"hospital_SJBH, LLC" last_updated_ 2023-12-31 version_1 "hospital_San Jose, California" hospital_address 455 Silicon Valley Boulevard license_ 550003449 |CA "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded in this machine-readable file is true, accurate, and complete as of the date indicated in this file" description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AETNA|HMO/PPO] standard_charge|[payer_AETNA|HMO/PPO] |percent standard_charge|[payer_AETNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA|HMO/PPO] standard_charge|[payer_AETNA MEDICARE|MNGD MEDICARE] standard_charge|[payer_AETNA MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE|MNGD MEDICARE] standard_charge|[payer_ALAMEDA COUNTY BHCS|MANAGED MEDICAID] standard_charge|[payer_ALAMEDA COUNTY BHCS|MANAGED MEDICAID] |percent standard_charge|[payer_ALAMEDA COUNTY BHCS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_ALAMEDA COUNTY BHCS|MANAGED MEDICAID] standard_charge|[payer_AMADOR COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_AMADOR COUNTY BHS|MANAGED MEDICAID] |percent standard_charge|[payer_AMADOR COUNTY BHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMADOR COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_ANTHEM BCBS|BLUE CROSS] standard_charge|[payer_ANTHEM BCBS|BLUE CROSS] |percent standard_charge|[payer_ANTHEM BCBS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_ANTHEM BCBS|BLUE CROSS] standard_charge|[payer_ANTHEM BCBS FEP|BLUE CROSS] standard_charge|[payer_ANTHEM BCBS FEP|BLUE CROSS] |percent standard_charge|[payer_ANTHEM BCBS FEP|BLUE CROSS] |contracting_method additional_payer_notes |[payer_ANTHEM BCBS FEP|BLUE CROSS] standard_charge|[payer_ANTHEM BCBS MEDICARE|MNGD MEDICARE] standard_charge|[payer_ANTHEM BCBS MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_ANTHEM BCBS MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_ANTHEM BCBS MEDICARE|MNGD MEDICARE] standard_charge|[payer_ANTHEM BCBS OOS|BLUE CROSS] standard_charge|[payer_ANTHEM BCBS OOS|BLUE CROSS] |percent standard_charge|[payer_ANTHEM BCBS OOS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_ANTHEM BCBS OOS|BLUE CROSS] standard_charge|[payer_BLUE SHIELD MGD MEDICARE|MNGD MEDICARE] standard_charge|[payer_BLUE SHIELD MGD MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_BLUE SHIELD MGD MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_BLUE SHIELD MGD MEDICARE|MNGD MEDICARE] standard_charge|[payer_BLUE SHIELD OF CA OOA|BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CA OOA|BLUE CROSS] |percent standard_charge|[payer_BLUE SHIELD OF CA OOA|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BLUE SHIELD OF CA OOA|BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CALIFORNIA|BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CALIFORNIA|BLUE CROSS] |percent standard_charge|[payer_BLUE SHIELD OF CALIFORNIA|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BLUE SHIELD OF CALIFORNIA|BLUE CROSS] standard_charge|[payer_BRAND NEW DAY|MNGD MEDICARE] standard_charge|[payer_BRAND NEW DAY|MNGD MEDICARE] |percent standard_charge|[payer_BRAND NEW DAY|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_BRAND NEW DAY|MNGD MEDICARE] standard_charge|[payer_BUTTE COUNTY BHD|MANAGED MEDICAID] standard_charge|[payer_BUTTE COUNTY BHD|MANAGED MEDICAID] |percent standard_charge|[payer_BUTTE COUNTY BHD|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BUTTE COUNTY BHD|MANAGED MEDICAID] standard_charge|[payer_CALAVERAS COUNTY HHS|MANAGED MEDICAID] standard_charge|[payer_CALAVERAS COUNTY HHS|MANAGED MEDICAID] |percent standard_charge|[payer_CALAVERAS COUNTY HHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CALAVERAS COUNTY HHS|MANAGED MEDICAID] standard_charge|[payer_CARE1ST HEALTH PLAN|MNGD MEDICARE] standard_charge|[payer_CARE1ST HEALTH PLAN|MNGD MEDICARE] |percent standard_charge|[payer_CARE1ST HEALTH PLAN|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_CARE1ST