hospital_name	last_updated_on	version	hospital_location	hospital_address	license_number|MO	"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."																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																				
Lakeland Behavioral Health System	5/31/2024	2.0.0	"Springfield, Missouri"	440 S Market Ave.	license_ 432-26 | MO	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 MERCY MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_AETNA MERCY MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_AETNA MERCY MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_AETNA MERCY MCR]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_AETNA MERCY MCR]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_AETNA MERCY MCR]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_AETNA MERCY STJ CLMS]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_AETNA MERCY STJ CLMS]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_AETNA MERCY STJ CLMS]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_AETNA MERCY STJ CLMS]|[plan_HMO/PPO] 	standard_charge|[payer_AETNA MERCY STJ CLMS]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_AETNA MERCY STJ CLMS]|[Plan_HMO/PPO]	standard_charge|[payer_ALABAMA CHAMBER CTY DHR]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_ALABAMA CHAMBER CTY DHR]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_ALABAMA CHAMBER CTY DHR]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_ALABAMA CHAMBER CTY DHR]|[plan_LOCAL GOVT] 	standard_charge|[payer_ALABAMA CHAMBER CTY DHR]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_ALABAMA CHAMBER CTY DHR]|[Plan_LOCAL GOVT]	standard_charge|[payer_ALASKA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_ALASKA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_ALASKA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_ALASKA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_ALASKA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_ALASKA MCD TPL ENTER INS]|[Plan_MEDICAID: CBS OOS]	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_AMBETTER CENPATICO]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_AMBETTER CENPATICO]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_AMBETTER CENPATICO]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_AMBETTER CENPATICO]|[plan_HMO/PPO] 	standard_charge|[payer_AMBETTER CENPATICO]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_AMBETTER CENPATICO]|[Plan_HMO/PPO]	standard_charge|[payer_ANTHEM BLUE CROSS]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_ANTHEM BLUE CROSS]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_ANTHEM BLUE CROSS]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_ANTHEM BLUE CROSS]|[plan_BLUE CROSS] 	standard_charge|[payer_ANTHEM BLUE CROSS]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_ANTHEM BLUE CROSS]|[Plan_BLUE CROSS]	standard_charge|[payer_ANTHEM FEDERAL BC]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_ANTHEM FEDERAL BC]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_ANTHEM FEDERAL BC]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_ANTHEM FEDERAL BC]|[plan_BLUE CROSS] 	standard_charge|[payer_ANTHEM FEDERAL BC]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_ANTHEM FEDERAL BC]|[Plan_BLUE CROSS]	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_ARIZONA BANNER UNI HEALTH]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARIZONA BANNER UNI HEALTH]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARIZONA BANNER UNI HEALTH]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARIZONA DCS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_ARIZONA DCS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_ARIZONA DCS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_ARIZONA DCS]|[plan_LOCAL GOVT] 	standard_charge|[payer_ARIZONA DCS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_ARIZONA DCS]|[Plan_LOCAL GOVT]	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_ARIZONA HEALTH CHOICE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARIZONA HEALTH CHOICE]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARIZONA HEALTH CHOICE]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARIZONA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_ARIZONA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_ARIZONA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_ARIZONA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_ARIZONA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_ARIZONA MCD TPL ENTER INS]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_ARIZONA MERCY CARE MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARIZONA MERCY CARE MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARIZONA MERCY CARE MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_ARIZONA UHC COMMUNITYPLAN]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARIZONA UHC COMMUNITYPLAN]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARKANSAS CARESOURCE]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARKANSAS CARESOURCE]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARKANSAS CARESOURCE]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARKANSAS CARESOURCE]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARKANSAS CARESOURCE]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARKANSAS CARESOURCE]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARKANSAS EMPOWER MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARKANSAS EMPOWER MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARKANSAS EMPOWER MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARKANSAS EMPOWER MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARKANSAS EMPOWER MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARKANSAS EMPOWER MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARKANSAS MCD TPL ENTERINS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARKANSAS MCD TPL ENTERINS]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARKANSAS MCD TPL ENTERINS]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARKANSAS MCD TPL ENTERINS]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARKANSAS MCD TPL ENTERINS]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARKANSAS MCD TPL ENTERINS]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARKANSAS MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARKANSAS SUMMIT MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARKANSAS SUMMIT MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARKANSAS SUMMIT MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARKANSAS SUMMIT MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARKANSAS SUMMIT MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARKANSAS SUMMIT MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ARKANSAS TOTAL CARE MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_ARKANSAS TOTAL CARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_ARKANSAS TOTAL CARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_ARKANSAS TOTAL CARE MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_ARKANSAS TOTAL CARE MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_ARKANSAS TOTAL CARE MCD]|[Plan_MEDICAID: OUT OF STATE]	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_BENEFITS ADMINISTRATIVE S]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_BENEFITS ADMINISTRATIVE S]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_BENEFITS ADMINISTRATIVE S]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_BENEFITS ADMINISTRATIVE S]|[plan_COMMERCIAL] 	standard_charge|[payer_BENEFITS ADMINISTRATIVE S]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_BENEFITS ADMINISTRATIVE S]|[Plan_COMMERCIAL]	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 BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] 	standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH]|[Plan_HMO/PPO]	standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_CO EPDST]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_COLORADO ACCESS MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_COLORADO ACCESS MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_COLORADO ACCESS MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_COLORADO BEACON]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_COLORADO BEACON]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_COLORADO BEACON]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_COLORADO BEACON]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_COLORADO BEACON]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_COLORADO BEACON]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_COLORADO CHIP MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_COLORADO CHIP MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_COLORADO CHIP MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_COLORADO COMMUNITY HEALTH]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_COLORADO COMMUNITY HEALTH]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_COLORADO COMMUNITY HEALTH]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_COLORADO EL PASO CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_COLORADO EL PASO CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_COLORADO EL PASO CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_COLORADO EL PASO CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_COLORADO EL PASO CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_COLORADO EL PASO CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_COLORADO ROCKY MTN MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_COLORADO ROCKY MTN MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_COLORADO ROCKY MTN MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_COLORADO ROCKY MTN MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_COLORADO ROCKY MTN MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_COLORADO ROCKY MTN MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_COMMERCIAL/ENTER NAME]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_COMMERCIAL/ENTER NAME]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_COMMERCIAL/ENTER NAME]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_COMMERCIAL/ENTER NAME]|[plan_COMMERCIAL] 	standard_charge|[payer_COMMERCIAL/ENTER NAME]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_COMMERCIAL/ENTER NAME]|[Plan_COMMERCIAL]	standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_COMPSYCH]|[plan_COMMERCIAL] 	standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_COMPSYCH]|[Plan_COMMERCIAL]	standard_charge|[payer_COX HEALTH SYSTEMS]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_COX HEALTH SYSTEMS]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_COX HEALTH SYSTEMS]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_COX HEALTH SYSTEMS]|[plan_COMMERCIAL] 	standard_charge|[payer_COX HEALTH SYSTEMS]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_COX HEALTH SYSTEMS]|[Plan_COMMERCIAL]	standard_charge|[payer_DELAWARE DSCYF]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_DELAWARE DSCYF]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_DELAWARE DSCYF]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_DELAWARE DSCYF]|[plan_LOCAL GOVT] 	standard_charge|[payer_DELAWARE DSCYF]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_DELAWARE DSCYF]|[Plan_LOCAL GOVT]	standard_charge|[payer_ESSENCE HEALTHCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_ESSENCE HEALTHCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_ESSENCE HEALTHCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_ESSENCE HEALTHCARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_ESSENCE HEALTHCARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_ESSENCE HEALTHCARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_FL KIDS CENTRAL GOVT]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_FL KIDS CENTRAL GOVT]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_FL KIDS CENTRAL GOVT]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_FL KIDS CENTRAL GOVT]|[plan_LOCAL GOVT] 	standard_charge|[payer_FL KIDS CENTRAL GOVT]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_FL KIDS CENTRAL GOVT]|[Plan_LOCAL GOVT]	standard_charge|[payer_FLORIDA ACCESS BEHAVIORAL]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_FLORIDA ACCESS BEHAVIORAL]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_FLORIDA ACCESS BEHAVIORAL]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_FLORIDA ACCESS BEHAVIORAL]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_FLORIDA ACCESS BEHAVIORAL]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_FLORIDA ACCESS BEHAVIORAL]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_FLORIDA BEACON]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_FLORIDA BEACON]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_FLORIDA BEACON]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_FLORIDA BEACON]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_FLORIDA BEACON]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_FLORIDA MAGELLEN COMPLETE]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_FLORIDA MAGELLEN COMPLETE]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_FLORIDA MAGELLEN COMPLETE]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_FLORIDA MAGELLEN COMPLETE]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_FLORIDA MAGELLEN COMPLETE]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_FLORIDA MAGELLEN COMPLETE]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_FLORIDA MOLINA]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_FLORIDA MOLINA]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_FLORIDA MOLINA]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_FLORIDA MOLINA]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_FLORIDA MOLINA]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_FLORIDA MOLINA]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_FLORIDA SUNSHINECENPATICO]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_FLORIDA SUNSHINECENPATICO]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_FLORIDA SUNSHINECENPATICO]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_FLORIDA WELLCARE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_FLORIDA WELLCARE]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_FLORIDA WELLCARE]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_FRINGE BENEFIT GROUP]|[plan_COMMERCIAL] 	standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_FRINGE BENEFIT GROUP]|[Plan_COMMERCIAL]	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_HAWAII CAMHD]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_HAWAII CAMHD]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_HAWAII CAMHD]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_HAWAII CAMHD]|[plan_LOCAL GOVT] 	standard_charge|[payer_HAWAII CAMHD]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_HAWAII CAMHD]|[Plan_LOCAL GOVT]	standard_charge|[payer_HAWAII HMSA MEDICAID BC]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_HAWAII HMSA MEDICAID BC]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_HAWAII HMSA MEDICAID BC]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_HAWAII HMSA MEDICAID BC]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_HAWAII HMSA MEDICAID BC]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_HAWAII HMSA MEDICAID BC]|[Plan_MEDICAID: OUT OF STATE]	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_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_IDAHO IDHW]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_IDAHO IDHW]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_IDAHO IDHW]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_IDAHO IDHW]|[plan_LOCAL GOVT] 	standard_charge|[payer_IDAHO IDHW]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_IDAHO IDHW]|[Plan_LOCAL GOVT]	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_IDAHO MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_IDAHO MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_IDAHO MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_IDAHO MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_IDAHO MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_ILLINOIS DCFS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_ILLINOIS DCFS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_ILLINOIS DCFS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_ILLINOIS DCFS]|[plan_LOCAL GOVT] 	standard_charge|[payer_ILLINOIS DCFS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_ILLINOIS DCFS]|[Plan_LOCAL GOVT]	standard_charge|[payer_ILLINOIS HFS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_ILLINOIS HFS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_ILLINOIS HFS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_ILLINOIS HFS]|[plan_LOCAL GOVT] 	standard_charge|[payer_ILLINOIS HFS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_ILLINOIS HFS]|[Plan_LOCAL GOVT]	standard_charge|[payer_IOWA DHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_IOWA DHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_IOWA DHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_IOWA DHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_IOWA DHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_IOWA DHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_IOWA MCD AMERIGROUP INC]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_IOWA MCD AMERIGROUP INC]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_IOWA MCD AMERIGROUP INC]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_IOWA MCD TOTAL CARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_IOWA MCD TOTAL CARE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_IOWA MCD TOTAL CARE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_IOWA MCD TOTAL CARE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_IOWA MCD TOTAL CARE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_IOWA MCD TOTAL CARE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_IOWA MEDICAID FFS]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_IOWA MEDICAID FFS]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_IOWA MEDICAID FFS]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_KANSAS AETNA MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_KANSAS AETNA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_KANSAS AETNA MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_KANSAS MERCY AETNA]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_KANSAS MERCY AETNA]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_KANSAS MERCY AETNA]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_KANSAS MERCY AETNA]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_KANSAS MERCY AETNA]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_KANSAS MERCY AETNA]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_KANSAS SUNFLOWER MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_KANSAS SUNFLOWER MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_KANSAS SUNFLOWER MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_KANSAS UHC KANCARE MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_KANSAS UHC KANCARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_KANSAS