"hospital_The Pavilion at HealthPark, LLC" last_updated_ 2023-12-31 version_1 "hospital_Fort Myers, Florida" hospital_address 9241 Park Royal Drive license_4507 | FL "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded in this machine-readable file is true, accurate, and complete as of the date indicated in this file" 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_1199 SEIU BENEFIT FUND | COMMERCIAL] standard_charge|[payer_1199 SEIU BENEFIT FUND | COMMERCIAL] |percent standard_charge|[payer_1199 SEIU BENEFIT FUND | COMMERCIAL] |contracting_method additional_payer_notes |[payer_1199 SEIU BENEFIT FUND | COMMERCIAL] standard_charge|[payer_AARP COMPLETE / UHC | MANAGED MEDICARE] standard_charge|[payer_AARP COMPLETE / UHC | MANAGED MEDICARE] |percent standard_charge|[payer_AARP COMPLETE / UHC | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AARP COMPLETE / UHC | MANAGED MEDICARE] standard_charge|[payer_AETNA | HMO/PPO] standard_charge|[payer_AETNA | HMO/PPO] |percent standard_charge|[payer_AETNA | HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA | HMO/PPO] standard_charge|[payer_AETNA BETTER HEALTH | HMO/PPO] standard_charge|[payer_AETNA BETTER HEALTH | HMO/PPO] |percent standard_charge|[payer_AETNA BETTER HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH | HMO/PPO] standard_charge|[payer_AETNA BETTER HEALTH MCARE | MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER HEALTH MCARE | MANAGED MEDICARE] |percent standard_charge|[payer_AETNA BETTER HEALTH MCARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH MCARE | MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER HEALTH OF FL | MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH OF FL | MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH OF FL | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH OF FL | MANAGED MEDICAID] standard_charge|[payer_AETNA CIEE | COMMERCIAL] standard_charge|[payer_AETNA CIEE | COMMERCIAL] |percent standard_charge|[payer_AETNA CIEE | COMMERCIAL] |contracting_method additional_payer_notes |[payer_AETNA CIEE | COMMERCIAL] standard_charge|[payer_AETNA MEDICARE REPLMENT | MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE REPLMENT | MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE REPLMENT | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE REPLMENT | MANAGED MEDICARE] standard_charge|[payer_AETNA SENIOR SUPPLEMENT | MANAGED MEDICARE] standard_charge|[payer_AETNA SENIOR SUPPLEMENT | MANAGED MEDICARE] |percent standard_charge|[payer_AETNA SENIOR SUPPLEMENT | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA SENIOR SUPPLEMENT | MANAGED MEDICARE] standard_charge|[payer_ALIGNMENT HEALTH | MANAGED MEDICARE] standard_charge|[payer_ALIGNMENT HEALTH | MANAGED MEDICARE] |percent standard_charge|[payer_ALIGNMENT HEALTH | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ALIGNMENT HEALTH | MANAGED MEDICARE] standard_charge|[payer_AM BETTER SUNSHINE | COMMERCIAL] standard_charge|[payer_AM BETTER SUNSHINE | COMMERCIAL] |percent standard_charge|[payer_AM BETTER SUNSHINE | COMMERCIAL] |contracting_method additional_payer_notes |[payer_AM BETTER SUNSHINE | COMMERCIAL] standard_charge|[payer_AM BETTER SUNSHINE | HMO/PPO] standard_charge|[payer_AM BETTER SUNSHINE | HMO/PPO] |percent standard_charge|[payer_AM BETTER SUNSHINE | HMO/PPO] |contracting_method additional_payer_notes |[payer_AM BETTER SUNSHINE | HMO/PPO] standard_charge|[payer_AMERIGROUP MEDICAID HMO | MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP MEDICAID HMO | MANAGED MEDICAID] |percent standard_charge|[payer_AMERIGROUP MEDICAID HMO | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIGROUP MEDICAID HMO | MANAGED MEDICAID] standard_charge|[payer_BANKERS LIFE INS | COMMERCIAL] standard_charge|[payer_BANKERS LIFE INS | COMMERCIAL] |percent standard_charge|[payer_BANKERS LIFE INS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_BANKERS LIFE INS | COMMERCIAL] standard_charge|[payer_BCBS FEDERAL | BLUE CROSS] standard_charge|[payer_BCBS FEDERAL | BLUE CROSS] |percent standard_charge|[payer_BCBS FEDERAL | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS FEDERAL | BLUE CROSS] standard_charge|[payer_BCBS FLORIDA | BLUE CROSS] standard_charge|[payer_BCBS FLORIDA | BLUE CROSS] |percent standard_charge|[payer_BCBS FLORIDA | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS FLORIDA | BLUE CROSS] standard_charge|[payer_BCBS MCR | MANAGED MEDICARE] standard_charge|[payer_BCBS MCR | MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MCR | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MCR | MANAGED MEDICARE] standard_charge|[payer_BCBS OUT OF STATE | BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE | BLUE CROSS] |percent standard_charge|[payer_BCBS OUT OF STATE | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OUT OF STATE | BLUE CROSS] standard_charge|[payer_BEACON HEALTH | HMO/PPO] standard_charge|[payer_BEACON HEALTH | HMO/PPO] |percent standard_charge|[payer_BEACON HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HEALTH | HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS | MANAGED MEDICARE] standard_charge|[payer_BEACON HEALTH OPTIONS | MANAGED MEDICARE] |percent standard_charge|[payer_BEACON HEALTH OPTIONS | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS | MANAGED MEDICARE] standard_charge|[payer_BEACON HUMANA MEDICAID | MANAGED MEDICAID] standard_charge|[payer_BEACON HUMANA MEDICAID | MANAGED MEDICAID] |percent standard_charge|[payer_BEACON HUMANA MEDICAID | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BEACON HUMANA MEDICAID | MANAGED MEDICAID] standard_charge|[payer_BLUECROSS COMPLETE | BLUE CROSS] standard_charge|[payer_BLUECROSS COMPLETE | BLUE CROSS] |percent standard_charge|[payer_BLUECROSS COMPLETE | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BLUECROSS COMPLETE | BLUE CROSS] standard_charge|[payer_BRIGHT HEALTH MEDICARE | MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_BRIGHT HEALTH MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BRIGHT HEALTH MEDICARE | MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH PLAN | HMO/PPO] standard_charge|[payer_BRIGHT HEALTH PLAN | HMO/PPO] |percent standard_charge|[payer_BRIGHT HEALTH PLAN | HMO/PPO] |contracting_method additional_payer_notes |[payer_BRIGHT HEALTH PLAN | HMO/PPO] standard_charge|[payer_CAREPLUS | MANAGED MEDICARE] standard_charge|[payer_CAREPLUS | MANAGED MEDICARE] |percent standard_charge|[payer_CAREPLUS | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CAREPLUS | MANAGED MEDICARE] standard_charge|[payer_CARISK BEHAVIORAL HEALTH | COMMERCIAL] standard_charge|[payer_CARISK BEHAVIORAL HEALTH | COMMERCIAL] |percent standard_charge|[payer_CARISK BEHAVIORAL HEALTH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_CARISK BEHAVIORAL HEALTH | COMMERCIAL] standard_charge|[payer_CHAMPVA | VETERANS ADMIN] standard_charge|[payer_CHAMPVA | VETERANS ADMIN] |percent standard_charge|[payer_CHAMPVA | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_CHAMPVA | VETERANS ADMIN] standard_charge|[payer_CIGNA ALLEGIANCE | HMO/PPO] standard_charge|[payer_CIGNA ALLEGIANCE | HMO/PPO] |percent standard_charge|[payer_CIGNA ALLEGIANCE | HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA ALLEGIANCE | HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL | HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL | HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL | HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL | HMO/PPO] standard_charge|[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTH SPRINGS | HMO/PPO] standard_charge|[payer_CIGNA HEALTH SPRINGS | HMO/PPO] |percent standard_charge|[payer_CIGNA HEALTH SPRINGS | HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA HEALTH SPRINGS | HMO/PPO] standard_charge|[payer_CIGNA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_CIGNA MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_CLEAR HEALTH ALLIANCE | MANAGED MEDICAID] standard_charge|[payer_CLEAR HEALTH ALLIANCE | MANAGED MEDICAID] |percent standard_charge|[payer_CLEAR HEALTH ALLIANCE | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CLEAR HEALTH ALLIANCE | MANAGED MEDICAID] standard_charge|[payer_COLONIAL PENN LIFE | COMMERCIAL] standard_charge|[payer_COLONIAL PENN LIFE | COMMERCIAL] |percent standard_charge|[payer_COLONIAL PENN LIFE | COMMERCIAL] |contracting_method additional_payer_notes |[payer_COLONIAL PENN LIFE | COMMERCIAL] standard_charge|[payer_COMPSYCH | COMMERCIAL] standard_charge|[payer_COMPSYCH | COMMERCIAL] |percent standard_charge|[payer_COMPSYCH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_COMPSYCH | COMMERCIAL] standard_charge|[payer_CSU - SELFPAY | LOCAL GOVT] standard_charge|[payer_CSU - SELFPAY | LOCAL GOVT] |percent standard_charge|[payer_CSU - SELFPAY | LOCAL GOVT] |contracting_method additional_payer_notes |[payer_CSU - SELFPAY | LOCAL GOVT] standard_charge|[payer_EMBLEM HEALTH | COMMERCIAL] standard_charge|[payer_EMBLEM HEALTH | COMMERCIAL] |percent standard_charge|[payer_EMBLEM HEALTH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_EMBLEM HEALTH | COMMERCIAL] standard_charge|[payer_FIDELIS MEDICAID | MANAGED MEDICAID] standard_charge|[payer_FIDELIS MEDICAID | MANAGED MEDICAID] |percent standard_charge|[payer_FIDELIS MEDICAID | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FIDELIS MEDICAID | MANAGED MEDICAID] standard_charge|[payer_FIRST HEALTH | COMMERCIAL] standard_charge|[payer_FIRST HEALTH | COMMERCIAL] |percent standard_charge|[payer_FIRST HEALTH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_FIRST HEALTH | COMMERCIAL] standard_charge|[payer_FLORIDA COMMUNITY CARE | MANAGED MEDICAID] standard_charge|[payer_FLORIDA COMMUNITY CARE | MANAGED MEDICAID] |percent standard_charge|[payer_FLORIDA COMMUNITY CARE | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FLORIDA COMMUNITY CARE | MANAGED MEDICAID] standard_charge|[payer_FREEDOM HEALTH MEDICAID | MANAGED MEDICAID] standard_charge|[payer_FREEDOM HEALTH MEDICAID | MANAGED MEDICAID] |percent standard_charge|[payer_FREEDOM HEALTH MEDICAID | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FREEDOM HEALTH MEDICAID | MANAGED MEDICAID] standard_charge|[payer_FREEDOM MCR BEACON HEALTH | MANAGED MEDICARE] standard_charge|[payer_FREEDOM MCR BEACON HEALTH | MANAGED MEDICARE] |percent standard_charge|[payer_FREEDOM MCR BEACON HEALTH | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_FREEDOM MCR BEACON HEALTH | MANAGED MEDICARE] standard_charge|[payer_GEHA | COMMERCIAL] standard_charge|[payer_GEHA | COMMERCIAL] |percent standard_charge|[payer_GEHA | COMMERCIAL] |contracting_method additional_payer_notes |[payer_GEHA | COMMERCIAL] standard_charge|[payer_GHI IBM | COMMERCIAL] standard_charge|[payer_GHI IBM | COMMERCIAL] |percent standard_charge|[payer_GHI IBM | COMMERCIAL] |contracting_method additional_payer_notes |[payer_GHI IBM | COMMERCIAL] standard_charge|[payer_GLOBAL EXCEL MANAGEMENT | COMMERCIAL] standard_charge|[payer_GLOBAL EXCEL MANAGEMENT | COMMERCIAL] |percent standard_charge|[payer_GLOBAL EXCEL MANAGEMENT | COMMERCIAL] |contracting_method additional_payer_notes |[payer_GLOBAL EXCEL MANAGEMENT | COMMERCIAL] standard_charge|[payer_GOLDEN RULE | COMMERCIAL] standard_charge|[payer_GOLDEN RULE | COMMERCIAL] |percent standard_charge|[payer_GOLDEN RULE | COMMERCIAL] |contracting_method additional_payer_notes |[payer_GOLDEN RULE | COMMERCIAL] standard_charge|[payer_HEALTH FIRST HEALTH PLAN | COMMERCIAL] standard_charge|[payer_HEALTH FIRST HEALTH PLAN | COMMERCIAL] |percent standard_charge|[payer_HEALTH FIRST HEALTH PLAN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTH FIRST HEALTH PLAN | COMMERCIAL] standard_charge|[payer_HOP ADMINISTRATION UNIT | COMMERCIAL] standard_charge|[payer_HOP ADMINISTRATION UNIT | COMMERCIAL] |percent standard_charge|[payer_HOP ADMINISTRATION UNIT | COMMERCIAL] |contracting_method additional_payer_notes |[payer_HOP ADMINISTRATION UNIT | COMMERCIAL] standard_charge|[payer_HUMANA | HMO/PPO] standard_charge|[payer_HUMANA | HMO/PPO] |percent standard_charge|[payer_HUMANA | HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA | HMO/PPO] standard_charge|[payer_HUMANA MCR | MANAGED MEDICARE] standard_charge|[payer_HUMANA MCR | MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MCR | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MCR | MANAGED MEDICARE] standard_charge|[payer_HUMANA TRICARE MILITARY | TRICARE] standard_charge|[payer_HUMANA TRICARE MILITARY | TRICARE] |percent standard_charge|[payer_HUMANA TRICARE MILITARY | TRICARE] |contracting_method additional_payer_notes |[payer_HUMANA TRICARE MILITARY | TRICARE] standard_charge|[payer_KEY BENEFIT ADMINISTRATOR | COMMERCIAL] standard_charge|[payer_KEY BENEFIT ADMINISTRATOR | COMMERCIAL] |percent standard_charge|[payer_KEY BENEFIT ADMINISTRATOR | COMMERCIAL] |contracting_method additional_payer_notes |[payer_KEY BENEFIT ADMINISTRATOR | COMMERCIAL] standard_charge|[payer_LEON HEALTH INC | MANAGED MEDICARE] standard_charge|[payer_LEON HEALTH INC | MANAGED MEDICARE] |percent