HEALTH PLAN|MNGD MEDICARE] standard_charge|[payer_CARELON|COMMERCIAL] standard_charge|[payer_CARELON|COMMERCIAL] |percent standard_charge|[payer_CARELON|COMMERCIAL] |contracting_method additional_payer_notes |[payer_CARELON|COMMERCIAL] standard_charge|[payer_CARELON MANAGED MEDICARE|MNGD MEDICARE] standard_charge|[payer_CARELON MANAGED MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_CARELON MANAGED MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_CARELON MANAGED MEDICARE|MNGD MEDICARE] standard_charge|[payer_CAREMORE HEALTH PLAN|MNGD MEDICARE] standard_charge|[payer_CAREMORE HEALTH PLAN|MNGD MEDICARE] |percent standard_charge|[payer_CAREMORE HEALTH PLAN|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_CAREMORE HEALTH PLAN|MNGD MEDICARE] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_CIGNA MEDICARE|MNGD MEDICARE] standard_charge|[payer_CIGNA MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_CIGNA MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA MEDICARE|MNGD MEDICARE] standard_charge|[payer_COLUSA COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_COLUSA COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_COLUSA COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_COLUSA COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_COMPSYCH|HMO/PPO] standard_charge|[payer_COMPSYCH|HMO/PPO] |percent standard_charge|[payer_COMPSYCH|HMO/PPO] |contracting_method additional_payer_notes |[payer_COMPSYCH|HMO/PPO] standard_charge|[payer_CONTRA COSTA COUNTY|MANAGED MEDICAID] standard_charge|[payer_CONTRA COSTA COUNTY|MANAGED MEDICAID] |percent standard_charge|[payer_CONTRA COSTA COUNTY|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CONTRA COSTA COUNTY|MANAGED MEDICAID] standard_charge|[payer_EL DORADO COUNTY|MANAGED MEDICAID] standard_charge|[payer_EL DORADO COUNTY|MANAGED MEDICAID] |percent standard_charge|[payer_EL DORADO COUNTY|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_EL DORADO COUNTY|MANAGED MEDICAID] standard_charge|[payer_EMBLEM HEALTH (GHI)|COMMERCIAL] standard_charge|[payer_EMBLEM HEALTH (GHI)|COMMERCIAL] |percent standard_charge|[payer_EMBLEM HEALTH (GHI)|COMMERCIAL] |contracting_method additional_payer_notes |[payer_EMBLEM HEALTH (GHI)|COMMERCIAL] standard_charge|[payer_FRESNO COUNTY ADOLESCENT|MANAGED MEDICAID] standard_charge|[payer_FRESNO COUNTY ADOLESCENT|MANAGED MEDICAID] |percent standard_charge|[payer_FRESNO COUNTY ADOLESCENT|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FRESNO COUNTY ADOLESCENT|MANAGED MEDICAID] standard_charge|[payer_FRESNO COUNTY ADULT|MANAGED MEDICAID] standard_charge|[payer_FRESNO COUNTY ADULT|MANAGED MEDICAID] |percent standard_charge|[payer_FRESNO COUNTY ADULT|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FRESNO COUNTY ADULT|MANAGED MEDICAID] standard_charge|[payer_GLENN COUNTY HHSA|MANAGED MEDICAID] standard_charge|[payer_GLENN COUNTY HHSA|MANAGED MEDICAID] |percent standard_charge|[payer_GLENN COUNTY HHSA|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_GLENN COUNTY HHSA|MANAGED MEDICAID] standard_charge|[payer_HALCYON BEHAVIORAL|COMMERCIAL] standard_charge|[payer_HALCYON BEHAVIORAL|COMMERCIAL] |percent standard_charge|[payer_HALCYON BEHAVIORAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HALCYON BEHAVIORAL|COMMERCIAL] standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA|COMMERCIAL] standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA|COMMERCIAL] |percent standard_charge|[payer_HEALTHNET MCR SUPPLEMENTA|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTHNET MCR SUPPLEMENTA|COMMERCIAL] standard_charge|[payer_HMC HEALTHWORKS|COMMERCIAL] standard_charge|[payer_HMC HEALTHWORKS|COMMERCIAL] |percent standard_charge|[payer_HMC HEALTHWORKS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HMC HEALTHWORKS|COMMERCIAL] standard_charge|[payer_HUMANA|HMO/PPO] standard_charge|[payer_HUMANA|HMO/PPO] |percent standard_charge|[payer_HUMANA|HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA|HMO/PPO] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE|MNGD MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE|MNGD MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE ADVANTAGE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE|MNGD MEDICARE] standard_charge|[payer_HUMBOLDT COUNTY DHHS|MANAGED MEDICAID] standard_charge|[payer_HUMBOLDT COUNTY DHHS|MANAGED MEDICAID] |percent standard_charge|[payer_HUMBOLDT COUNTY DHHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HUMBOLDT COUNTY DHHS|MANAGED MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADOLESCENT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADOLESCENT|MEDICAID] |percent standard_charge|[payer_I/P MEDI-CAL ADOLESCENT|MEDICAID] |contracting_method additional_payer_notes |[payer_I/P MEDI-CAL ADOLESCENT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADULT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL ADULT|MEDICAID] |percent standard_charge|[payer_I/P MEDI-CAL ADULT|MEDICAID] |contracting_method additional_payer_notes |[payer_I/P MEDI-CAL ADULT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT|MEDICAID] |percent standard_charge|[payer_I/P MEDI-CAL SD ADOLESCNT|MEDICAID] |contracting_method additional_payer_notes |[payer_I/P MEDI-CAL SD ADOLESCNT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADULT|MEDICAID] standard_charge|[payer_I/P MEDI-CAL SD ADULT|MEDICAID] |percent standard_charge|[payer_I/P MEDI-CAL SD ADULT|MEDICAID] |contracting_method additional_payer_notes |[payer_I/P MEDI-CAL SD ADULT|MEDICAID] standard_charge|[payer_INYO COUNTY HHS|MANAGED MEDICAID] standard_charge|[payer_INYO COUNTY HHS|MANAGED MEDICAID] |percent standard_charge|[payer_INYO COUNTY HHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_INYO COUNTY HHS|MANAGED MEDICAID] standard_charge|[payer_KAISER ADVANTAGE|MNGD MEDICARE] standard_charge|[payer_KAISER ADVANTAGE|MNGD MEDICARE] |percent standard_charge|[payer_KAISER ADVANTAGE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_KAISER ADVANTAGE|MNGD MEDICARE] standard_charge|[payer_KAISER HAWAII|HMO/PPO] standard_charge|[payer_KAISER HAWAII|HMO/PPO] |percent standard_charge|[payer_KAISER HAWAII|HMO/PPO] |contracting_method additional_payer_notes |[payer_KAISER HAWAII|HMO/PPO] standard_charge|[payer_KAISER PERMANENTE|HMO/PPO] standard_charge|[payer_KAISER PERMANENTE|HMO/PPO] |percent standard_charge|[payer_KAISER PERMANENTE|HMO/PPO] |contracting_method additional_payer_notes |[payer_KAISER PERMANENTE|HMO/PPO] standard_charge|[payer_KAISER SELF FUNDED|HMO/PPO] standard_charge|[payer_KAISER SELF FUNDED|HMO/PPO] |percent standard_charge|[payer_KAISER SELF FUNDED|HMO/PPO] |contracting_method additional_payer_notes |[payer_KAISER SELF FUNDED|HMO/PPO] standard_charge|[payer_KAISER SOUTHERN CAL|HMO/PPO] standard_charge|[payer_KAISER SOUTHERN CAL|HMO/PPO] |percent standard_charge|[payer_KAISER SOUTHERN CAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_KAISER SOUTHERN CAL|HMO/PPO] standard_charge|[payer_KERN COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_KERN COUNTY BHRS|MANAGED MEDICAID] |percent standard_charge|[payer_KERN COUNTY BHRS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_KERN COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_KINGS COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_KINGS COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_KINGS COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_KINGS COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_LAKE COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_LAKE COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_LAKE COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_LAKE COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_LOS ANGELES COUNTY|MANAGED MEDICAID] standard_charge|[payer_LOS ANGELES COUNTY|MANAGED MEDICAID] |percent standard_charge|[payer_LOS ANGELES COUNTY|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_LOS ANGELES COUNTY|MANAGED MEDICAID] standard_charge|[payer_MADERA COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_MADERA COUNTY BHS|MANAGED MEDICAID] |percent standard_charge|[payer_MADERA COUNTY BHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MADERA COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_MAGELLAN|HMO/PPO] standard_charge|[payer_MAGELLAN|HMO/PPO] |percent standard_charge|[payer_MAGELLAN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN|HMO/PPO] standard_charge|[payer_MAGELLAN WHA|HMO/PPO] standard_charge|[payer_MAGELLAN WHA|HMO/PPO] |percent standard_charge|[payer_MAGELLAN WHA|HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN WHA|HMO/PPO] standard_charge|[payer_MARIN COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_MARIN COUNTY BHRS|MANAGED MEDICAID] |percent standard_charge|[payer_MARIN COUNTY BHRS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MARIN COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_MARIPOSA COUNTY BHD|MANAGED MEDICAID] standard_charge|[payer_MARIPOSA COUNTY BHD|MANAGED MEDICAID] |percent standard_charge|[payer_MARIPOSA COUNTY BHD|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MARIPOSA COUNTY BHD|MANAGED MEDICAID] standard_charge|[payer_MEDI-CAL SALESFORCE ONLY|MEDICAID] standard_charge|[payer_MEDI-CAL SALESFORCE ONLY|MEDICAID] |percent standard_charge|[payer_MEDI-CAL SALESFORCE ONLY|MEDICAID] |contracting_method additional_payer_notes |[payer_MEDI-CAL SALESFORCE ONLY|MEDICAID] standard_charge|[payer_MEDICARE|MEDICARE] standard_charge|[payer_MEDICARE|MEDICARE] |percent standard_charge|[payer_MEDICARE|MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE|MEDICARE] standard_charge|[payer_MENDOCINO COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_MENDOCINO COUNTY BHRS|MANAGED MEDICAID] |percent standard_charge|[payer_MENDOCINO COUNTY BHRS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MENDOCINO COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_MERCED COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_MERCED COUNTY BHRS|MANAGED MEDICAID] |percent standard_charge|[payer_MERCED COUNTY BHRS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MERCED COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_MERITAIN HEALTH|HMO/PPO] standard_charge|[payer_MERITAIN HEALTH|HMO/PPO] |percent standard_charge|[payer_MERITAIN HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH|HMO/PPO] standard_charge|[payer_MHN|HMO/PPO] standard_charge|[payer_MHN|HMO/PPO] |percent standard_charge|[payer_MHN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MHN|HMO/PPO] standard_charge|[payer_MHN MEDICARE|MNGD MEDICARE] standard_charge|[payer_MHN MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_MHN MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_MHN MEDICARE|MNGD MEDICARE] standard_charge|[payer_MISC COMMERCIAL|COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL|COMMERCIAL] |percent standard_charge|[payer_MISC COMMERCIAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MISC COMMERCIAL|COMMERCIAL] standard_charge|[payer_MISC HMO PPO|HMO/PPO] standard_charge|[payer_MISC HMO PPO|HMO/PPO] |percent standard_charge|[payer_MISC HMO PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_MISC HMO PPO|HMO/PPO] standard_charge|[payer_MISC MANAGED MEDICAL|MANAGED MEDICAID] standard_charge|[payer_MISC MANAGED MEDICAL|MANAGED MEDICAID] |percent standard_charge|[payer_MISC MANAGED MEDICAL|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MISC MANAGED MEDICAL|MANAGED MEDICAID] standard_charge|[payer_MISC MANAGED MEDICARE|MNGD MEDICARE] standard_charge|[payer_MISC MANAGED MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_MISC MANAGED MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_MISC MANAGED MEDICARE|MNGD MEDICARE] standard_charge|[payer_MONO COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_MONO COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_MONO COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MONO COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_MONTEREY COUNTY HEALTH DP|MANAGED MEDICAID] standard_charge|[payer_MONTEREY COUNTY HEALTH DP|MANAGED MEDICAID] |percent standard_charge|[payer_MONTEREY COUNTY HEALTH DP|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MONTEREY COUNTY HEALTH DP|MANAGED MEDICAID] standard_charge|[payer_NAPA COUNTY HHSA|MANAGED MEDICAID] standard_charge|[payer_NAPA COUNTY HHSA|MANAGED MEDICAID] |percent standard_charge|[payer_NAPA COUNTY HHSA|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_NAPA COUNTY HHSA|MANAGED MEDICAID] standard_charge|[payer_NEVADA COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_NEVADA COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_NEVADA COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_NEVADA COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADOLSECENT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADOLSECENT|MEDICAID] |percent standard_charge|[payer_O/P MEDI-CAL ADOLSECENT|MEDICAID] |contracting_method additional_payer_notes |[payer_O/P MEDI-CAL ADOLSECENT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADULT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL ADULT|MEDICAID] |percent standard_charge|[payer_O/P MEDI-CAL ADULT|MEDICAID] |contracting_method additional_payer_notes |[payer_O/P MEDI-CAL ADULT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT|MEDICAID] |percent standard_charge|[payer_O/P MEDI-CAL SD ADOLESCNT|MEDICAID] |contracting_method additional_payer_notes |[payer_O/P MEDI-CAL SD ADOLESCNT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADULT|MEDICAID] standard_charge|[payer_O/P MEDI-CAL SD ADULT|MEDICAID] |percent standard_charge|[payer_O/P MEDI-CAL SD ADULT|MEDICAID] |contracting_method additional_payer_notes |[payer_O/P MEDI-CAL SD ADULT|MEDICAID] standard_charge|[payer_OPTUM - SAN DIEGO COUNTY|MANAGED MEDICAID] standard_charge|[payer_OPTUM - SAN DIEGO COUNTY|MANAGED MEDICAID] |percent standard_charge|[payer_OPTUM - SAN DIEGO COUNTY|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_OPTUM - SAN DIEGO COUNTY|MANAGED MEDICAID] standard_charge|[payer_OPTUM HEALTHCARE|HMO/PPO] standard_charge|[payer_OPTUM HEALTHCARE|HMO/PPO] |percent standard_charge|[payer_OPTUM HEALTHCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM HEALTHCARE|HMO/PPO] standard_charge|[payer_OPTUM MEDICARE|MNGD MEDICARE] standard_charge|[payer_OPTUM MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_OPTUM MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_OPTUM MEDICARE|MNGD MEDICARE] standard_charge|[payer_ORANGE COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_ORANGE COUNTY BHS|MANAGED MEDICAID] |percent standard_charge|[payer_ORANGE COUNTY BHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_ORANGE COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_PLACER COUNTY HHS|MANAGED MEDICAID] standard_charge|[payer_PLACER COUNTY HHS|MANAGED MEDICAID] |percent standard_charge|[payer_PLACER COUNTY HHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_PLACER COUNTY HHS|MANAGED MEDICAID] standard_charge|[payer_POINT COMFORT UNDERWRITER|COMMERCIAL] standard_charge|[payer_POINT COMFORT UNDERWRITER|COMMERCIAL] |percent standard_charge|[payer_POINT COMFORT UNDERWRITER|COMMERCIAL] |contracting_method additional_payer_notes |[payer_POINT COMFORT UNDERWRITER|COMMERCIAL] standard_charge|[payer_RIVERSIDE COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_RIVERSIDE COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_RIVERSIDE COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_RIVERSIDE COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_SACRAMENTO COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_SACRAMENTO COUNTY BHS|MANAGED MEDICAID] |percent standard_charge|[payer_SACRAMENTO COUNTY BHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SACRAMENTO COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_SAN BENITO COUNTY BHD|MANAGED MEDICAID] standard_charge|[payer_SAN BENITO COUNTY BHD|MANAGED MEDICAID] |percent standard_charge|[payer_SAN BENITO COUNTY BHD|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SAN BENITO COUNTY BHD|MANAGED MEDICAID] standard_charge|[payer_SAN BERNARDINO COUNTY DBH|MANAGED MEDICAID] standard_charge|[payer_SAN BERNARDINO COUNTY DBH|MANAGED MEDICAID] |percent standard_charge|[payer_SAN BERNARDINO COUNTY DBH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SAN BERNARDINO COUNTY DBH|MANAGED MEDICAID] standard_charge|[payer_SAN FRANCISCO COUNTY BHA|MANAGED MEDICAID] standard_charge|[payer_SAN FRANCISCO COUNTY BHA|MANAGED MEDICAID] |percent standard_charge|[payer_SAN FRANCISCO COUNTY BHA|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SAN FRANCISCO COUNTY BHA|MANAGED MEDICAID] standard_charge|[payer_SAN JOAQUIN BHS|MANAGED MEDICAID] standard_charge|[payer_SAN JOAQUIN BHS|MANAGED MEDICAID] |percent standard_charge|[payer_SAN JOAQUIN BHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SAN JOAQUIN BHS|MANAGED MEDICAID] standard_charge|[payer_SAN LUIS OBISPO COUNTY|MANAGED MEDICAID] standard_charge|[payer_SAN LUIS OBISPO COUNTY|MANAGED MEDICAID] |percent standard_charge|[payer_SAN LUIS OBISPO COUNTY|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SAN LUIS OBISPO COUNTY|MANAGED MEDICAID] standard_charge|[payer_SAN MATEO COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_SAN MATEO COUNTY BHRS|MANAGED MEDICAID] |percent standard_charge|[payer_SAN MATEO COUNTY BHRS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SAN MATEO COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_SANTA BARBARA COUNTY BW|MANAGED MEDICAID] standard_charge|[payer_SANTA BARBARA COUNTY BW|MANAGED MEDICAID] |percent standard_charge|[payer_SANTA BARBARA COUNTY BW|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SANTA BARBARA COUNTY BW|MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADOLESCENT|MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADOLESCENT|MANAGED MEDICAID] |percent standard_charge|[payer_SANTA CLARA CO ADOLESCENT|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SANTA CLARA CO ADOLESCENT|MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADULT|MANAGED MEDICAID] standard_charge|[payer_SANTA CLARA CO ADULT|MANAGED MEDICAID] |percent standard_charge|[payer_SANTA CLARA CO ADULT|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SANTA CLARA CO ADULT|MANAGED MEDICAID] standard_charge|[payer_SANTA CRUZ COUNTY MHS|MANAGED MEDICAID] standard_charge|[payer_SANTA CRUZ COUNTY MHS|MANAGED MEDICAID] |percent standard_charge|[payer_SANTA CRUZ COUNTY MHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SANTA CRUZ COUNTY MHS|MANAGED MEDICAID] standard_charge|[payer_SCFHP MEDICONNECT|MNGD MEDICARE] standard_charge|[payer_SCFHP MEDICONNECT|MNGD MEDICARE] |percent standard_charge|[payer_SCFHP MEDICONNECT|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_SCFHP MEDICONNECT|MNGD MEDICARE] standard_charge|[payer_SHASTA COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_SHASTA COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_SHASTA COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SHASTA COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_SISKIYOU COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_SISKIYOU COUNTY BHS|MANAGED MEDICAID] |percent standard_charge|[payer_SISKIYOU COUNTY BHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SISKIYOU COUNTY BHS|MANAGED MEDICAID] standard_charge|[payer_SOLANO COUNTY MHS|MANAGED MEDICAID] standard_charge|[payer_SOLANO COUNTY MHS|MANAGED MEDICAID] |percent standard_charge|[payer_SOLANO COUNTY MHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SOLANO COUNTY MHS|MANAGED MEDICAID] standard_charge|[payer_SONOMA COUNTY DHS|MANAGED