UHC KANCARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_KANSAS UHC KANCARE MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_KANSAS UHC KANCARE MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_KANSAS UHC KANCARE MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_KENTUCKY AETNA MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_KENTUCKY AETNA MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_KENTUCKY AETNA MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_KENTUCKY AETNA MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_KENTUCKY AETNA MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_KENTUCKY AETNA MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_KENTUCKY DCBS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_KENTUCKY DCBS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_KENTUCKY DCBS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_KENTUCKY DCBS]|[plan_LOCAL GOVT] 	standard_charge|[payer_KENTUCKY DCBS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_KENTUCKY DCBS]|[Plan_LOCAL GOVT]	standard_charge|[payer_KENTUCKY MOLINA]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_KENTUCKY MOLINA]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_KENTUCKY MOLINA]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_KENTUCKY MOLINA]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_KENTUCKY MOLINA]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_KENTUCKY MOLINA]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_KENTUCKY WELLCARE MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_KENTUCKY WELLCARE MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_KENTUCKY WELLCARE MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_LOUISANA HEALTHY BLUE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_LOUISANA HEALTHY BLUE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_LOUISANA HEALTHY BLUE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_LOUISANA HEALTHY BLUE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_LOUISANA HEALTHY BLUE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_LOUISANA HEALTHY BLUE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_LOUISANA HLTHCARE CONNECT]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_LOUISANA HLTHCARE CONNECT]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_LOUISANA HLTHCARE CONNECT]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_LOUISANA HLTHCARE CONNECT]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_LOUISANA HLTHCARE CONNECT]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_LOUISANA HLTHCARE CONNECT]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_LOUISANA UHC MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_LOUISANA UHC MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_LOUISANA UHC MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_MAGELLAN HEALTH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_MAGELLAN HEALTH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_MAGELLAN HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_MAGELLAN HEALTH]|[plan_COMMERCIAL] 	standard_charge|[payer_MAGELLAN HEALTH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_MAGELLAN HEALTH]|[Plan_COMMERCIAL]	standard_charge|[payer_MAINE OCFS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MAINE OCFS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MAINE OCFS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MAINE OCFS]|[plan_LOCAL GOVT] 	standard_charge|[payer_MAINE OCFS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MAINE OCFS]|[Plan_LOCAL GOVT]	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_MAINECARE MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_MAINECARE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_MAINECARE MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_MARYLAND DHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MARYLAND DHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MARYLAND DHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MARYLAND DHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_MARYLAND DHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MARYLAND DHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_MCC OF FL]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_MCC OF FL]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_MCC OF FL]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_MCC OF FL]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_MCC OF FL]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_MCC OF FL]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_MED PAY]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_MED PAY]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_MED PAY]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_MED PAY]|[plan_HMO/PPO] 	standard_charge|[payer_MED PAY]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_MED PAY]|[Plan_HMO/PPO]	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_MERCY MO HLTHY BLUE]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MERCY MO HLTHY BLUE]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MERCY MO HLTHY BLUE]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MERCY MO HLTHY BLUE]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MERCY MO HLTHY BLUE]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MERCY MO HLTHY BLUE]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] 	standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_MERITAIN HEALTH]|[Plan_COMMERCIAL]	standard_charge|[payer_MH NET]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_MH NET]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_MH NET]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_MH NET]|[plan_HMO/PPO] 	standard_charge|[payer_MH NET]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_MH NET]|[Plan_HMO/PPO]	standard_charge|[payer_MH NET]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_MH NET]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_MH NET]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_MH NET]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_MH NET]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_MH NET]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_MICHIGAN DHHR]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MICHIGAN DHHR]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MICHIGAN DHHR]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MICHIGAN DHHR]|[plan_LOCAL GOVT] 	standard_charge|[payer_MICHIGAN DHHR]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MICHIGAN DHHR]|[Plan_LOCAL GOVT]	standard_charge|[payer_MINES & ASSOC CO]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_MINES & ASSOC CO]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_MINES & ASSOC CO]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_MINES & ASSOC CO]|[plan_COMMERCIAL] 	standard_charge|[payer_MINES & ASSOC CO]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_MINES & ASSOC CO]|[Plan_COMMERCIAL]	standard_charge|[payer_MINNESOTA CROWWING]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MINNESOTA CROWWING]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MINNESOTA CROWWING]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MINNESOTA CROWWING]|[plan_LOCAL GOVT] 	standard_charge|[payer_MINNESOTA CROWWING]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MINNESOTA CROWWING]|[Plan_LOCAL GOVT]	standard_charge|[payer_MINNESOTA DSS ANOKA CO]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MINNESOTA DSS ANOKA CO]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MINNESOTA DSS ANOKA CO]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MINNESOTA DSS ANOKA CO]|[plan_LOCAL GOVT] 	standard_charge|[payer_MINNESOTA DSS ANOKA CO]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MINNESOTA DSS ANOKA CO]|[Plan_LOCAL GOVT]	standard_charge|[payer_MINNESOTA LOCAL GOVT]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MINNESOTA LOCAL GOVT]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MINNESOTA LOCAL GOVT]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MINNESOTA LOCAL GOVT]|[plan_LOCAL GOVT] 	standard_charge|[payer_MINNESOTA LOCAL GOVT]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MINNESOTA LOCAL GOVT]|[Plan_LOCAL GOVT]	standard_charge|[payer_MINNESOTA OLMSTED CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MINNESOTA OLMSTED CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MINNESOTA OLMSTED CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MINNESOTA OLMSTED CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_MINNESOTA OLMSTED CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MINNESOTA OLMSTED CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_MINNESOTA OTTER TAIL CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MINNESOTA OTTER TAIL CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MINNESOTA OTTER TAIL CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MINNESOTA OTTER TAIL CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_MINNESOTA OTTER TAIL CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MINNESOTA OTTER TAIL CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI ADULT MEDICAID]|[plan_SELF PAY CHARITY]|negotiated_dollar	standard_charge|[payer_MISSOURI ADULT MEDICAID]|[plan_SELF PAY CHARITY] |negotiated_percentage	standard_charge|[payer_MISSOURI ADULT MEDICAID]|[plan_SELF PAY CHARITY] |negotiated_algorithm	estimated_amount|[payer_MISSOURI ADULT MEDICAID]|[plan_SELF PAY CHARITY] 	standard_charge|[payer_MISSOURI ADULT MEDICAID]|[plan_SELF PAY CHARITY] |methodology	additional_payer_notes |[payer_MISSOURI ADULT MEDICAID]|[Plan_SELF PAY CHARITY]	standard_charge|[payer_MISSOURI ALLIANCE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI ALLIANCE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI ALLIANCE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI ALLIANCE]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI ALLIANCE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI ALLIANCE]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI CENPATICO MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MISSOURI CENPATICO MCD]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MISSOURI CENPATICO MCD]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MISSOURI CENPATICO MCD]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MISSOURI CENPATICO MCD]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MISSOURI CENPATICO MCD]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MISSOURI CPP]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI CPP]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI CPP]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI CPP]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI CPP]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI CPP]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI DSS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI DSS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI DSS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI DSS]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI DSS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI DSS]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI DYS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI DYS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI DYS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI DYS]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI DYS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI DYS]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI EVERY CHILDS HOP]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI EVERY CHILDS HOP]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI EVERY CHILDS HOP]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI EVERY CHILDS HOP]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI EVERY CHILDS HOP]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI EVERY CHILDS HOP]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI GREAT CIRCLE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI GREAT CIRCLE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI GREAT CIRCLE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI GREAT CIRCLE]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI GREAT CIRCLE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI GREAT CIRCLE]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI HEALTHY BLUE MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MISSOURI HEALTHY BLUE MCD]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MISSOURI HEALTHY BLUE MCD]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MISSOURI HEALTHY BLUE MCD]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MISSOURI HEALTHY BLUE MCD]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MISSOURI HEALTHY BLUE MCD]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MISSOURI MEDICAID]|[plan_MEDICAID ]|negotiated_dollar	standard_charge|[payer_MISSOURI MEDICAID]|[plan_MEDICAID ] |negotiated_percentage	standard_charge|[payer_MISSOURI MEDICAID]|[plan_MEDICAID ] |negotiated_algorithm	estimated_amount|[payer_MISSOURI MEDICAID]|[plan_MEDICAID ] 	standard_charge|[payer_MISSOURI MEDICAID]|[plan_MEDICAID ] |methodology	additional_payer_notes |[payer_MISSOURI MEDICAID]|[Plan_MEDICAID ]	standard_charge|[payer_MISSOURI SUBACUTE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MISSOURI SUBACUTE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MISSOURI SUBACUTE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MISSOURI SUBACUTE]|[plan_LOCAL GOVT] 	standard_charge|[payer_MISSOURI SUBACUTE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MISSOURI SUBACUTE]|[Plan_LOCAL GOVT]	standard_charge|[payer_MISSOURI UHC MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MISSOURI UHC MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MISSOURI UHC MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MISSOURI UHC MEDICAID]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MISSOURI UHC MEDICAID]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MISSOURI UHC MEDICAID]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MO ALLIANCE SUBACUTE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MO ALLIANCE SUBACUTE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MO ALLIANCE SUBACUTE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MO ALLIANCE SUBACUTE]|[plan_LOCAL GOVT] 	standard_charge|[payer_MO ALLIANCE SUBACUTE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MO ALLIANCE SUBACUTE]|[Plan_LOCAL GOVT]	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MO SHOW ME HEALTHY KIDS]|[plan_LOCAL GOVT] 	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MO SHOW ME HEALTHY KIDS]|[Plan_LOCAL GOVT]	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MO SHOW ME HEALTHY KIDS]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MO SHOW ME HEALTHY KIDS]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MO SHOW ME HEALTHY KIDS]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MONTANA DPHHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_MONTANA DPHHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_MONTANA DPHHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_MONTANA DPHHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_MONTANA DPHHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_MONTANA DPHHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_MONTANA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_MONTANA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_MONTANA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_MONTANA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_MONTANA MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_MONTANA MCD TPL ENTER INS]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_MONTANA MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_MONTANA MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_MONTANA MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	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_NEBRASKA DHHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_NEBRASKA DHHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_NEBRASKA DHHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA DHHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_NEBRASKA DHHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_NEBRASKA DHHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_NEBRASKA DJJ]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_NEBRASKA DJJ]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_NEBRASKA DJJ]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA DJJ]|[plan_LOCAL GOVT] 	standard_charge|[payer_NEBRASKA DJJ]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_NEBRASKA DJJ]|[Plan_LOCAL GOVT]	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEBRASKA HEALTHY BLUE MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEBRASKA HEALTHY BLUE MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEBRASKA HEALTHY BLUE MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEBRASKA MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEBRASKA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEBRASKA MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEBRASKA TOTALCARE MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEBRASKA TOTALCARE MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEBRASKA TOTALCARE MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEBRASKA TPL]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_NEBRASKA TPL]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_NEBRASKA TPL]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA TPL]|[plan_LOCAL GOVT] 	standard_charge|[payer_NEBRASKA TPL]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_NEBRASKA TPL]|[Plan_LOCAL GOVT]	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA UHC]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEBRASKA UHC]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEBRASKA UHC]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEBRASKA UHC]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEBRASKA UHC]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEVADA DHHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_NEVADA DHHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_NEVADA DHHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_NEVADA DHHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_NEVADA DHHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_NEVADA DHHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEVADA HEALTH PLAN MCO]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEVADA HEALTH PLAN MCO]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEVADA HEALTH PLAN MCO]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEVADA MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEVADA MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEVADA MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEVADA SILVERSUMMIT]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEVADA SILVERSUMMIT]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEVADA SILVERSUMMIT]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEW HAMPSHIRE BEACON MCD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEW HAMPSHIRE BEACON MCD]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEW HAMPSHIRE BEACON MCD]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEW HAMPSHIRE DHHS DCYF]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_NEW HAMPSHIRE DHHS DCYF]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_NEW HAMPSHIRE DHHS DCYF]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_NEW HAMPSHIRE DHHS DCYF]|[plan_LOCAL GOVT] 	standard_charge|[payer_NEW HAMPSHIRE DHHS DCYF]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_NEW HAMPSHIRE DHHS DCYF]|[Plan_LOCAL GOVT]	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEW HAMPSHIRE MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEW HAMPSHIRE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEW HAMPSHIRE MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEW MEX MCD BCBS]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEW MEX MCD BCBS]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEW MEX MCD BCBS]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEW MEX MCD PRES MAGELLAN]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEW MEX MCD PRES MAGELLAN]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEW MEX MCD PRES MAGELLAN]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NEW MEX MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEW MEX MCD TPL ENTER INS]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEW MEX MCD TPL ENTER INS]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NEW MEX MCD WESTERN SKY]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_NEW MEX MCD WESTERN SKY]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_NEW MEX MCD WESTERN SKY]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_NORTH CAROLINA EASTPOINT]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_NORTH CAROLINA EASTPOINT]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_NORTH CAROLINA EASTPOINT]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_NORTH CAROLINA EASTPOINT]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_NORTH CAROLINA EASTPOINT]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_NORTH CAROLINA EASTPOINT]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_OHIO AETNA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_OHIO AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_OHIO AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_OHIO AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_OHIO AETNA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_OHIO AETNA MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_OHIO BUTLER COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_OHIO BUTLER COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_OHIO BUTLER COUNTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_OHIO BUTLER COUNTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_OHIO BUTLER COUNTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_OHIO BUTLER COUNTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_OHIO COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_OHIO COUNTY]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_OHIO COUNTY]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_OHIO COUNTY]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_OHIO COUNTY]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_OHIO COUNTY]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_OHIO FRANKLIN COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_OHIO FRANKLIN COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_OHIO FRANKLIN COUNTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_OHIO FRANKLIN COUNTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_OHIO FRANKLIN COUNTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_OHIO FRANKLIN COUNTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_OHIO HAMILTON DJFS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_OHIO HAMILTON DJFS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_OHIO HAMILTON DJFS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_OHIO HAMILTON DJFS]|[plan_LOCAL GOVT] 	standard_charge|[payer_OHIO HAMILTON DJFS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_OHIO HAMILTON DJFS]|[Plan_LOCAL GOVT]	standard_charge|[payer_OHIO MIAMI COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_OHIO MIAMI COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_OHIO MIAMI COUNTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_OHIO MIAMI COUNTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_OHIO MIAMI COUNTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_OHIO MIAMI COUNTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_OHIO MONTGOMERY CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_OHIO MONTGOMERY CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_OHIO MONTGOMERY CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_OHIO MONTGOMERY CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_OHIO MONTGOMERY CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_OHIO MONTGOMERY CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_OKLAHOMA BRYAN CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_OKLAHOMA BRYAN CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_OKLAHOMA BRYAN CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_OKLAHOMA BRYAN CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_OKLAHOMA BRYAN CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_OKLAHOMA BRYAN CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_OKLAHOMA MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_OKLAHOMA MEDICAID OHCA]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_OKLAHOMA MEDICAID OHCA]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_OKLAHOMA MEDICAID OHCA]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_OKLAHOMA MEDICAID OHCA]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_OKLAHOMA MEDICAID OHCA]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_OKLAHOMA MEDICAID OHCA]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_OUT OF STATE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_OUT OF STATE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_OUT OF STATE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_OUT OF STATE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_OUT OF STATE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_OUT OF STATE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_PENNSYLVANIA MCD CCBH]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_PENNSYLVANIA MCD CCBH]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_PENNSYLVANIA MCD CCBH]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_PENNSYLVANIA MCD CCBH]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_PENNSYLVANIA MCD CCBH]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_PENNSYLVANIA MCD CCBH]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_PENNSYLVANIA YORK COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_PENNSYLVANIA YORK COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_PENNSYLVANIA YORK COUNTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_PENNSYLVANIA YORK COUNTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_PENNSYLVANIA YORK COUNTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_PENNSYLVANIA YORK COUNTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_PRESBYTERIAN MAGELLAN]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_PRESBYTERIAN MAGELLAN]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_PRESBYTERIAN MAGELLAN]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_PRESBYTERIAN MAGELLAN]|[plan_HMO/PPO] 	standard_charge|[payer_PRESBYTERIAN MAGELLAN]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_PRESBYTERIAN MAGELLAN]|[Plan_HMO/PPO]	standard_charge|[payer_RHODE ISLAND DCYF]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_RHODE ISLAND DCYF]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_RHODE ISLAND DCYF]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_RHODE ISLAND DCYF]|[plan_LOCAL GOVT] 	standard_charge|[payer_RHODE ISLAND DCYF]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_RHODE ISLAND DCYF]|[Plan_LOCAL GOVT]	standard_charge|[payer_SOUTH CAROLINA BLUECHOICE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_SOUTH CAROLINA BLUECHOICE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_SOUTH CAROLINA BLUECHOICE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_SOUTH CAROLINA BLUECHOICE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_SOUTH CAROLINA BLUECHOICE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_SOUTH CAROLINA BLUECHOICE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_TENN MCD AMERIGROUP]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_TENN MCD AMERIGROUP]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_TENN MCD AMERIGROUP]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_TENN MCD AMERIGROUP]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_TENN MCD AMERIGROUP]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_TENN MCD AMERIGROUP]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_TENN MCD BLUECARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_TENN MCD BLUECARE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_TENN MCD BLUECARE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_TENN MCD BLUECARE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_TENN MCD BLUECARE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_TENN MCD BLUECARE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT] 	standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_TENNESSEE DCS]|[Plan_LOCAL GOVT]	standard_charge|[payer_TEXAS 2INGAGE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_TEXAS 2INGAGE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_TEXAS 2INGAGE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_TEXAS 2INGAGE]|[plan_LOCAL GOVT] 	standard_charge|[payer_TEXAS 2INGAGE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_TEXAS 2INGAGE]|[Plan_LOCAL GOVT]	standard_charge|[payer_TEXAS DFPS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_TEXAS DFPS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_TEXAS DFPS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_TEXAS DFPS]|[plan_LOCAL GOVT] 	standard_charge|[payer_TEXAS DFPS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_TEXAS DFPS]|[Plan_LOCAL GOVT]	standard_charge|[payer_THE LOOMIS COMPANY]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_THE LOOMIS COMPANY]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_THE LOOMIS COMPANY]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_THE LOOMIS COMPANY]|[plan_COMMERCIAL] 	standard_charge|[payer_THE LOOMIS COMPANY]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_THE LOOMIS COMPANY]|[Plan_COMMERCIAL]	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 OVERSEAS]|[plan_TRICARE]|negotiated_dollar	standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE] |negotiated_percentage	standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE] |negotiated_algorithm	estimated_amount|[payer_TRICARE OVERSEAS]|[plan_TRICARE] 	standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE] |methodology	additional_payer_notes |[payer_TRICARE OVERSEAS]|[Plan_TRICARE]	standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE]|negotiated_dollar	standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE] |negotiated_percentage	standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE] |negotiated_algorithm	estimated_amount|[payer_TRICARE WEST HNFS]|[plan_TRICARE] 	standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE] |methodology	additional_payer_notes |[payer_TRICARE WEST HNFS]|[Plan_TRICARE]	standard_charge|[payer_TX BELONG SJRC]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_TX BELONG SJRC]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_TX BELONG SJRC]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_TX BELONG SJRC]|[plan_LOCAL GOVT] 	standard_charge|[payer_TX BELONG SJRC]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_TX BELONG SJRC]|[Plan_LOCAL GOVT]	standard_charge|[payer_UBH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_UBH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_UBH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_UBH]|[plan_COMMERCIAL] 	standard_charge|[payer_UBH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_UBH]|[Plan_COMMERCIAL]	standard_charge|[payer_UBH]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_UBH]|[plan_HMO/PPO] 	standard_charge|[payer_UBH]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_UBH]|[Plan_HMO/PPO]	standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_UBH MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_UBH MEDICARE DUALCOMPLETE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_UBH MEDICARE DUALCOMPLETE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_UBH MEDICARE DUALCOMPLETE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_UBH MEDICARE DUALCOMPLETE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_UBH MEDICARE DUALCOMPLETE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_UBH MEDICARE DUALCOMPLETE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_UCHEALTH PLAN ADMIN LLC]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_UCHEALTH PLAN ADMIN LLC]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_UCHEALTH PLAN ADMIN LLC]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_UCHEALTH PLAN ADMIN LLC]|[plan_COMMERCIAL] 	standard_charge|[payer_UCHEALTH PLAN ADMIN LLC]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_UCHEALTH PLAN ADMIN LLC]|[Plan_COMMERCIAL]	standard_charge|[payer_UHC ALL SAVERS]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_UHC ALL SAVERS]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_UHC ALL SAVERS]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_UHC ALL SAVERS]|[plan_HMO/PPO] 	standard_charge|[payer_UHC ALL SAVERS]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_UHC ALL SAVERS]|[Plan_HMO/PPO]	standard_charge|[payer_UHC GLOBAL]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_UHC GLOBAL]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_UHC GLOBAL]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_UHC GLOBAL]|[plan_COMMERCIAL] 	standard_charge|[payer_UHC GLOBAL]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_UHC GLOBAL]|[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_UMR QUAPAW TRIBAL]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_UMR QUAPAW TRIBAL]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_UMR QUAPAW TRIBAL]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_UMR QUAPAW TRIBAL]|[plan_HMO/PPO] 	standard_charge|[payer_UMR QUAPAW TRIBAL]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_UMR QUAPAW TRIBAL]|[Plan_HMO/PPO]	standard_charge|[payer_VERMONT DCFS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_VERMONT DCFS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_VERMONT DCFS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_VERMONT DCFS]|[plan_LOCAL GOVT] 	standard_charge|[payer_VERMONT DCFS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_VERMONT DCFS]|[Plan_LOCAL GOVT]	standard_charge|[payer_VIRGINIA BEACH DHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_VIRGINIA BEACH DHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_VIRGINIA BEACH DHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_VIRGINIA BEACH DHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_VIRGINIA BEACH DHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_VIRGINIA BEACH DHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_VIRGINIA CHESAPEAKE CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_VIRGINIA CHESAPEAKE CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_VIRGINIA CHESAPEAKE CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_VIRGINIA CHESAPEAKE CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_VIRGINIA CHESAPEAKE CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_VIRGINIA CHESAPEAKE CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_VIRGINIA DSS LEE CITY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_VIRGINIA DSS LEE CITY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_VIRGINIA DSS LEE CITY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_VIRGINIA DSS LEE CITY]|[plan_LOCAL GOVT] 	standard_charge|[payer_VIRGINIA DSS LEE CITY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_VIRGINIA DSS LEE CITY]|[Plan_LOCAL GOVT]	standard_charge|[payer_VIRGINIA MCD AETNA BETTER]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_VIRGINIA MCD AETNA BETTER]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_VIRGINIA MCD AETNA BETTER]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_VIRGINIA MCD AETNA BETTER]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_VIRGINIA MCD AETNA BETTER]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_VIRGINIA MCD AETNA BETTER]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_VIRGINIA OPTIMA MGD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_VIRGINIA OPTIMA MGD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_VIRGINIA OPTIMA MGD]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_VIRGINIA OPTIMA MGD]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_VIRGINIA OPTIMA MGD]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_VIRGINIA OPTIMA MGD]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_VIRGINIA RUSSELL CTY]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_VIRGINIA RUSSELL CTY]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_VIRGINIA RUSSELL CTY]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_VIRGINIA RUSSELL CTY]|[plan_LOCAL GOVT] 	standard_charge|[payer_VIRGINIA RUSSELL CTY]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_VIRGINIA RUSSELL CTY]|[Plan_LOCAL GOVT]	standard_charge|[payer_WASHINGTON DC CFSA]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WASHINGTON DC CFSA]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WASHINGTON DC CFSA]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WASHINGTON DC CFSA]|[plan_LOCAL GOVT] 	standard_charge|[payer_WASHINGTON DC CFSA]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WASHINGTON DC CFSA]|[Plan_LOCAL GOVT]	standard_charge|[payer_WASHINGTON DC HSCSN]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_WASHINGTON DC HSCSN]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_WASHINGTON DC HSCSN]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_WASHINGTON DC HSCSN]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_WASHINGTON DC HSCSN]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_WASHINGTON DC HSCSN]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_WEST VA SUBACUTE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WEST VA SUBACUTE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WEST VA SUBACUTE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WEST VA SUBACUTE]|[plan_LOCAL GOVT] 	standard_charge|[payer_WEST VA SUBACUTE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WEST VA SUBACUTE]|[Plan_LOCAL GOVT]	standard_charge|[payer_WEST VIRGINIA AETNA]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_WEST VIRGINIA AETNA]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_WEST VIRGINIA AETNA]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_WEST VIRGINIA AETNA]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_WEST VIRGINIA AETNA]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_WEST VIRGINIA AETNA]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_WEST VIRGINIA DHHR]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WEST VIRGINIA DHHR]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WEST VIRGINIA DHHR]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WEST VIRGINIA DHHR]|[plan_LOCAL GOVT] 	standard_charge|[payer_WEST VIRGINIA DHHR]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WEST VIRGINIA DHHR]|[Plan_LOCAL GOVT]	standard_charge|[payer_WEST VIRGINIA HEALTH PLAN]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_WEST VIRGINIA HEALTH PLAN]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_WEST VIRGINIA HEALTH PLAN]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_WEST VIRGINIA HEALTH PLAN]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_WEST VIRGINIA HEALTH PLAN]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_WEST VIRGINIA HEALTH PLAN]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_WEST VIRGINIA UNICARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_WEST VIRGINIA UNICARE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_WEST VIRGINIA UNICARE]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_WEST VIRGINIA UNICARE]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_WEST VIRGINIA UNICARE]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_WEST VIRGINIA UNICARE]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_WISCONSIN DHS EAU CLAIRE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WISCONSIN DHS EAU CLAIRE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WISCONSIN DHS EAU CLAIRE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WISCONSIN DHS EAU CLAIRE]|[plan_LOCAL GOVT] 	standard_charge|[payer_WISCONSIN DHS EAU CLAIRE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WISCONSIN DHS EAU CLAIRE]|[Plan_LOCAL GOVT]	standard_charge|[payer_WISCONSIN PORTAGE CTY DHS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WISCONSIN PORTAGE CTY DHS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WISCONSIN PORTAGE CTY DHS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WISCONSIN PORTAGE CTY DHS]|[plan_LOCAL GOVT] 	standard_charge|[payer_WISCONSIN PORTAGE CTY DHS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WISCONSIN PORTAGE CTY DHS]|[Plan_LOCAL GOVT]	standard_charge|[payer_WYOMING DEPT OF HEALTH]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WYOMING DEPT OF HEALTH]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WYOMING DEPT OF HEALTH]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WYOMING DEPT OF HEALTH]|[plan_LOCAL GOVT] 	standard_charge|[payer_WYOMING DEPT OF HEALTH]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WYOMING DEPT OF HEALTH]|[Plan_LOCAL GOVT]	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm	estimated_amount|[payer_WYOMING MEDICAID]|[plan_MEDICAID: CBS OOS] 	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology	additional_payer_notes |[payer_WYOMING MEDICAID]|[Plan_MEDICAID: CBS OOS]	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm	estimated_amount|[payer_WYOMING MEDICAID]|[plan_MEDICAID: OUT OF STATE] 	standard_charge|[payer_WYOMING MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology	additional_payer_notes |[payer_WYOMING MEDICAID]|[Plan_MEDICAID: OUT OF STATE]	standard_charge|[payer_WYOMING NADFS]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WYOMING NADFS]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WYOMING NADFS]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WYOMING NADFS]|[plan_LOCAL GOVT] 	standard_charge|[payer_WYOMING NADFS]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WYOMING NADFS]|[Plan_LOCAL GOVT]	standard_charge|[payer_WYOMING SUBACUTE]|[plan_LOCAL GOVT]|negotiated_dollar	standard_charge|[payer_WYOMING SUBACUTE]|[plan_LOCAL GOVT] |negotiated_percentage	standard_charge|[payer_WYOMING SUBACUTE]|[plan_LOCAL GOVT] |negotiated_algorithm	estimated_amount|[payer_WYOMING SUBACUTE]|[plan_LOCAL GOVT] 	standard_charge|[payer_WYOMING SUBACUTE]|[plan_LOCAL GOVT] |methodology	additional_payer_notes |[payer_WYOMING SUBACUTE]|[Plan_LOCAL GOVT]	additional_generic_notes
ROOM AND CARE ADOL	124	RC	facility	inpatient				2000	750	350	2000	750				per diem		750				per diem		2000				per diem		900				per diem		900				per diem		900				per diem		925				per diem		880				per diem		880				per diem		816				per diem		816				per diem						  		816				per diem		816				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		350				per diem		647				per diem		647				per diem		647				per diem		647				per diem		647				per diem		750				per diem		2000				per diem		1015				per diem		852				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		1950				per diem						  		2000				per diem		750				per diem		2000				per diem						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		699				per diem		2000				per diem		2000				per diem		2000				per diem		1007				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		699				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		725				per diem		820				per diem		820				per diem		2000				per diem		738				per diem		738				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		750				per diem		2000				per diem		820				per diem		2000				per diem		820				per diem		2000				per diem		820				per diem		820				per diem		820				per diem		820				per diem		950				per diem		820				per diem		950				per diem		820				per diem		820				per diem		2000				per diem						  						  						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		574				per diem		574				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		850				per diem		850				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		597				per diem		785				per diem		2000				per diem		2000				per diem		2000				per diem		850				per diem		1025				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		1248				per diem						  		1342				per diem		2000				per diem		2000				per diem		794				per diem		794				per diem		785				per diem		2000				per diem		699				per diem		750				per diem		794				per diem		699				per diem		1200				per diem		900				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		900				per diem		2000				per diem		2000				per diem		850				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		2000				per diem		950				per diem		
ROOM AND CARE CHILD	124	RC	facility	inpatient				2000	750	350	2000	750				per diem		750				per diem		2000				per diem		900				per diem		900				per diem		900				per diem		925				per diem		880				per diem		880				per diem		816				per diem		816				per diem						  		816				per diem		816				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		350				per diem		647				per diem		647				per diem		647				per diem		647				per diem		647				per diem		750				per diem		2000				per diem		1015				per diem		852				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		1950				per diem						  		2000				per diem		750				per diem		2000				per diem						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		699				per diem		2000				per diem		2000				per diem		2000				per diem		1007				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		699				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		725				per diem		820				per diem		820				per diem		1950				per diem		738				per diem		738				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		750				per diem		2000				per diem		820				per diem		2000				per diem		820				per diem		2000				per diem		820				per diem		820				per diem		820				per diem		820				per diem		950				per diem		820				per diem		950				per diem		820				per diem		820				per diem		2000				per diem						  						  						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		574				per diem		574				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		850				per diem		850				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		597				per diem		785				per diem		2000				per diem		2000				per diem		2000				per diem		850				per diem		1025				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		1248				per diem						  		1342				per diem		2000				per diem		2000				per diem		794				per diem		794				per diem		785				per diem		2000				per diem		699				per diem		750				per diem		794				per diem		699				per diem		1200				per diem		900				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		900				per diem		2000				per diem		2000				per diem		850				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		2000				per diem		950				per diem		
