hospital_name last_updated_on version hospital_location hospital_address license_number|CA "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." "SJBH, LLC" 5/31/2024 2.0.0 "San Jose, California" 455 Silicon Valley Boulevard license_ 550003449 |CA 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_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_AETNA MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_ALAMEDA COUNTY BHCS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ALAMEDA COUNTY BHCS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ALAMEDA COUNTY BHCS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ALAMEDA COUNTY BHCS]|[plan_MANAGED MEDICAID] standard_charge|[payer_ALAMEDA COUNTY BHCS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ALAMEDA COUNTY BHCS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AMADOR COUNTY BHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMADOR COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMADOR COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMADOR COUNTY BHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMADOR COUNTY BHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMADOR COUNTY BHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_ANTHEM BCBS]|[Plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS FEP]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS FEP]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_ANTHEM BCBS FEP]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS FEP]|[plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS FEP]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_ANTHEM BCBS FEP]|[Plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_ANTHEM BCBS MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_ANTHEM BCBS MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_ANTHEM BCBS MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_ANTHEM BCBS OOS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS OOS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_ANTHEM BCBS OOS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS OOS]|[plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS OOS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_ANTHEM BCBS OOS]|[Plan_BLUE CROSS] standard_charge|[payer_BLUE SHIELD MGD MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE SHIELD MGD MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE SHIELD MGD MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE SHIELD MGD MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_BLUE SHIELD MGD MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_BLUE SHIELD MGD MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_BLUE SHIELD OF CA OOA]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE SHIELD OF CA OOA]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE SHIELD OF CA OOA]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE SHIELD OF CA OOA]|[plan_BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CA OOA]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE SHIELD OF CA OOA]|[Plan_BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE SHIELD OF CALIFORNIA]|[Plan_BLUE CROSS] standard_charge|[payer_BRAND NEW DAY]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_BRAND NEW DAY]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_BRAND NEW DAY]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_BRAND NEW DAY]|[plan_MNGD MEDICARE] standard_charge|[payer_BRAND NEW DAY]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_BRAND NEW DAY]|[Plan_MNGD MEDICARE] standard_charge|[payer_BUTTE COUNTY BHD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BUTTE COUNTY BHD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BUTTE COUNTY BHD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BUTTE COUNTY BHD]|[plan_MANAGED MEDICAID] standard_charge|[payer_BUTTE COUNTY BHD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BUTTE COUNTY BHD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CALAVERAS COUNTY HHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CALAVERAS COUNTY HHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CALAVERAS COUNTY HHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CALAVERAS COUNTY HHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_CALAVERAS COUNTY HHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CALAVERAS COUNTY HHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CARE1ST HEALTH PLAN]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_CARE1ST HEALTH PLAN]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_CARE1ST HEALTH PLAN]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARE1ST HEALTH PLAN]|[plan_MNGD MEDICARE] standard_charge|[payer_CARE1ST HEALTH PLAN]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_CARE1ST HEALTH PLAN]|[Plan_MNGD MEDICARE] standard_charge|[payer_CARELON]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_CARELON]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CARELON]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CARELON]|[plan_COMMERCIAL] standard_charge|[payer_CARELON]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_CARELON]|[Plan_COMMERCIAL] standard_charge|[payer_CARELON MANAGED MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_CARELON MANAGED MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_CARELON MANAGED MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARELON MANAGED MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_CARELON MANAGED MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_CARELON MANAGED MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_CAREMORE HEALTH PLAN]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_CAREMORE HEALTH PLAN]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_CAREMORE HEALTH PLAN]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_CAREMORE HEALTH PLAN]|[plan_MNGD MEDICARE] standard_charge|[payer_CAREMORE HEALTH PLAN]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_CAREMORE HEALTH PLAN]|[Plan_MNGD MEDICARE] 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_CIGNA MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_CIGNA MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_CIGNA MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_COLUSA COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COLUSA COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_COLUSA COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_COLUSA COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_COLUSA COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_COLUSA COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_COMPSYCH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_COMPSYCH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_COMPSYCH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COMPSYCH]|[plan_HMO/PPO] standard_charge|[payer_COMPSYCH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_COMPSYCH]|[Plan_HMO/PPO] standard_charge|[payer_CONTRA COSTA COUNTY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CONTRA COSTA COUNTY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CONTRA COSTA COUNTY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CONTRA COSTA COUNTY]|[plan_MANAGED MEDICAID] standard_charge|[payer_CONTRA COSTA COUNTY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CONTRA COSTA COUNTY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_EL DORADO COUNTY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EL DORADO COUNTY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EL DORADO COUNTY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EL DORADO COUNTY]|[plan_MANAGED MEDICAID] standard_charge|[payer_EL DORADO COUNTY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EL DORADO COUNTY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_EMBLEM HEALTH (GHI)]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_EMBLEM HEALTH (GHI)]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_EMBLEM HEALTH (GHI)]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_EMBLEM HEALTH (GHI)]|[plan_COMMERCIAL] standard_charge|[payer_EMBLEM HEALTH (GHI)]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_EMBLEM HEALTH (GHI)]|[Plan_COMMERCIAL] standard_charge|[payer_FRESNO COUNTY ADOLESCENT]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_FRESNO COUNTY ADOLESCENT]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_FRESNO COUNTY ADOLESCENT]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_FRESNO COUNTY ADOLESCENT]|[plan_MANAGED MEDICAID] standard_charge|[payer_FRESNO COUNTY ADOLESCENT]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_FRESNO COUNTY ADOLESCENT]|[Plan_MANAGED MEDICAID] standard_charge|[payer_FRESNO COUNTY ADULT]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_FRESNO COUNTY ADULT]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_FRESNO COUNTY ADULT]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_FRESNO COUNTY ADULT]|[plan_MANAGED MEDICAID] standard_charge|[payer_FRESNO COUNTY ADULT]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_FRESNO COUNTY ADULT]|[Plan_MANAGED MEDICAID] standard_charge|[payer_GLENN COUNTY HHSA]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_GLENN COUNTY HHSA]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_GLENN COUNTY HHSA]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_GLENN COUNTY HHSA]|[plan_MANAGED MEDICAID] standard_charge|[payer_GLENN COUNTY HHSA]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_GLENN COUNTY HHSA]|[Plan_MANAGED MEDICAID] standard_charge|[payer_HALCYON BEHAVIORAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HALCYON BEHAVIORAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HALCYON BEHAVIORAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HALCYON BEHAVIORAL]|[plan_COMMERCIAL] standard_charge|[payer_HALCYON BEHAVIORAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HALCYON BEHAVIORAL]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTHNET MCR SUPPLEMENTA]|[plan_COMMERCIAL] standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTHNET MCR SUPPLEMENTA]|[Plan_COMMERCIAL] standard_charge|[payer_HMC HEALTHWORKS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HMC HEALTHWORKS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HMC HEALTHWORKS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HMC HEALTHWORKS]|[plan_COMMERCIAL] standard_charge|[payer_HMC HEALTHWORKS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HMC HEALTHWORKS]|[Plan_COMMERCIAL] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE]|[Plan_MNGD MEDICARE] standard_charge|[payer_HUMBOLDT COUNTY DHHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HUMBOLDT COUNTY DHHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HUMBOLDT COUNTY DHHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HUMBOLDT COUNTY DHHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_HUMBOLDT COUNTY DHHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HUMBOLDT COUNTY DHHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADOLESCENT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_I/P MEDI-CAL ADOLESCENT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_I/P MEDI-CAL ADOLESCENT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_I/P MEDI-CAL ADOLESCENT]|[plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADOLESCENT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_I/P MEDI-CAL ADOLESCENT]|[Plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADULT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_I/P MEDI-CAL ADULT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_I/P MEDI-CAL ADULT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_I/P MEDI-CAL ADULT]|[plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADULT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_I/P MEDI-CAL ADULT]|[Plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_I/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_I/P MEDI-CAL SD ADOLESCNT]|[Plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADULT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_I/P MEDI-CAL SD ADULT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_I/P MEDI-CAL SD ADULT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_I/P MEDI-CAL SD ADULT]|[plan_MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADULT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_I/P MEDI-CAL SD ADULT]|[Plan_MEDICAID] standard_charge|[payer_INYO COUNTY HHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_INYO COUNTY HHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_INYO COUNTY HHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_INYO COUNTY HHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_INYO COUNTY HHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_INYO COUNTY HHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_KAISER ADVANTAGE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_KAISER ADVANTAGE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_KAISER ADVANTAGE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_KAISER ADVANTAGE]|[plan_MNGD MEDICARE] standard_charge|[payer_KAISER ADVANTAGE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_KAISER ADVANTAGE]|[Plan_MNGD MEDICARE] standard_charge|[payer_KAISER HAWAII]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_KAISER HAWAII]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_KAISER HAWAII]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_KAISER HAWAII]|[plan_HMO/PPO] standard_charge|[payer_KAISER HAWAII]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_KAISER HAWAII]|[Plan_HMO/PPO] 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 SELF FUNDED]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_KAISER SELF FUNDED]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_KAISER SELF FUNDED]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_KAISER SELF FUNDED]|[plan_HMO/PPO] standard_charge|[payer_KAISER SELF FUNDED]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_KAISER SELF FUNDED]|[Plan_HMO/PPO] standard_charge|[payer_KAISER SOUTHERN CAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_KAISER SOUTHERN CAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_KAISER SOUTHERN CAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_KAISER SOUTHERN CAL]|[plan_HMO/PPO] standard_charge|[payer_KAISER SOUTHERN CAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_KAISER SOUTHERN CAL]|[Plan_HMO/PPO] standard_charge|[payer_KERN COUNTY BHRS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_KERN COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_KERN COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_KERN COUNTY BHRS]|[plan_MANAGED MEDICAID] standard_charge|[payer_KERN COUNTY BHRS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_KERN COUNTY BHRS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_KINGS COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_KINGS COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_KINGS COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_KINGS COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_KINGS COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_KINGS COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_LAKE COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_LAKE COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_LAKE COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_LAKE COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_LAKE COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_LAKE COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_LOS ANGELES COUNTY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_LOS ANGELES COUNTY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_LOS ANGELES COUNTY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_LOS ANGELES COUNTY]|[plan_MANAGED MEDICAID] standard_charge|[payer_LOS ANGELES COUNTY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_LOS ANGELES COUNTY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MADERA COUNTY BHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MADERA COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MADERA COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MADERA COUNTY BHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_MADERA COUNTY BHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MADERA COUNTY BHS]|[Plan_MANAGED MEDICAID] 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_MAGELLAN WHA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN WHA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN WHA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN WHA]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN WHA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN WHA]|[Plan_HMO/PPO] standard_charge|[payer_MARIN COUNTY BHRS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MARIN COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MARIN COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MARIN COUNTY BHRS]|[plan_MANAGED MEDICAID] standard_charge|[payer_MARIN COUNTY BHRS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MARIN COUNTY BHRS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MARIPOSA COUNTY BHD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MARIPOSA COUNTY BHD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MARIPOSA COUNTY BHD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MARIPOSA COUNTY BHD]|[plan_MANAGED MEDICAID] standard_charge|[payer_MARIPOSA COUNTY BHD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MARIPOSA COUNTY BHD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MEDI-CAL SALESFORCE ONLY]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_MEDI-CAL SALESFORCE ONLY]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_MEDI-CAL SALESFORCE ONLY]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDI-CAL SALESFORCE ONLY]|[plan_MEDICAID] standard_charge|[payer_MEDI-CAL SALESFORCE ONLY]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_MEDI-CAL SALESFORCE ONLY]|[Plan_MEDICAID] standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE]|[Plan_MEDICARE] standard_charge|[payer_MENDOCINO COUNTY BHRS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MENDOCINO COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MENDOCINO COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MENDOCINO COUNTY BHRS]|[plan_MANAGED MEDICAID] standard_charge|[payer_MENDOCINO COUNTY BHRS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MENDOCINO COUNTY BHRS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MERCED COUNTY BHRS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MERCED COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MERCED COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MERCED COUNTY BHRS]|[plan_MANAGED MEDICAID] standard_charge|[payer_MERCED COUNTY BHRS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MERCED COUNTY BHRS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MERITAIN HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_MHN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MHN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MHN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MHN]|[plan_HMO/PPO] standard_charge|[payer_MHN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MHN]|[Plan_HMO/PPO] standard_charge|[payer_MHN MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_MHN MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_MHN MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_MHN MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_MHN MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_MHN MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MISC COMMERCIAL]|[Plan_COMMERCIAL] standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MISC HMO PPO]|[plan_HMO/PPO] standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MISC HMO PPO]|[Plan_HMO/PPO] standard_charge|[payer_MISC MANAGED MEDICAL]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MANAGED MEDICAL]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MISC MANAGED MEDICAL]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MISC MANAGED MEDICAL]|[plan_MANAGED MEDICAID] standard_charge|[payer_MISC MANAGED MEDICAL]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MISC MANAGED MEDICAL]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MANAGED MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_MISC MANAGED MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_MONO COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MONO COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MONO COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MONO COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_MONO COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MONO COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MONTEREY COUNTY HEALTH DP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MONTEREY COUNTY HEALTH DP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MONTEREY COUNTY HEALTH DP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MONTEREY COUNTY HEALTH DP]|[plan_MANAGED MEDICAID] standard_charge|[payer_MONTEREY COUNTY HEALTH DP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MONTEREY COUNTY HEALTH DP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_NAPA COUNTY HHSA]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_NAPA COUNTY HHSA]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_NAPA COUNTY HHSA]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_NAPA COUNTY HHSA]|[plan_MANAGED MEDICAID] standard_charge|[payer_NAPA COUNTY HHSA]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_NAPA COUNTY HHSA]|[Plan_MANAGED MEDICAID] standard_charge|[payer_NEVADA COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_NEVADA COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_NEVADA COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_NEVADA COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_NEVADA COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_NEVADA COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADOLSECENT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_O/P MEDI-CAL ADOLSECENT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_O/P MEDI-CAL ADOLSECENT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_O/P MEDI-CAL ADOLSECENT]|[plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADOLSECENT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_O/P MEDI-CAL ADOLSECENT]|[Plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADULT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_O/P MEDI-CAL ADULT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_O/P MEDI-CAL ADULT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_O/P MEDI-CAL ADULT]|[plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADULT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_O/P MEDI-CAL ADULT]|[Plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_O/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_O/P MEDI-CAL SD ADOLESCNT]|[Plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADULT]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_O/P MEDI-CAL SD ADULT]|[plan_MEDICAID] |negotiated_percentage standard_charge|[payer_O/P MEDI-CAL SD ADULT]|[plan_MEDICAID] |negotiated_algorithm estimated_amount|[payer_O/P MEDI-CAL SD ADULT]|[plan_MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADULT]|[plan_MEDICAID] |methodology additional_payer_notes |[payer_O/P MEDI-CAL SD ADULT]|[Plan_MEDICAID] standard_charge|[payer_OPTUM - SAN DIEGO COUNTY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM - SAN DIEGO COUNTY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM - SAN DIEGO COUNTY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM - SAN DIEGO COUNTY]|[plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM - SAN DIEGO COUNTY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM - SAN DIEGO COUNTY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM HEALTHCARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM HEALTHCARE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM HEALTHCARE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM HEALTHCARE]|[plan_HMO/PPO] standard_charge|[payer_OPTUM HEALTHCARE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM HEALTHCARE]|[Plan_HMO/PPO] standard_charge|[payer_OPTUM MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM MEDICARE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_OPTUM MEDICARE]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_OPTUM MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_OPTUM MEDICARE]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_OPTUM MEDICARE]|[Plan_MNGD MEDICARE] standard_charge|[payer_ORANGE COUNTY BHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ORANGE COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ORANGE COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ORANGE COUNTY BHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_ORANGE COUNTY BHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ORANGE COUNTY BHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_PLACER COUNTY HHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PLACER COUNTY HHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_PLACER COUNTY HHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_PLACER COUNTY HHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_PLACER COUNTY HHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_PLACER COUNTY HHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_POINT COMFORT UNDERWRITER]|[Plan_COMMERCIAL] standard_charge|[payer_RIVERSIDE COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_RIVERSIDE COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_RIVERSIDE COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_RIVERSIDE COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_RIVERSIDE COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_RIVERSIDE COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SACRAMENTO COUNTY BHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SACRAMENTO COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SACRAMENTO COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SACRAMENTO COUNTY BHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SACRAMENTO COUNTY BHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SACRAMENTO COUNTY BHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAN BENITO COUNTY BHD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN BENITO COUNTY BHD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN BENITO COUNTY BHD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN BENITO COUNTY BHD]|[plan_MANAGED MEDICAID] standard_charge|[payer_SAN BENITO COUNTY BHD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN BENITO COUNTY BHD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAN BERNARDINO COUNTY DBH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN BERNARDINO COUNTY DBH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN BERNARDINO COUNTY DBH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN BERNARDINO COUNTY DBH]|[plan_MANAGED MEDICAID] standard_charge|[payer_SAN BERNARDINO COUNTY DBH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN BERNARDINO COUNTY DBH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAN FRANCISCO COUNTY BHA]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN FRANCISCO COUNTY BHA]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN FRANCISCO COUNTY BHA]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN FRANCISCO COUNTY BHA]|[plan_MANAGED MEDICAID] standard_charge|[payer_SAN FRANCISCO COUNTY BHA]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN FRANCISCO COUNTY BHA]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAN JOAQUIN BHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN JOAQUIN BHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN JOAQUIN BHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN JOAQUIN BHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SAN JOAQUIN BHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN JOAQUIN BHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAN LUIS OBISPO COUNTY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN LUIS OBISPO COUNTY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN LUIS OBISPO COUNTY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN LUIS OBISPO COUNTY]|[plan_MANAGED MEDICAID] standard_charge|[payer_SAN LUIS OBISPO COUNTY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN LUIS OBISPO COUNTY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAN MATEO COUNTY BHRS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN MATEO COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN MATEO COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN MATEO COUNTY BHRS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SAN MATEO COUNTY BHRS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN MATEO COUNTY BHRS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SANTA BARBARA COUNTY BW]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SANTA BARBARA COUNTY BW]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SANTA BARBARA COUNTY BW]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SANTA BARBARA COUNTY BW]|[plan_MANAGED MEDICAID] standard_charge|[payer_SANTA BARBARA COUNTY BW]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SANTA BARBARA COUNTY BW]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADOLESCENT]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SANTA CLARA CO ADOLESCENT]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SANTA CLARA CO ADOLESCENT]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SANTA CLARA CO ADOLESCENT]|[plan_MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADOLESCENT]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SANTA CLARA CO ADOLESCENT]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADULT]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SANTA CLARA CO ADULT]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SANTA CLARA CO ADULT]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SANTA CLARA CO ADULT]|[plan_MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADULT]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SANTA CLARA CO ADULT]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SANTA CRUZ COUNTY MHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SANTA CRUZ COUNTY MHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SANTA CRUZ COUNTY MHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SANTA CRUZ COUNTY MHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SANTA CRUZ COUNTY MHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SANTA CRUZ COUNTY MHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SCFHP MEDICONNECT]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_SCFHP MEDICONNECT]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_SCFHP MEDICONNECT]|[plan_MNGD MEDICARE] |negotiated_algorithm estimated_amount|[payer_SCFHP MEDICONNECT]|[plan_MNGD MEDICARE] standard_charge|[payer_SCFHP MEDICONNECT]|[plan_MNGD MEDICARE] |methodology additional_payer_notes |[payer_SCFHP MEDICONNECT]|[Plan_MNGD MEDICARE] standard_charge|[payer_SHASTA COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SHASTA COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SHASTA COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SHASTA COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_SHASTA COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SHASTA COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SISKIYOU COUNTY BHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SISKIYOU COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SISKIYOU COUNTY BHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SISKIYOU COUNTY BHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SISKIYOU COUNTY BHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SISKIYOU COUNTY BHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SOLANO COUNTY MHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SOLANO COUNTY MHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SOLANO COUNTY MHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SOLANO COUNTY MHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SOLANO COUNTY MHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SOLANO COUNTY MHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SONOMA COUNTY DHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SONOMA COUNTY DHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SONOMA COUNTY DHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SONOMA COUNTY DHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SONOMA COUNTY DHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SONOMA COUNTY DHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_STANFORD HOSPITAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_STANFORD HOSPITAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_STANFORD HOSPITAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_STANFORD HOSPITAL]|[plan_COMMERCIAL] standard_charge|[payer_STANFORD HOSPITAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_STANFORD HOSPITAL]|[Plan_COMMERCIAL] standard_charge|[payer_STANISLAUS COUNTY BHRS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_STANISLAUS COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_STANISLAUS COUNTY BHRS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_STANISLAUS COUNTY BHRS]|[plan_MANAGED MEDICAID] standard_charge|[payer_STANISLAUS COUNTY BHRS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_STANISLAUS COUNTY BHRS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SUTTER-YUBA COUNTY MHS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUTTER-YUBA COUNTY MHS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUTTER-YUBA COUNTY MHS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUTTER-YUBA COUNTY MHS]|[plan_MANAGED MEDICAID] standard_charge|[payer_SUTTER-YUBA COUNTY MHS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUTTER-YUBA COUNTY MHS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TEHAMA COUNTY HSA]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TEHAMA COUNTY HSA]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TEHAMA COUNTY HSA]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TEHAMA COUNTY HSA]|[plan_MANAGED MEDICAID] standard_charge|[payer_TEHAMA COUNTY HSA]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TEHAMA COUNTY HSA]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TRICARE WEST]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE WEST]|[plan_TRICARE] standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE WEST]|[Plan_TRICARE] standard_charge|[payer_TULARE COUNTY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TULARE COUNTY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TULARE COUNTY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TULARE COUNTY]|[plan_MANAGED MEDICAID] standard_charge|[payer_TULARE COUNTY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TULARE COUNTY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TUOLUMNE COUNTY BH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TUOLUMNE COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TUOLUMNE COUNTY BH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TUOLUMNE COUNTY BH]|[plan_MANAGED MEDICAID] standard_charge|[payer_TUOLUMNE COUNTY BH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TUOLUMNE COUNTY BH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_UMR]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UMR]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UMR]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_COMMERCIAL] standard_charge|[payer_UMR]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UMR]|[Plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE (AARP)]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE (AARP)]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE (AARP)]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE (AARP)]|[plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE (AARP)]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE (AARP)]|[Plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE OPTIONS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE OPTIONS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE OPTIONS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE OPTIONS]|[plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE OPTIONS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE OPTIONS]|[Plan_COMMERCIAL] standard_charge|[payer_VHP COMMERCIAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_VHP COMMERCIAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_VHP COMMERCIAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_VHP COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_VHP COMMERCIAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_VHP COMMERCIAL]|[Plan_HMO/PPO] standard_charge|[payer_VHP COVERED CALIFORNIA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_VHP COVERED CALIFORNIA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_VHP COVERED CALIFORNIA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_VHP COVERED CALIFORNIA]|[plan_HMO/PPO] standard_charge|[payer_VHP COVERED CALIFORNIA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_VHP COVERED CALIFORNIA]|[Plan_HMO/PPO] standard_charge|[payer_WESTERN GROWERS ASSURANCE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_WESTERN GROWERS ASSURANCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_WESTERN GROWERS ASSURANCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_WESTERN GROWERS ASSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_WESTERN GROWERS ASSURANCE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_WESTERN GROWERS ASSURANCE]|[Plan_COMMERCIAL] standard_charge|[payer_YOLO COUNTY HHSA]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_YOLO COUNTY HHSA]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_YOLO COUNTY HHSA]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_YOLO COUNTY HHSA]|[plan_MANAGED MEDICAID] standard_charge|[payer_YOLO COUNTY HHSA]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_YOLO COUNTY HHSA]|[Plan_MANAGED MEDICAID] additional_generic_notes ROOM AND BOARD ADOLESCENTESCENT PSYCH 1 124 RC facility inpatient 2895 1500 1183 2895 1925 per diem 1486 per diem 1386 per diem 1617 per diem 1617 per diem 1617 per diem 1625 per diem 1625 per diem 1476 per diem 1518 per diem 2895 per diem 1183 per diem 2024 per diem 1450 per diem 1595 per diem 1763 per diem 1386 per diem 2895 per diem 2094 per diem 2094 per diem 1904 per diem 2895 per diem 2895 per diem 2895 per diem 1800 per diem 1386 per diem 2094 per diem 2094 per diem 1867 per diem 1867 per diem 1518 per diem 2079 per diem 2079 per diem 2079 per diem 2079 per diem 1450 per diem 1633 per diem 1386 per diem 1485 per diem 1904 per diem 1902 per diem 1902 per diem 2094 per diem 1598 per diem 1685 per diem 1386 per diem 1486 per diem 1400 per diem 1648 per diem 2895 per diem 2895 per diem 2895 per diem 1415 per diem 1763 per diem 1343 per diem 1386 per diem 1550 per diem 1674 per diem 1386 per diem 1450 per diem 2600 per diem 1485 per diem 1386 per diem 1553 per diem 1386 per diem 1386 per diem 1386 per diem 1685 per diem 2094 per diem 1281 per diem 2094 per diem 2094 per diem 1741 per diem 1763 per diem 1485 per diem 2094 per diem 1685 per diem 2895 per diem 1386 per diem 1386 per diem 1518 per diem 1750 per diem 1867 per diem 1763 per diem 2895 per diem 2895 per diem 2895 per diem 1644 per diem 1441 per diem 2895 per diem 1485 per diem ROOM AND BOARD ADULT PSYCH 124 RC facility inpatient 2895 1500 1183 2895 1925 per diem 1486 per diem 1386 per diem 1617 per diem 1617 per diem 1617 per diem 1625 per diem 1625 per diem 1476 per diem 1518 per diem 2895 per diem 1183 per diem 2024 per diem 1450 per diem 1595 per diem 1763 per diem 1386 per diem 2895 per diem 2094 per diem 2094 per diem 1904 per diem 2895 per diem 2895 per diem 2895 per diem 1800 per diem 1386 per diem 2094 per diem 2094 per diem 1867 per diem 1867 per diem 1518 per diem 2079 per diem 2079 per diem 2079 per diem 2079 per diem 1450 per diem 1633 per diem 1386 per diem 1485 per diem 1904 per diem 1902 per diem 1902 per diem 2094 per diem 1598 per diem 1685 per diem 1386 per diem 1486 per diem 1400 per diem 1648 per diem 2895 per diem 2895 per diem 2895 per diem 1415 per diem 1763 per diem 1343 per diem 1386 per diem 1550 per diem 1674 per diem 1386 per diem 1450 per diem 2600 per diem 1485 per diem 1386 per diem 1553 per diem 1386 per diem 1386 per diem 1386 per diem 1685 per diem 2094 per diem 1281 per diem 2094 per diem 2094 per diem 1741 per diem 1763 per diem 1485 per diem 2094 per diem 1685 per diem 2895 per diem 1386 per diem 1386 per diem 1518 per diem 1750 per diem 1867 per diem 1763 per diem 2895 per diem 2895 per diem 2895 per diem 1644 per diem 1441 per diem 2895 per diem 1485 per diem ROOM AND BOARD GERIACTRIC PSYCH 124 RC facility inpatient 2895 1500 1183 2895 1925 per diem 1486 per diem 1386 per diem 1617 per diem 1617 per diem 1617 per diem 1625 per diem 1625 per diem 1476 per diem 1518 per diem 2895 per diem 1183 per diem 2024 per diem 1450 per diem 1595 per diem 1763 per diem 1386 per diem 2895 per diem 2094 per diem 2094 per diem 1904 per diem 2895 per diem 2895 per diem 2895 per diem 1800 per diem 1386 per diem 2094 per diem 2094 per diem 1867 per diem 1867 per diem 1518 per diem 2079 per diem 2079 per diem 2079 per diem 2079 per diem 1450 per diem 1633 per diem 1386 per diem 1485 per diem 1904 per diem 1902 per diem 1902 per diem 2094 per diem 1598 per diem 1685 per diem 1386 per diem 1486 per diem 1400 per diem 1648 per diem 2895 per diem 2895 per diem 2895 per diem 1415 per diem 1763 per diem 1343 per diem 1386 per diem 1550 per diem 1674 per diem 1386 per diem 1450 per diem 2600 per diem 1485 per diem 1386 per diem 1553 per diem 1386 per diem 1386 per diem 1386 per diem 1685 per diem 2094 per diem 1281 per diem 2094 per diem 2094 per diem 1741 per diem 1763 per diem 1485 per diem 2094 per diem 1685 per diem 2895 per diem 1386 per diem 1386 per diem 1518 per diem 1750 per diem 1867 per diem 1763 per diem 2895 per diem 2895 per diem 2895 per diem 1644 per diem 1441 per diem 2895 per diem 1485 per diem ROOM AND BOARD ADOLESCENTSCENT DETOX 126 RC facility inpatient 2895 1500 1183 2895 1236 per diem 1617 per diem 1617 per diem 1617 per diem 1625 per diem 1625 per diem 2895 per diem 1183 per diem 2024 per diem 1595 per diem 2895 per diem 2895 per diem 2895 per diem 2895 per diem 1800 per diem 2033 per diem 2033 per diem 2033 per diem 2033 per diem 1902 per diem 1902 per diem 1685 per diem 1200 per diem 1648 per diem 2895 per diem 2895 per diem 2895 per diem 1674 per diem 2600 per diem 2895 per diem 1750 per diem 2895 per diem 2895 per diem 2895 per diem 1644 per diem 1441 per diem ROOM AND BOARD ADULT DETOX 126 RC facility inpatient 2895 1500 1183 2895 1236 per diem 1617 per diem 1617 per diem 1617 per diem 1625 per diem 1625 per diem 2895 per diem 1183 per diem 2024 per diem 1595 per diem 2895 per diem 2895 per diem 2895 per diem 2895 per diem 1800 per diem 2033 per diem 2033 per diem 2033 per diem 2033 per diem 1902 per diem 1902 per diem 1685 per diem 1200 per diem 1648 per diem 2895 per diem 2895 per diem 2895 per diem 1674 per diem 2600 per diem 2895 per diem 1750 per diem 2895 per diem 2895 per diem 2895 per diem 1644 per diem 1441 per diem ROOM AND BOARD GERIACTRIC DETOX 126 RC facility inpatient 2895 1500 1183 2895 1236 per diem 1617 per diem 1617 per diem 1617 per diem 1625 per diem 1625 per diem 2895 per diem 1183 per diem 2024 per diem 1595 per diem 2895 per diem 2895 per diem 2895 per diem 2895 per diem 1800 per diem 2033 per diem 2033 per diem 2033 per diem 2033 per diem 1902 per diem 1902 per diem 1685 per diem 1200 per diem 1648 per diem 2895 per diem 2895 per diem 2895 per diem 1674 per diem 2600 per diem 2895 per diem 1750 per diem 2895 per diem 2895 per diem 2895 per diem 1644 per diem 1441 per diem 1:1 SUPERVISION INPATIENT 230 RC facility inpatient 529 529 578 578 per diem 578 per diem 529 per diem 529 per diem 529 per diem 529 per diem 578 per diem 578 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT PSYCH 905 RC facility outpatient 725 500 115 725 624 per diem 292 per diem 386 per diem 386 per diem 386 per diem 386 per diem 355 per diem 355 per diem 355 per diem 725 per diem 725 per diem 725 per diem 725 per diem 300 per diem 437 per diem 428 per diem 450 per diem 725 per diem 450 per diem 450 per diem 528 per diem 540 per diem 540 per diem 540 per diem 540 per diem 398 per diem 350 per diem 391 per diem 380 per diem 725 per diem 725 per diem 725 per diem 725 per diem 710 per diem 710 per diem 710 per diem 710 per diem 389 per diem 378 per diem 435 per diem 350 per diem 115 per diem 725 per diem 363 per diem 330 per diem INTENSIVE OUTPATIENT PROGRAM ADULT/GERIACTRIC PSYCH 905 RC facility outpatient 725 500 115 725 624 per diem 292 per diem 386 per diem 386 per diem 386 per diem 386 per diem 355 per diem 355 per diem 355 per diem 725 per diem 725 per diem 725 per diem 725 per diem 300 per diem 437 per diem 428 per diem 450 per diem 725 per diem 450 per diem 450 per diem 528 per diem 540 per diem 540 per diem 540 per diem 540 per diem 398 per diem 350 per diem 391 per diem 380 per diem 725 per diem 725 per diem 725 per diem 725 per diem 710 per diem 710 per diem 710 per diem 710 per diem 389 per diem 378 per diem 435 per diem 350 per diem 115 per diem 725 per diem 363 per diem 330 per diem INTENSIVE OUTPATIENT PROGRAM TELE ADULT PSYCH 905 RC facility outpatient 725 500 115 725 624 per diem 292 per diem 386 per diem 386 per diem 386 per diem 386 per diem 355 per diem 355 per diem 355 per diem 725 per diem 725 per diem 725 per diem 725 per diem 300 per diem 437 per diem 428 per diem 450 per diem 725 per diem 450 per diem 450 per diem 528 per diem 540 per diem 540 per diem 540 per diem 540 per diem 398 per diem 350 per diem 391 per diem 380 per diem 725 per diem 725 per diem 725 per diem 725 per diem 710 per diem 710 per diem 710 per diem 710 per diem 389 per diem 378 per diem 435 per diem 350 per diem 115 per diem 725 per diem 363 per diem 330 per diem SCRUZ INTENSIVE OUTPATIENT PROGRAM ADULT/GERIACTRIC 905 RC facility outpatient 725 500 115 725 624 per diem 292 per diem 386 per diem 386 per diem 386 per diem 386 per diem 355 per diem 355 per diem 355 per diem 725 per diem 725 per diem 725 per diem 725 per diem 300 per diem 437 per diem 428 per diem 450 per diem 725 per diem 450 per diem 450 per diem 528 per diem 540 per diem 540 per diem 540 per diem 540 per diem 398 per diem 350 per diem 391 per diem 380 per diem 725 per diem 725 per diem 725 per diem 725 per diem 710 per diem 710 per diem 710 per diem 710 per diem 389 per diem 378 per diem 435 per diem 350 per diem 115 per diem 725 per diem 363 per diem 330 per diem PARTIAL HOSPITAL PROGRAM TRI PROCESS GROUP 912 RC facility outpatient 300 800 350 1450 858 per diem 611 per diem 611 per diem 611 per diem 611 per diem 595 per diem 595 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 350 per diem 793 per diem 777 per diem 670 per diem 1450 per diem 795 per diem 795 per diem 845 per diem 865 per diem 865 per diem 865 per diem 865 per diem 744 per diem 600 per diem 613 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 1090 per diem 1090 per diem 1090 per diem 1090 per diem 645 per diem 625 per diem 850 per diem 600 per diem 700 per diem 1450 per diem 700 per diem 577 per diem PARTIAL HOSPITAL PROGRAM ADOLESCENT PSYCH 912 RC facility outpatient 1450 800 350 1450 858 per diem 611 per diem 611 per diem 611 per diem 611 per diem 595 per diem 595 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 350 per diem 793 per diem 777 per diem 670 per diem 1450 per diem 795 per diem 795 per diem 845 per diem 865 per diem 865 per diem 865 per diem 865 per diem 744 per diem 600 per diem 613 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 1090 per diem 1090 per diem 1090 per diem 1090 per diem 645 per diem 625 per diem 850 per diem 600 per diem 700 per diem 1450 per diem 700 per diem 577 per diem PARTIAL HOSPITAL PROGRAM ADULT/GERIACTRIC PSYCH 912 RC facility outpatient 1450 800 350 1450 858 per diem 611 per diem 611 per diem 611 per diem 611 per diem 595 per diem 595 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 350 per diem 793 per diem 777 per diem 670 per diem 1450 per diem 795 per diem 795 per diem 845 per diem 865 per diem 865 per diem 865 per diem 865 per diem 744 per diem 600 per diem 613 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 1090 per diem 1090 per diem 1090 per diem 1090 per diem 645 per diem 625 per diem 850 per diem 600 per diem 700 per diem 1450 per diem 700 per diem 577 per diem PARTIAL HOSPITAL PROGRAM TELE ADULT PSYCH 912 RC facility outpatient 1450 800 350 1450 858 per diem 611 per diem 611 per diem 611 per diem 611 per diem 595 per diem 595 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 350 per diem 793 per diem 777 per diem 670 per diem 1450 per diem 795 per diem 795 per diem 845 per diem 865 per diem 865 per diem 865 per diem 865 per diem 744 per diem 600 per diem 613 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 1090 per diem 1090 per diem 1090 per diem 1090 per diem 645 per diem 625 per diem 850 per diem 600 per diem 700 per diem 1450 per diem 700 per diem 577 per diem SCRUZ PARTIAL HOSPITAL PROGRAM ADULT/GERIACTRIC 912 RC facility outpatient 1450 800 350 1450 858 per diem 611 per diem 611 per diem 611 per diem 611 per diem 595 per diem 595 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 350 per diem 793 per diem 777 per diem 670 per diem 1450 per diem 795 per diem 795 per diem 845 per diem 865 per diem 865 per diem 865 per diem 865 per diem 744 per diem 600 per diem 613 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 1090 per diem 1090 per diem 1090 per diem 1090 per diem 645 per diem 625 per diem 850 per diem 600 per diem 700 per diem 1450 per diem 700 per diem 577 per diem SCRUZ PARTIAL HOSPITAL PROGRAM TELE ADULT 912 RC facility outpatient 1450 800 350 1450 858 per diem 611 per diem 611 per diem 611 per diem 611 per diem 595 per diem 595 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 350 per diem 793 per diem 777 per diem 670 per diem 1450 per diem 795 per diem 795 per diem 845 per diem 865 per diem 865 per diem 865 per diem 865 per diem 744 per diem 600 per diem 613 per diem 595 per diem 1450 per diem 1450 per diem 1450 per diem 1450 per diem 1090 per diem 1090 per diem 1090 per diem 1090 per diem 645 per diem 625 per diem 850 per diem 600 per diem 700 per diem 1450 per diem 700 per diem 577 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 915 RC facility outpatient 195 409 584 584 per diem 409 per diem PARTIAL HOSPITAL PROGRAM MOTORIC CONGNITIVE RISK/TREATMENT PROCESS 915 RC facility outpatient 300 409 584 584 per diem 409 per diem PARTIAL HOSPITAL PROGRAM TRICARE ADOLESCENT 915 RC facility outpatient 300 409 584 584 per diem 409 per diem SCRUZ PROCESS GROUP 915 RC facility outpatient 300 409 584 584 per diem 409 per diem