standard_charge|[payer_LEON HEALTH INC | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_LEON HEALTH INC | MANAGED MEDICARE] standard_charge|[payer_LMC HEALTH PLAN | MANAGED MEDICARE] standard_charge|[payer_LMC HEALTH PLAN | MANAGED MEDICARE] |percent standard_charge|[payer_LMC HEALTH PLAN | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_LMC HEALTH PLAN | MANAGED MEDICARE] standard_charge|[payer_LMHBED CONTRACT | COMMERCIAL] standard_charge|[payer_LMHBED CONTRACT | COMMERCIAL] |percent standard_charge|[payer_LMHBED CONTRACT | COMMERCIAL] |contracting_method additional_payer_notes |[payer_LMHBED CONTRACT | COMMERCIAL] standard_charge|[payer_MAGELLAN | HMO/PPO] standard_charge|[payer_MAGELLAN | HMO/PPO] |percent standard_charge|[payer_MAGELLAN | HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN | HMO/PPO] standard_charge|[payer_MAGELLAN | MANAGED MEDICAID] standard_charge|[payer_MAGELLAN | MANAGED MEDICAID] |percent standard_charge|[payer_MAGELLAN | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MAGELLAN | MANAGED MEDICAID] standard_charge|[payer_MAGELLAN COMP CARE MCD | MANAGED MEDICAID] standard_charge|[payer_MAGELLAN COMP CARE MCD | MANAGED MEDICAID] |percent standard_charge|[payer_MAGELLAN COMP CARE MCD | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MAGELLAN COMP CARE MCD | MANAGED MEDICAID] standard_charge|[payer_MAGELLAN HMO | HMO/PPO] standard_charge|[payer_MAGELLAN HMO | HMO/PPO] |percent standard_charge|[payer_MAGELLAN HMO | HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN HMO | HMO/PPO] standard_charge|[payer_MAGELLAN MCR HMO | MANAGED MEDICARE] standard_charge|[payer_MAGELLAN MCR HMO | MANAGED MEDICARE] |percent standard_charge|[payer_MAGELLAN MCR HMO | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MAGELLAN MCR HMO | MANAGED MEDICARE] standard_charge|[payer_MEDICARE | MEDICARE] standard_charge|[payer_MEDICARE | MEDICARE] |percent standard_charge|[payer_MEDICARE | MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE | MEDICARE] standard_charge|[payer_MERITAIN HEALTH AETNA | HMO/PPO] standard_charge|[payer_MERITAIN HEALTH AETNA | HMO/PPO] |percent standard_charge|[payer_MERITAIN HEALTH AETNA | HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH AETNA | HMO/PPO] standard_charge|[payer_MMM HEALTHCARE LLC | MANAGED MEDICARE] standard_charge|[payer_MMM HEALTHCARE LLC | MANAGED MEDICARE] |percent standard_charge|[payer_MMM HEALTHCARE LLC | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MMM HEALTHCARE LLC | MANAGED MEDICARE] standard_charge|[payer_MOLINA HEALTHCARE OF FL | MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF FL | MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA HEALTHCARE OF FL | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA HEALTHCARE OF FL | MANAGED MEDICAID] standard_charge|[payer_MOLINA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_MOLINA MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_MOLINA MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MOLINA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_MUTUAL OF OMAHA | COMMERCIAL] standard_charge|[payer_MUTUAL OF OMAHA | COMMERCIAL] |percent standard_charge|[payer_MUTUAL OF OMAHA | COMMERCIAL] |contracting_method additional_payer_notes |[payer_MUTUAL OF OMAHA | COMMERCIAL] standard_charge|[payer_OOS MEDICAID | MEDICAID: OUT OF STATE] standard_charge|[payer_OOS MEDICAID | MEDICAID: OUT OF STATE] |percent standard_charge|[payer_OOS MEDICAID | MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_OOS MEDICAID | MEDICAID: OUT OF STATE] standard_charge|[payer_OPTIMUM MCARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_OPTIMUM MCARE ADVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_OPTIMUM MCARE ADVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_OPTIMUM MCARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_OPTUM CARE | MANAGED MEDICARE] standard_charge|[payer_OPTUM CARE | MANAGED MEDICARE] |percent standard_charge|[payer_OPTUM CARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_OPTUM CARE | MANAGED MEDICARE] standard_charge|[payer_PHILADELPHIA LIFE INS | COMMERCIAL] standard_charge|[payer_PHILADELPHIA LIFE INS | COMMERCIAL] |percent standard_charge|[payer_PHILADELPHIA LIFE INS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_PHILADELPHIA LIFE INS | COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH PLAN | COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH PLAN | COMMERCIAL] |percent standard_charge|[payer_PRIORITY HEALTH PLAN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_PRIORITY HEALTH PLAN | COMMERCIAL] standard_charge|[payer_SEMINOLE TRIBE OF FL | COMMERCIAL] standard_charge|[payer_SEMINOLE TRIBE OF FL | COMMERCIAL] |percent standard_charge|[payer_SEMINOLE TRIBE OF FL | COMMERCIAL] |contracting_method additional_payer_notes |[payer_SEMINOLE TRIBE OF FL | COMMERCIAL] standard_charge|[payer_SIMPLY HEALTHCARE | MANAGED MEDICARE] standard_charge|[payer_SIMPLY HEALTHCARE | MANAGED MEDICARE] |percent standard_charge|[payer_SIMPLY HEALTHCARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_SIMPLY HEALTHCARE | MANAGED MEDICARE] standard_charge|[payer_SIMPLY HEALTHCARE PLANS | MANAGED MEDICAID] standard_charge|[payer_SIMPLY HEALTHCARE PLANS | MANAGED MEDICAID] |percent standard_charge|[payer_SIMPLY HEALTHCARE PLANS | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SIMPLY HEALTHCARE PLANS | MANAGED MEDICAID] standard_charge|[payer_SIMPLY MEDICARE | MANAGED MEDICARE] standard_charge|[payer_SIMPLY MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_SIMPLY MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_SIMPLY MEDICARE | MANAGED MEDICARE] standard_charge|[payer_SUNSHINE | MANAGED MEDICAID] standard_charge|[payer_SUNSHINE | MANAGED MEDICAID] |percent standard_charge|[payer_SUNSHINE | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUNSHINE | MANAGED MEDICAID] standard_charge|[payer_TRANSAMERICA EMPLOYEE BEN | COMMERCIAL] standard_charge|[payer_TRANSAMERICA EMPLOYEE BEN | COMMERCIAL] |percent standard_charge|[payer_TRANSAMERICA EMPLOYEE BEN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_TRANSAMERICA EMPLOYEE BEN | COMMERCIAL] standard_charge|[payer_TRICARE | TRICARE] standard_charge|[payer_TRICARE | TRICARE] |percent standard_charge|[payer_TRICARE | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE | TRICARE] standard_charge|[payer_TRIWEST VA COMMUNITY CARE | VETERANS ADMIN] standard_charge|[payer_TRIWEST VA COMMUNITY CARE | VETERANS ADMIN] |percent standard_charge|[payer_TRIWEST VA COMMUNITY CARE | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_TRIWEST VA COMMUNITY CARE | VETERANS ADMIN] standard_charge|[payer_TUFTS HEALTH PLAN | COMMERCIAL] standard_charge|[payer_TUFTS HEALTH PLAN | COMMERCIAL] |percent standard_charge|[payer_TUFTS HEALTH PLAN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_TUFTS HEALTH PLAN | COMMERCIAL] standard_charge|[payer_UBH ALL SAVERS | HMO/PPO] standard_charge|[payer_UBH ALL SAVERS | HMO/PPO] |percent standard_charge|[payer_UBH ALL SAVERS | HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH ALL SAVERS | HMO/PPO] standard_charge|[payer_UBH FLONEX | HMO/PPO] standard_charge|[payer_UBH FLONEX | HMO/PPO] |percent standard_charge|[payer_UBH FLONEX | HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH FLONEX | HMO/PPO] standard_charge|[payer_UBH MEDICARE | MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_UBH MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UBH MEDICARE | MANAGED MEDICARE] standard_charge|[payer_UBH STUDENT RESOURCES | COMMERCIAL] standard_charge|[payer_UBH STUDENT RESOURCES | COMMERCIAL] |percent standard_charge|[payer_UBH STUDENT RESOURCES | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UBH STUDENT RESOURCES | COMMERCIAL] standard_charge|[payer_UBH/OPTUM | HMO/PPO] standard_charge|[payer_UBH/OPTUM | HMO/PPO] |percent standard_charge|[payer_UBH/OPTUM | HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH/OPTUM | HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES | HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES | HMO/PPO] |percent standard_charge|[payer_UHC SHARED SERVICES | HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC SHARED SERVICES | HMO/PPO] standard_charge|[payer_UMR | HMO/PPO] standard_charge|[payer_UMR | HMO/PPO] |percent standard_charge|[payer_UMR | HMO/PPO] |contracting_method additional_payer_notes |[payer_UMR | HMO/PPO] standard_charge|[payer_UNICARE BEACON HEALTH | HMO/PPO] standard_charge|[payer_UNICARE BEACON HEALTH | HMO/PPO] |percent standard_charge|[payer_UNICARE BEACON HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_UNICARE BEACON HEALTH | HMO/PPO] standard_charge|[payer_UNITED AMERICAN | COMMERCIAL] standard_charge|[payer_UNITED AMERICAN | COMMERCIAL] |percent standard_charge|[payer_UNITED AMERICAN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UNITED AMERICAN | COMMERCIAL] standard_charge|[payer_UNITED HEALTH OXFORD | HMO/PPO] standard_charge|[payer_UNITED HEALTH OXFORD | HMO/PPO] |percent standard_charge|[payer_UNITED HEALTH OXFORD | HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTH OXFORD | HMO/PPO] standard_charge|[payer_UNITED MEDICAID DUAL PLAN | MANAGED MEDICAID] standard_charge|[payer_UNITED MEDICAID DUAL PLAN | MANAGED MEDICAID] |percent standard_charge|[payer_UNITED MEDICAID DUAL PLAN | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UNITED MEDICAID DUAL PLAN | MANAGED MEDICAID] standard_charge|[payer_UNITED MEDICARE DUAL PLAN | MANAGED MEDICARE] standard_charge|[payer_UNITED MEDICARE DUAL PLAN | MANAGED MEDICARE] |percent standard_charge|[payer_UNITED MEDICARE DUAL PLAN | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UNITED MEDICARE DUAL PLAN | MANAGED MEDICARE] standard_charge|[payer_VA BAY PINES | VETERANS ADMIN] standard_charge|[payer_VA BAY PINES | VETERANS ADMIN] |percent standard_charge|[payer_VA BAY PINES | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA BAY PINES | VETERANS ADMIN] standard_charge|[payer_VA CCN CLAIMS MEDICAL | VETERANS ADMIN] standard_charge|[payer_VA CCN CLAIMS MEDICAL | VETERANS ADMIN] |percent standard_charge|[payer_VA CCN CLAIMS MEDICAL | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA CCN CLAIMS MEDICAL | VETERANS ADMIN] standard_charge|[payer_VALUE OPTIONS | HMO/PPO] standard_charge|[payer_VALUE OPTIONS | HMO/PPO] |percent standard_charge|[payer_VALUE OPTIONS | HMO/PPO] |contracting_method additional_payer_notes |[payer_VALUE OPTIONS | HMO/PPO] standard_charge|[payer_VIRGINIA CARDINAL CARE | MEDICAID: OUT OF STATE] standard_charge|[payer_VIRGINIA CARDINAL CARE | MEDICAID: OUT OF STATE] |percent standard_charge|[payer_VIRGINIA CARDINAL CARE | MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_VIRGINIA CARDINAL CARE | MEDICAID: OUT OF STATE] standard_charge|[payer_VIVA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_VIVA MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_VIVA MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_VIVA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_VIVIDA HEALTH | MANAGED MEDICAID] standard_charge|[payer_VIVIDA HEALTH | MANAGED MEDICAID] |percent standard_charge|[payer_VIVIDA HEALTH | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_VIVIDA HEALTH | MANAGED MEDICAID] standard_charge|[payer_WEBTPA | COMMERCIAL] standard_charge|[payer_WEBTPA | COMMERCIAL] |percent standard_charge|[payer_WEBTPA | COMMERCIAL] |contracting_method additional_payer_notes |[payer_WEBTPA | COMMERCIAL] standard_charge|[payer_WELLCARE MEDICARE | MANAGED MEDICARE] standard_charge|[payer_WELLCARE MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE MEDICARE | MANAGED MEDICARE] standard_charge|[payer_WELLCARE STAYWELL | MANAGED MEDICAID] standard_charge|[payer_WELLCARE STAYWELL | MANAGED MEDICAID] |percent standard_charge|[payer_WELLCARE STAYWELL | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_WELLCARE STAYWELL | MANAGED MEDICAID] standard_charge|[payer_WELLPATH | MANAGED MEDICARE] standard_charge|[payer_WELLPATH | MANAGED MEDICARE] |percent standard_charge|[payer_WELLPATH | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLPATH | MANAGED MEDICARE] standard_charge|[payer_ZELIS | COMMERCIAL] standard_charge|[payer_ZELIS | COMMERCIAL] |percent standard_charge|[payer_ZELIS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_ZELIS | COMMERCIAL] ROOM AND BOARD GERIATRIC 3B 124 RC facility inpatient 2400.00 750 565 2400 2400 per diem 875 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 1087 per diem 1360 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1110.18 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 1025 per diem 1025 per diem 875 per diem 996 per diem 1025 per diem 1025 per diem 1025 per diem 909 per diem 2400 per diem 1025 per diem 763 per diem 875 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 700 per diem 2400 per diem 2400 per diem ROOM AND BOARD PSYCH ADULT 2A 124 RC facility inpatient 2400.00 750 565 2400 2400 per diem 875 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 1087 per diem 1360 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1110.18 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 1025 per diem 1025 per diem 875 per diem 996 per diem 1025 per diem 1025 per diem 1025 per diem 909 per diem 2400 per diem 1025 per diem 763 per diem 875 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 700 per diem 2400 per diem 2400 per diem ROOM AND BOARD DETOX 2B 126 RC facility inpatient 2400.00 750 565 2400 2400 per diem 825 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 855 per diem 1125 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1200 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 905 per diem 905 per diem 825 per diem 875 per diem 905 per diem 905 per diem 905 per diem 909 per diem 2400 per diem 905 per diem 763 per diem 825 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 600 per diem 2400 per diem 2400 per diem ROOM AND BOARD GERIATRIC DETOX 126 RC facility inpatient 2400.00 750 565 2400 2400 per diem 825 per diem 900 per diem 1050 per diem 950 per diem 800 per diem 900 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 855 per diem 1125 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 2400 per diem 1200 per diem 565 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 750 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 900 per diem 2400 per diem 800 per diem 909 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 2400 per diem 905 per diem 905 per diem 825 per diem 875 per diem 905 per diem 905 per diem 905 per diem 909 per diem 2400 per diem 905 per diem 763 per diem 825 per diem 724.5 per diem 909 per diem 2400 per diem 2400 per diem 909 per diem 1200 per diem 600 per diem 2400 per diem 2400 per diem CD/REHAB ADULT 3A 128 RC facility inpatient 2400.00 750 500 2400 825 per diem 825 per diem 1050 per diem 950 per diem 800 per diem 825 per diem 2400 per diem 2400 per diem 960 per diem 960 per diem 2400 per diem 2400 per diem 1155 per diem 1155 per diem 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem 855 per diem 1125 per diem 2400 per diem 2400 per diem 900 per diem 900 per diem 900 per diem 900 per diem 909 per diem 1110.18 per diem 909 per diem 909 per diem 2400 per diem 500 per diem 2400 per diem 795 per diem 795 per diem 795 per diem 795 per diem 795 per diem 825 per diem 2400 per diem 800 per diem 909 per diem 909 per diem 909 per diem 775 per diem 2400 per diem 1057 per diem 770 per diem 770 per diem 825 per diem 742 per diem 770 per diem 770 per diem 770 per diem 909 per diem 770 per diem 763 per diem 825 per diem 909 per diem 909 per diem 600 per diem 2400 per diem ELECTOCONVULSIVE THERAPY - INPATIENT ANC 901 RC facility inpatient/outpatient 1650.00 500 385.08 3300 1650 per diem 610 per diem 625 per diem 550 per diem 550 per diem 500 per diem 625 per diem 625 per diem 1650 per diem 1650 per diem 665 per diem 665 per diem 3300 per diem 3300 per diem 662 per diem 662 per diem 662 per diem 662 per diem 657 per diem 1122 per diem 561 per diem 630 per diem 1780 per diem 2380 per diem 3300 per diem 1650 per diem 1650 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 561 per diem 1650 per diem 660 per diem 3300 per diem 1650 per diem 1650 per diem 1650 per diem 561 per diem 1122 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 1650 per diem 1650 per diem 500 per diem 500 per diem 3300 per diem 3300 per diem 1650 per diem 3300 per diem 1650 per diem 450 per diem 450 per diem 450 per diem 450 per diem 450 per diem 454.69 per diem 625 per diem 1650 per diem 561 per diem 561 per diem 3300 per diem 3300 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 3300 per diem 561 per diem 561 per diem 561 per diem 525 per diem 1650 per diem 385.08 per diem 1650 per diem 3300 per diem 610 per diem 610 per diem 610 per diem 578 per diem 610 per diem 610 per diem 610 per diem 561 per diem 3300 per diem 610 per diem 570 per diem 610 per diem 1650 per diem 1650 per diem 561 per diem 1650 per diem 1650 per diem 561 per diem 525 per diem 500 per diem 500 per diem 1650 per diem 1650 per diem ELECTOCONVULSIVE THERAPY OUTPATIENT 901 RC facility inpatient/outpatient 1650.00 500 385.08 3300 1650 per diem 610 per diem 625 per diem 550 per diem 550 per diem 500 per diem 625 per diem 625 per diem 1650 per diem 1650 per diem 665 per diem 665 per diem 3300 per diem 3300 per diem 662 per diem 662 per diem 662 per diem 662 per diem 657 per diem 1122 per diem 561 per diem 630 per diem 1780 per diem 2380 per diem 3300 per diem 1650 per diem 1650 per diem 450 per diem 450 per diem 450 per diem 450 per diem 450 per diem 561 per diem 1650 per diem 660 per diem 3300 per diem 1650 per diem 1650 per diem 1650 per diem 561 per diem 1122 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 1650 per diem 1650 per diem 500 per diem 500 per diem 3300 per diem 3300 per diem 1650 per diem 3300 per diem 1650 per diem 450 per diem 450 per diem 450 per diem 450 per diem 450 per diem 454.69 per diem 625 per diem 1650 per diem 561 per diem 561 per diem 3300 per diem 3300 per diem 3300 per diem 1650 per diem 1650 per diem 3300 per diem 3300 per diem 561 per diem 561 per diem 561 per diem 525 per diem 1650 per diem 385.08 per diem 1650 per diem 3300 per diem 610 per diem 610 per diem 610 per diem 578 per diem 610 per diem 610 per diem 610 per diem 561 per diem 3300 per diem 610 per diem 570 per diem 610 per diem 1650 per diem 1650 per diem 561 per diem 1650 per diem 1650 per diem 561 per diem 525 per diem 500 per diem 500 per diem 1650 per diem 1650 per diem INTENSIVE OUTPATIENT PROGRAM MH PROGRAM 905 RC facility outpatient 540.00 200 150 540 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 540 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 540 per diem 215 per diem 215 per diem 210 per diem 196 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 170 per diem 210 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem INTENSIVE OUTPATIENT PROGRAM PROGRAM TH 905 RC facility outpatient 540.00 200 150 540 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 540 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 540 per diem 215 per diem 215 per diem 210 per diem 196 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 170 per diem 210 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADOLESCENT 905 RC facility outpatient 540.00 200 150 540 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 540 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 540 per diem 215 per diem 215 per diem 210 per diem 196 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 170 per diem 210 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem INTENSIVE OUTPATIENT PROGRAM S.A PROGRAM 906 RC facility outpatient 540.00 200 150 540 210 per diem 200 per diem 250 per diem 250 per diem 250 per diem 200 per diem 200 per diem 220 per diem 220 per diem 540 per diem 540 per diem 265 per diem 265 per diem 265 per diem 265 per diem 225 per diem 229 per diem 229.5 per diem 245 per diem 326 per diem 359 per diem 540 per diem 540 per diem 275 per diem 275 per diem 275 per diem 275 per diem 275 per diem 229.5 per diem 250 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 150 per diem 150 per diem 540 per diem 540 per diem 225 per diem 225 per diem 225 per diem 214.02 per diem 200 per diem 229.5 per diem 229.5 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 229 per diem 229.5 per diem 229.5 per diem 200 per diem 329 per diem 540 per diem 215 per diem 215 per diem 215 per diem 540 per diem 215 per diem 540 per diem 540 per diem 229.5 per diem 229.5 per diem 300 per diem 225 per diem 225 per diem PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC facility outpatient 875.00 350 252.77 875 430 per diem 320 per diem 425 per diem 425 per diem 400 per diem 320 per diem 320 per diem 320 per diem 320 per diem 875 per diem 875 per diem 425 per diem 425 per diem 425 per diem 425 per diem 435 per diem 399 per diem 399.3 per diem 375 per diem 408 per diem 469 per diem 875 per diem 875 per diem 375 per diem 375 per diem 375 per diem 375 per diem 375 per diem 399.33 per diem 529.79 per diem 875 per diem 399.33 per diem 399.33 per diem 875 per diem 875 per diem 875 per diem 350 per diem 350 per diem 875 per diem 875 per diem 875 per diem 875 per diem 285 per diem 285 per diem 285 per diem 252.77 per diem 320 per diem 399.33 per diem 399.33 per diem 875 per diem 875 per diem 875 per diem 875 per diem 875 per diem 399 per diem 399.33 per diem 399.33 per diem 300 per diem 438 per diem 875 per diem 875 per diem 440 per diem 440 per diem 430 per diem 415 per diem 440 per diem 440 per diem 440 per diem 875 per diem 440 per diem 377 per diem 430 per diem 875 per diem 875 per diem 399.33 per diem 399.33 per diem 875 per diem 275 per diem 275 per diem