ROOM AND CARE GERI	124	RC	facility	inpatient				2000	750	350	2000	750				per diem		750				per diem		2000				per diem		900				per diem		900				per diem		900				per diem		925				per diem		880				per diem		880				per diem		816				per diem		816				per diem						  		816				per diem		816				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		350				per diem		647				per diem		647				per diem		647				per diem		647				per diem		647				per diem		750				per diem		2000				per diem		1015				per diem		852				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		1950				per diem						  		2000				per diem		750				per diem		2000				per diem						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		699				per diem		2000				per diem		2000				per diem		2000				per diem		1007				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		699				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		725				per diem		820				per diem		820				per diem		1950				per diem		738				per diem		738				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		750				per diem		2000				per diem		820				per diem		2000				per diem		820				per diem		2000				per diem		820				per diem		820				per diem		820				per diem		820				per diem		950				per diem		820				per diem		950				per diem		820				per diem		820				per diem		2000				per diem						  						  						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		574				per diem		574				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		850				per diem		850				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		597				per diem		785				per diem		2000				per diem		2000				per diem		2000				per diem		850				per diem		1025				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		1248				per diem						  		1342				per diem		2000				per diem		2000				per diem		794				per diem		794				per diem		785				per diem		2000				per diem		699				per diem		750				per diem		794				per diem		699				per diem		1200				per diem		900				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		900				per diem		2000				per diem		2000				per diem		850				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem		2000				per diem						  		2000				per diem		950				per diem		
ROOM AND CARE RTC	129	RC	facility	inpatient				1450	450	311	1950					  		450				per diem		1450				per diem		475				per diem		475				per diem		475				per diem		525				per diem		495				per diem		495				per diem		500				per diem		500				per diem		550				per diem		500				per diem		500				per diem		1450				per diem		550				per diem		550				per diem		1450				per diem		1450				per diem						  		350				per diem		350				per diem		350				per diem		350				per diem		350				per diem		500				per diem		1450				per diem		508				per diem		568				per diem		1450				per diem						  		765				per diem		765				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		709				per diem		765				per diem		1450				per diem		1450				per diem						  		1400				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  						  		439				per diem		1450				per diem						  						  		1450				per diem		1450				per diem		1450				per diem		530				per diem		1450				per diem		1450				per diem		500				per diem		1400				per diem		550				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem						  		500				per diem		1400				per diem		500				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		500				per diem		1400				per diem		450				per diem		478				per diem		725				per diem						  						  		1450				per diem		1450				per diem						  		1950				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  		475				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  						  		1450				per diem						  		1450				per diem		1450				per diem						  		1400				per diem		452				per diem		448				per diem		452				per diem						  		1450				per diem		484				per diem		550				per diem		550				per diem		1450				per diem		1450				per diem		550				per diem		550				per diem		1400				per diem		550				per diem		550				per diem		1450				per diem		1450				per diem		1450				per diem		515				per diem		515				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		450				per diem		450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1400				per diem		500				per diem		1450				per diem		1450				per diem		593				per diem		489				per diem		500				per diem		1450				per diem		1450				per diem						  						  		1450				per diem		1450				per diem		450				per diem		450				per diem		650				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		561				per diem		528				per diem		579				per diem		1450				per diem		1450				per diem						  						  						  		1450				per diem						  						  		1450				per diem		1450				per diem		515				per diem		765				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		721				per diem		1450				per diem		1450				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		475				per diem		311				per diem		311				per diem		1450				per diem		1450				per diem		
THERAPUTIC LOA	183	RC	facility	inpatient				1450		350	1450					  						  		1450				per diem		475				per diem		475				per diem		475				per diem		525				per diem						  						  		500				per diem		500				per diem						  		500				per diem		500				per diem		1450				per diem		550				per diem		550				per diem		1450				per diem		1450				per diem						  		350				per diem		350				per diem		350				per diem		350				per diem		350				per diem						  						  						  						  		1450				per diem						  		765				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		709				per diem		765				per diem		1450				per diem		1450				per diem						  		1400				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  						  		439				per diem		1450				per diem						  						  		1450				per diem		1450				per diem		1450				per diem		530				per diem		1450				per diem		1450				per diem		500				per diem		1400				per diem		550				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem						  		500				per diem		1400				per diem		500				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		1400				per diem		500				per diem		1400				per diem		450				per diem		478				per diem						  						  						  						  						  						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  		475				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  						  		1450				per diem						  		1450				per diem		1450				per diem						  		1400				per diem		452				per diem		448				per diem		452				per diem						  		1450				per diem		484				per diem		550				per diem		550				per diem		1450				per diem		1450				per diem		550				per diem		550				per diem		1400				per diem		550				per diem		550				per diem		1450				per diem		1450				per diem		1450				per diem		515				per diem		515				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		450				per diem		450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  		500				per diem		1450				per diem		1450				per diem		593				per diem		489				per diem		500				per diem		1450				per diem						  						  						  						  		1450				per diem						  		450				per diem		650				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem						  		561				per diem		528				per diem		579				per diem		1450				per diem		1450				per diem						  						  						  						  						  						  						  						  		515				per diem		765				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		721				per diem		1450				per diem		1450				per diem						  		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		1450				per diem		475				per diem						  						  		1450				per diem		1450				per diem		
INTENSIVE OUTPATIENT PROGRAM ADOL PGM	905	RC	facility	outpatient				500		150	450					  						  						  						  						  						  		150				per diem		190				per diem		200				per diem						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		450				per diem						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		400				per diem						  						  						  						  						  						  						  						  						  						  						  						  		150				per diem						  						  						  						  						  						  						  						  		158				per diem						  						  		150				per diem						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		198				per diem						  		198				per diem						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
Psych Eval with Meds	90792	RC	facility	both				250		100	185					  						  						  						  						  						  		100				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		140				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		185				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		185				fee schedule		185				fee schedule						  		185				fee schedule						  						  		185				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
"Subsequent Hospital Care, low complexity - 15 min"	99231	RC	facility	both				120		47	47					  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		47				fee schedule		47				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
"Subsequent Hospital Care, moderate complexity - 25 min"	99232	RC	facility	both				140		58	101	83				fee schedule		83				fee schedule						  						  						  						  		64				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		101				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		63				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		58				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		90				fee schedule						  		90				fee schedule		90				fee schedule						  						  						  		76				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
Initial Eval 50 min	99222	RC	facility	both				145		58	58					  																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																		58				per diem		58				per diem								58				per diem														58				per diem																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																
Initial Eval 70 min	99223	RC	facility	both				204		102	194					  																																166				per diem																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														163				per diem														163				per diem														163				per diem																																																																																																																																																																																																																																																																																																																																																																																												194				per diem								155				per diem		155				per diem																				102				per diem