239 per diem 239 per diem PARTIAL HOSPITALIZATION PROGRAM PASSE MCAID 9912 RC facility outpatient 800 214 214 214 per diem 214 per diem 214 per diem 214 per diem 214 per diem Psych Diagnostic Eval 90791 RC facility both 310 136 136 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem Psych Eval With Medical Services 90792 RC facility both 310 154 154 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem 154 per diem Admit Eval 99221 RC facility both 165 72 72 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem 72 per diem Admit Eval 99222 RC facility both 225 115 115 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem 115 per diem Initial Hospital Care 99223 RC facility both 250 153 153 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 15 Min Eval 99231 RC facility both 120 44 44 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 44 per diem 25 Min Eval 99232 RC facility both 140 70 70 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 70 per diem 35 Min Eval 99233 RC facility both 210 105 105 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem 105 per diem D/c Eval 99238 RC facility both 160 71 71 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem 71 per diem Discharge Day Mgmt >30 Min 99239 RC facility both 160 101 101 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem