hospital_name last_updated_on version hospital_location hospital_address license_number|GA "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." "Riverwoods Behavioral Health, LLC" 12/31/2024 2.0.0 "Riverdale, Georgia" 223 Medical Center Drive license_ 067-690 | GA 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]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA]|[plan_HMO/PPO] standard_charge|[payer_AETNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AETNA]|[Plan_HMO/PPO] standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALL SAVERS UHC]|[Plan_HMO/PPO] standard_charge|[payer_ALLIANT HEALTH PLANS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALLIANT HEALTH PLANS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALLIANT HEALTH PLANS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALLIANT HEALTH PLANS]|[plan_HMO/PPO] standard_charge|[payer_ALLIANT HEALTH PLANS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALLIANT HEALTH PLANS]|[Plan_HMO/PPO] standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALLIED BENEFIT SYSTEMS]|[Plan_HMO/PPO] standard_charge|[payer_AMBETTER]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AMBETTER]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMBETTER]|[plan_HMO/PPO] standard_charge|[payer_AMBETTER]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AMBETTER]|[Plan_HMO/PPO] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adult]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adult] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adult] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adult] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adult] |methodology additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_BLUE CROSS - Adult] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adol]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adol] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adol] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adol] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS - Adol] |methodology additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_BLUE CROSS - Adol] standard_charge|[payer_BCBS GEORGIA]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS GEORGIA]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS GEORGIA]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS GEORGIA]|[plan_BLUE CROSS] standard_charge|[payer_BCBS GEORGIA]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS GEORGIA]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS GEORGIA PPO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS GEORGIA PPO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS GEORGIA PPO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS GEORGIA PPO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS GEORGIA PPO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS GEORGIA PPO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BCBS MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BCBS MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BCBS MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS PPO GEORGIA]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS PPO GEORGIA]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS PPO GEORGIA]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS PPO GEORGIA]|[plan_BLUE CROSS] standard_charge|[payer_BCBS PPO GEORGIA]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS PPO GEORGIA]|[Plan_BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS]|[Plan_HMO/PPO] standard_charge|[payer_BUSINESS OFFICE MISC]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BUSINESS OFFICE MISC]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BUSINESS OFFICE MISC]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BUSINESS OFFICE MISC]|[plan_COMMERCIAL] standard_charge|[payer_BUSINESS OFFICE MISC]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BUSINESS OFFICE MISC]|[Plan_COMMERCIAL] standard_charge|[payer_CARESOURCE]|[plan_ MCD - Adults]|negotiated_dollar standard_charge|[payer_CARESOURCE]|[plan_ MCD - Adults]|negotiated_percentage standard_charge|[payer_CARESOURCE]|[plan_ MCD - Adults]|negotiated_algorithm estimated_amount|[payer_CARESOURCE]|[plan_ MCD - Adults standard_charge|[payer_CARESOURCE]|[plan_ MCD - Adults]|methodology additional_payer_notes |[payer_CARESOURCE]|[plan_ MCD - Adults] standard_charge|[payer_CARESOURCE ]|[plan_MCD - Adol]|negotiated_dollar standard_charge|[payer_CARESOURCE ]|[plan_MCD - Adol]|negotiated_percentage standard_charge|[payer_CARESOURCE ]|[plan_MCD - Adol]|negotiated_algorithm estimated_amount|[payer_CARESOURCE ]|[plan_MCD - Adol] standard_charge|[payer_CARESOURCE ]|[plan_MCD - Adol]|methodology additional_payer_notes |[payer_CARESOURCE ]|[plan_MCD - Adol] standard_charge|[payer_CARESOURCE]|[plan_ HMO]|negotiated_dollar standard_charge|[payer_CARESOURCE]|[plan_ HMO]|negotiated_percentage standard_charge|[payer_CARESOURCE]|[plan_ HMO]|negotiated_algorithm estimated_amount|[payer_CARESOURCE]|[plan_ HMO] standard_charge|[payer_CARESOURCE]|[plan_ HMO]|methodology additional_payer_notes |[payer_CARESOURCE]|[plan_ HMO] 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 HEALTHSPRING MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHSPRING MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHSPRING MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHSPRING MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTHSPRING MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CLEAR SPRINGS|COMMERCIAL]|negotiated_dollar standard_charge|[payer_CLEAR SPRINGS|COMMERCIAL]|negotiated_percentage standard_charge|[payer_CLEAR SPRINGS|COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_CLEAR SPRINGS|COMMERCIAL] standard_charge|[payer_CLEAR SPRINGS|COMMERCIAL]|methodology additional_payer_notes|[payer_CLEAR SPRINGS|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_DBHDD]| [plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_DBHDD]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_DBHDD]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_DBHDD]|[plan_HMO/PPO] standard_charge|[payer_DBHDD]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_DBHDD]|[plan_HMO/PPO] standard_charge|[payer_DFCS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DFCS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DFCS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DFCS]|[plan_LOCAL GOVT] standard_charge|[payer_DFCS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DFCS]|[Plan_LOCAL GOVT] standard_charge|[payer_EVERNORTH BEHAVIORAL HEAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_EVERNORTH BEHAVIORAL HEAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_EVERNORTH BEHAVIORAL HEAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_EVERNORTH BEHAVIORAL HEAL]|[plan_HMO/PPO] standard_charge|[payer_EVERNORTH BEHAVIORAL HEAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_EVERNORTH BEHAVIORAL HEAL]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA GOLD CHOICE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_KAISER PERMANENTE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_KAISER PERMANENTE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_KAISER PERMANENTE]|[plan_HMO/PPO] standard_charge|[payer_KAISER PERMANENTE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_KAISER PERMANENTE]|[Plan_HMO/PPO] standard_charge|[payer_KAISER SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_KAISER SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_KAISER SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_KAISER SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_KAISER SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_KAISER SENIOR ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN]|[Plan_HMO/PPO] standard_charge|[payer_MEDICAID 2NDARY TO MCR]|[plan_MCARE W/MCAID 2NDARY]|negotiated_dollar standard_charge|[payer_MEDICAID 2NDARY TO MCR]|[plan_MCARE W/MCAID 2NDARY] |negotiated_percentage standard_charge|[payer_MEDICAID 2NDARY TO MCR]|[plan_MCARE W/MCAID 2NDARY] |negotiated_algorithm estimated_amount|[payer_MEDICAID 2NDARY TO MCR]|[plan_MCARE W/MCAID 2NDARY] standard_charge|[payer_MEDICAID 2NDARY TO MCR]|[plan_MCARE W/MCAID 2NDARY] |methodology additional_payer_notes |[payer_MEDICAID 2NDARY TO MCR]|[Plan_MCARE W/MCAID 2NDARY] standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE]|[Plan_MEDICARE] standard_charge|[payer_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_MISC MGD MCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MISC MGD MCARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_NORTHSIDE ATLANTA]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_NORTHSIDE ATLANTA]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_NORTHSIDE ATLANTA]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_NORTHSIDE ATLANTA]|[plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE ATLANTA]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_NORTHSIDE ATLANTA]|[Plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE CHEROKEE]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_NORTHSIDE CHEROKEE]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_NORTHSIDE CHEROKEE]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_NORTHSIDE CHEROKEE]|[plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE CHEROKEE]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_NORTHSIDE CHEROKEE]|[Plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE DULUTH]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_NORTHSIDE DULUTH]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_NORTHSIDE DULUTH]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_NORTHSIDE DULUTH]|[plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE DULUTH]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_NORTHSIDE DULUTH]|[Plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE FORSYTH]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_NORTHSIDE FORSYTH]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_NORTHSIDE FORSYTH]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_NORTHSIDE FORSYTH]|[plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE FORSYTH]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_NORTHSIDE FORSYTH]|[Plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE GWINNETT]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_NORTHSIDE GWINNETT]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_NORTHSIDE GWINNETT]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_NORTHSIDE GWINNETT]|[plan_INDUSTRIAL] standard_charge|[payer_NORTHSIDE GWINNETT]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_NORTHSIDE GWINNETT]|[Plan_INDUSTRIAL] standard_charge|[payer__OSCAR HEALTH|HMO/PPO]|negotiated_dollar standard_charge|[payer__OSCAR HEALTH|HMO/PPO]|negotiated_percentage standard_charge|[payer__OSCAR HEALTH|HMO/PPO]|negotiated_algorithm estimated_amount|[payer__OSCAR HEALTH|HMO/PPO] standard_charge|[payer__OSCAR HEALTH|HMO/PPO]|methodology additional_payer_notes|[payer__OSCAR HEALTH|HMO/PPO] standard_charge|[payer_PEACH STATE AMBETTER|HMO/PPO]|negotiated_dollar standard_charge|[payer_PEACH STATE AMBETTER|HMO/PPO]|negotiated_percentage standard_charge|[payer_PEACH STATE AMBETTER|HMO/PPO]|negotiated_algorithm estimated_amount|[payer_PEACH STATE AMBETTER|HMO/PPO] standard_charge|[payer_PEACH STATE AMBETTER|HMO/PPO]|methodology additional_payer_notes|[payer_PEACH STATE AMBETTER|HMO/PPO] standard_charge|[payer_PEACH STATE MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PEACH STATE MCD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_PEACH STATE MCD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_PEACH STATE MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_PEACH STATE MCD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_PEACH STATE MCD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_PHCS SAVILITY PAYERS|COMMERCIAL]|negotiated_dollar standard_charge|[payer_PHCS SAVILITY PAYERS|COMMERCIAL]|negotiated_percentage standard_charge|[payer_PHCS SAVILITY PAYERS|COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_PHCS SAVILITY PAYERS|COMMERCIAL] standard_charge|[payer_PHCS SAVILITY PAYERS|COMMERCIAL]|methodology additional_payer_notes|[payer_PHCS SAVILITY PAYERS|COMMERCIAL] standard_charge|[payer_PIEDMONT ATHENS]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT ATHENS]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT ATHENS]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT ATHENS]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT ATHENS]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT ATHENS]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT ATLANTA]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT ATLANTA]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT ATLANTA]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT ATLANTA]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT ATLANTA]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT ATLANTA]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT AUGUSTA]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT AUGUSTA]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT AUGUSTA]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT AUGUSTA]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT AUGUSTA]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT AUGUSTA]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT EASTSIDE]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT EASTSIDE]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT EASTSIDE]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT EASTSIDE]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT EASTSIDE]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT EASTSIDE]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT FAYETTE]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT FAYETTE]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT FAYETTE]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT FAYETTE]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT FAYETTE]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT FAYETTE]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT HENRY]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT HENRY]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT HENRY]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT HENRY]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT HENRY]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT HENRY]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT MACON]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT MACON]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT MACON]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT MACON]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT MACON]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT MACON]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT MOUNTAINSIDE]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT MOUNTAINSIDE]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT MOUNTAINSIDE]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT MOUNTAINSIDE]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT MOUNTAINSIDE]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT MOUNTAINSIDE]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT NEWNAN]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT NEWNAN]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT NEWNAN]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT NEWNAN]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT NEWNAN]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT NEWNAN]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT NEWTON]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT NEWTON]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT NEWTON]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT NEWTON]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT NEWTON]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT NEWTON]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT ROCKDALE]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT ROCKDALE]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT ROCKDALE]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT ROCKDALE]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT ROCKDALE]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT ROCKDALE]|[Plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT WALTON]|[plan_INDUSTRIAL]|negotiated_dollar standard_charge|[payer_PIEDMONT WALTON]|[plan_INDUSTRIAL] |negotiated_percentage standard_charge|[payer_PIEDMONT WALTON]|[plan_INDUSTRIAL] |negotiated_algorithm estimated_amount|[payer_PIEDMONT WALTON]|[plan_INDUSTRIAL] standard_charge|[payer_PIEDMONT WALTON]|[plan_INDUSTRIAL] |methodology additional_payer_notes |[payer_PIEDMONT WALTON]|[Plan_INDUSTRIAL] standard_charge|[payer_S&S HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_S&S HEALTH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_S&S HEALTH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_S&S HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_S&S HEALTH]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_S&S HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_SONDER HEALTH PLANS|COMMERCIAL]|negotiated_dollar standard_charge|[payer_SONDER HEALTH PLANS|COMMERCIAL]|negotiated_percentage standard_charge|[payer_SONDER HEALTH PLANS|COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_SONDER HEALTH PLANS|COMMERCIAL] standard_charge|[payer_SONDER HEALTH PLANS|COMMERCIAL]|methodology additional_payer_notes|[payer_SONDER HEALTH PLANS|COMMERCIAL] standard_charge|[payer_SUREST|COMMERCIAL]|negotiated_dollar standard_charge|[payer_SUREST|COMMERCIAL]|negotiated_percentage standard_charge|[payer_SUREST|COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_SUREST|COMMERCIAL] standard_charge|[payer_SUREST|COMMERCIAL]|methodology additional_payer_notes|[payer_SUREST|COMMERCIAL] standard_charge|[payer_TRICARE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE]|[plan_TRICARE] standard_charge|[payer_TRICARE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE]|[Plan_TRICARE] standard_charge|[payer_UHC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC]|[plan_HMO/PPO] standard_charge|[payer_UHC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC]|[Plan_HMO/PPO] standard_charge|[payer_UHC MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC SHARED SERVICES]|[Plan_HMO/PPO] standard_charge|[payer_UHC STUDENT SERVICES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC STUDENT SERVICES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC STUDENT SERVICES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC STUDENT SERVICES]|[plan_HMO/PPO] standard_charge|[payer_UHC STUDENT SERVICES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC STUDENT SERVICES]|[Plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UMR]|[Plan_HMO/PPO] standard_charge|[payer_UNIFIEDLIFE|COMMERCIAL]|negotiated_dollar standard_charge|[payer_UNIFIEDLIFE|COMMERCIAL]|negotiated_percentage standard_charge|[payer_UNIFIEDLIFE|COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_UNIFIEDLIFE|COMMERCIAL] standard_charge|[payer_UNIFIEDLIFE|COMMERCIAL]|methodology additional_payer_notes|[payer_UNIFIEDLIFE|COMMERCIAL] standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA CCN OPTUM]|[Plan_VETERANS ADMIN] standard_charge|[payer_VA TRIWEST]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA TRIWEST]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA TRIWEST]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA TRIWEST]|[plan_VETERANS ADMIN] standard_charge|[payer_VA TRIWEST]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA TRIWEST]|[Plan_VETERANS ADMIN] standard_charge|[payer_WELLCARE MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE MCR]|[Plan_MANAGED MEDICARE] additional_generic_notes ROOM AND BOARD ADOL - PSYCH 2S 124 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 939 per diem 971 per diem 893 per diem 984 per diem 814 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem 874 per diem 750 per diem 750 per diem 850 per diem DRG 831 per diem 2940 per diem 1100 per diem 840 per diem 750 per diem 831 per diem 1007 per diem other DRG 1016 per diem DRG 750 per diem other DRG 966 per diem DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 967 per diem 984 per diem 801 per diem 1680 per diem 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem 939 per diem other DRG 939 per diem 2940 per diem 939 per diem 1500 per diem other DRG other DRG 975 per diem ROOM AND BOARD GERIACTRIC - PSYCH 1S 124 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 939 per diem 971 per diem 893 per diem 984 per diem 814 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem 874 per diem 750 per diem 750 per diem 850 per diem DRG 831 per diem 2940 per diem 1100 per diem 840 per diem 750 per diem 831 per diem 1007 per diem other DRG 1016 per diem DRG 750 per diem other DRG 966 per diem DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 967 per diem 984 per diem 801 per diem 1680 per diem 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem 939 per diem other DRG 939 per diem 2940 per diem 939 per diem 1500 per diem other DRG other DRG 975 per diem R&B ADULT-PSY 124 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 939 per diem 971 per diem 893 per diem per diem 814 per diem 800 per diem 800 per diem 800 per diem 800 per diem per diem 800 per diem 894 per diem 874 per diem 750 per diem 750 per diem 850 per diem DRG 831 per diem 2940 per diem 1100 per diem 840 per diem per diem 831 per diem 1007 per diem other DRG 1016 per diem DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 967 per diem 984 per diem 801 per diem 1680 per diem 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem 939 per diem other DRG per diem 2940 per diem 939 per diem 1500 per diem other DRG other DRG 975 per diem ROOM AND BOARD ADOL - DETOX 2S 126 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 939 per diem 971 per diem 893 per diem 984 per diem 814 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem 874 per diem 750 per diem 750 per diem 850 per diem DRG 831 per diem 2940 per diem 1100 per diem per diem 750 per diem 831 per diem 1007 per diem other DRG 939 per diem DRG 750 per diem other DRG 966 per diem DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 967 per diem 984 per diem 801 per diem 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem 939 per diem other DRG 939 per diem 2940 per diem 939 per diem 1500 per diem other DRG other DRG 975 per diem ROOM AND BOARD DETOX-ADULT 1N 126 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 939 per diem 971 per diem 893 per diem 984 per diem 814 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem 874 per diem 750 per diem 750 per diem 850 per diem DRG 831 per diem 2940 per diem 1100 per diem per diem 750 per diem 831 per diem 1007 per diem other DRG 939 per diem DRG 750 per diem other DRG 966 per diem DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 967 per diem 984 per diem 801 per diem 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem 939 per diem other DRG 939 per diem 2940 per diem 939 per diem 1500 per diem other DRG other DRG 975 per diem ROOM AND BOARD GERIACTRIC - DETOX 1S 126 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 939 per diem 971 per diem 893 per diem 984 per diem 814 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem 874 per diem 750 per diem 750 per diem 850 per diem DRG 831 per diem 2940 per diem 1100 per diem per diem 750 per diem 831 per diem 1007 per diem other DRG 939 per diem DRG 750 per diem other DRG 966 per diem DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 850 other DRG 967 per diem 984 per diem 801 per diem 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 840 other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem 939 per diem other DRG 939 per diem 2940 per diem 939 per diem 1500 per diem other DRG other DRG 975 per diem ROOM AND BOARD ADOL - REHAB 128 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 925 per diem 893 per diem 984 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem per diem per diem per diem DRG 831 per diem 2940 per diem 980 per diem per diem 750 per diem 831 per diem other DRG DRG 750 per diem other DRG 966 per diem DRG other DRG other DRG other DRG other DRG other DRG per diem other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem per diem other DRG 939 per diem 2940 per diem per diem 1500 per diem other DRG other DRG 975 per diem ROOM AND BOARD ADULT - REHAB 128 RC facility inpatient 2940 700 750 2940 966 per diem 966 per diem 925 per diem 893 per diem 984 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 894 per diem per diem per diem per diem DRG 831 per diem 2940 per diem 980 per diem per diem 750 per diem 831 per diem other DRG DRG 750 per diem other DRG 966 per diem DRG other DRG other DRG other DRG other DRG other DRG per diem other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG other DRG 2940 per diem 2940 per diem 2940 per diem 922 per diem per diem other DRG 939 per diem 2940 per diem per diem 1500 per diem other DRG other DRG 975 per diem INTENSIVE OUTPATIENT PROGRAM PSYADLT TELEHLTH 905 RC facility outpatient 476 200 150 476 216 per diem per diem 235 per diem 288 per diem per diem 225 per diem 197 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 214 per diem per diem 150 per diem 150 per diem 275 per diem 217 per diem per diem 217 per diem 265 per diem other DRG 349 per diem DRG 180 per diem 200 per diem other DRG 215 per diem other DRG 242 per diem 225 per diem 203 per diem 476 per diem 476 per diem per diem 235 per diem 229 per diem 235 per diem per diem 235 per diem per diem INTENSIVE OUTPATIENT PROGRAM CD-ADULT 906 RC facility outpatient 476 200 150 476 216 per diem per diem 235 per diem 288 per diem per diem 225 per diem 197 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 214 per diem per diem 150 per diem 150 per diem 275 per diem DRG 217 per diem per diem 217 per diem 265 per diem other DRG 349 per diem DRG 180 per diem 200 per diem other DRG 215 per diem other DRG 242 per diem 225 per diem 203 per diem 476 per diem 476 per diem per diem 235 per diem 229 per diem 235 per diem per diem 235 per diem per diem INTENSIVE OUTPATIENT PROGRAM CDADLT TELEHLTH 906 RC facility outpatient 476 200 150 476 216 per diem per diem 235 per diem 288 per diem per diem 225 per diem 197 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 214 per diem per diem 150 per diem 150 per diem 275 per diem DRG 217 per diem per diem 217 per diem 265 per diem other DRG 349 per diem DRG 180 per diem 200 per diem other DRG 215 per diem other DRG 242 per diem 225 per diem 203 per diem 476 per diem 476 per diem per diem 235 per diem 229 per diem 235 per diem per diem 235 per diem per diem PARTIAL HOSPITAL PROGRAM CD-ADULT 912 RC facility outpatient 788 300 280 788 406 per diem per diem 425 per diem 472 per diem per diem 443 per diem 355 per diem 425 per diem 425 per diem 425 per diem 425 per diem 425 per diem 425 per diem 383 per diem per diem 280 per diem 280 per diem 375 per diem DRG 409 per diem per diem per diem 409 per diem 371 per diem other DRG 649 per diem DRG 380 per diem 350 per diem other DRG 406 per diem other DRG 438 per diem 443 per diem 364 per diem 788 per diem 788 per diem 425 per diem 415 per diem 425 per diem per diem 425 per diem per diem PHP PSYCH-ADOLESCENT 912 RC facility outpatient 600 350 280 788 406 per diem per diem 425 per diem 472 per diem per diem 355 per diem 425 per diem 425 per diem 425 per diem 425 per diem per diem 425 per diem 383 per diem per diem 280 per diem 280 per diem 375 per diem DRG 409 per diem per diem 409 per diem 371 per diem other DRG 649 per diem per diem 350 per diem other DRG 438 per diem 443 per diem 364 per diem 788 per diem 788 per diem per diem 425 per diem 415 per diem per diem 425 per diem PARTIAL HOSPITAL PROGRAM MH Adult 913 RC facility outpatient 788 300 280 788 406 per diem per diem 425 per diem 472 per diem per diem 443 per diem 355 per diem 425 per diem 425 per diem 425 per diem 425 per diem 425 per diem 425 per diem 383 per diem per diem 280 per diem 280 per diem 375 per diem DRG 409 per diem per diem per diem 409 per diem 371 per diem other DRG 649 per diem DRG 380 per diem 350 per diem other DRG 406 per diem other DRG 438 per diem 443 per diem 364 per diem 788 per diem 788 per diem 425 per diem per diem 425 per diem per diem 425 per diem per diem INTENSIVE OUTPATIENT PROGRAM PSYC PROC GRP 1 915 RC facility outpatient 158.67 348 788 per diem per diem 348 other DRG DRG other DRG 788 per diem 788 per diem per diem IOP PROC 2 MCRE/TRIC 915 RC facility outpatient 158.67 348 788 per diem 348 other DRG other DRG 788 per diem 788 per diem IOP PROC 3 MCRE/TRIC 915 RC facility outpatient 158.66 348 788 per diem 348 other DRG 788 per diem 788 per diem IOP PSYCH-ADULT 915 RC facility outpatient 476 200 348 788 per diem 348 other DRG 788 per diem 788 per diem PROC GRP 1-MCAR/TRIC 915 RC facility outpatient 157.6 348 788 per diem 348 other DRG 788 per diem 788 per diem PROC GRP 2-MCAR/TRIC 915 RC facility outpatient 157.6 348 788 per diem 348 other DRG 788 per diem 788 per diem PROC GRP 3-MCAR/TRIC 915 RC facility outpatient 157.6 348 788 per diem 348 other DRG 788 per diem 788 per diem