MEDICAID] standard_charge|[payer_SONOMA COUNTY DHS|MANAGED MEDICAID] |percent standard_charge|[payer_SONOMA COUNTY DHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SONOMA COUNTY DHS|MANAGED MEDICAID] standard_charge|[payer_STANFORD HOSPITAL|COMMERCIAL] standard_charge|[payer_STANFORD HOSPITAL|COMMERCIAL] |percent standard_charge|[payer_STANFORD HOSPITAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_STANFORD HOSPITAL|COMMERCIAL] standard_charge|[payer_STANISLAUS COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_STANISLAUS COUNTY BHRS|MANAGED MEDICAID] |percent standard_charge|[payer_STANISLAUS COUNTY BHRS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_STANISLAUS COUNTY BHRS|MANAGED MEDICAID] standard_charge|[payer_SUTTER-YUBA COUNTY MHS|MANAGED MEDICAID] standard_charge|[payer_SUTTER-YUBA COUNTY MHS|MANAGED MEDICAID] |percent standard_charge|[payer_SUTTER-YUBA COUNTY MHS|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUTTER-YUBA COUNTY MHS|MANAGED MEDICAID] standard_charge|[payer_TEHAMA COUNTY HSA|MANAGED MEDICAID] standard_charge|[payer_TEHAMA COUNTY HSA|MANAGED MEDICAID] |percent standard_charge|[payer_TEHAMA COUNTY HSA|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TEHAMA COUNTY HSA|MANAGED MEDICAID] standard_charge|[payer_TRICARE WEST|TRICARE] standard_charge|[payer_TRICARE WEST|TRICARE] |percent standard_charge|[payer_TRICARE WEST|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE WEST|TRICARE] standard_charge|[payer_TULARE COUNTY|MANAGED MEDICAID] standard_charge|[payer_TULARE COUNTY|MANAGED MEDICAID] |percent standard_charge|[payer_TULARE COUNTY|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TULARE COUNTY|MANAGED MEDICAID] standard_charge|[payer_TUOLUMNE COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_TUOLUMNE COUNTY BH|MANAGED MEDICAID] |percent standard_charge|[payer_TUOLUMNE COUNTY BH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TUOLUMNE COUNTY BH|MANAGED MEDICAID] standard_charge|[payer_UMR|COMMERCIAL] standard_charge|[payer_UMR|COMMERCIAL] |percent standard_charge|[payer_UMR|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UMR|COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE (AARP)|COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE (AARP)|COMMERCIAL] |percent standard_charge|[payer_UNITED HEALTHCARE (AARP)|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE (AARP)|COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE OPTIONS|COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE OPTIONS|COMMERCIAL] |percent standard_charge|[payer_UNITED HEALTHCARE OPTIONS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE OPTIONS|COMMERCIAL] standard_charge|[payer_VHP COMMERCIAL|HMO/PPO] standard_charge|[payer_VHP COMMERCIAL|HMO/PPO] |percent standard_charge|[payer_VHP COMMERCIAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_VHP COMMERCIAL|HMO/PPO] standard_charge|[payer_VHP COVERED CALIFORNIA|HMO/PPO] standard_charge|[payer_VHP COVERED CALIFORNIA|HMO/PPO] |percent standard_charge|[payer_VHP COVERED CALIFORNIA|HMO/PPO] |contracting_method additional_payer_notes |[payer_VHP COVERED CALIFORNIA|HMO/PPO] standard_charge|[payer_WESTERN GROWERS ASSURANCE|COMMERCIAL] standard_charge|[payer_WESTERN GROWERS ASSURANCE|COMMERCIAL] |percent standard_charge|[payer_WESTERN GROWERS ASSURANCE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_WESTERN GROWERS ASSURANCE|COMMERCIAL] standard_charge|[payer_YOLO COUNTY HHSA|MANAGED MEDICAID] standard_charge|[payer_YOLO COUNTY HHSA|MANAGED MEDICAID] |percent standard_charge|[payer_YOLO COUNTY HHSA|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_YOLO COUNTY HHSA|MANAGED MEDICAID] ROOM AND BOARD ADOLESCENTESCENT PSYCH 1 124 RC facility inpatient 2895.00 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 1476.25 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 2895.00 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 1476.25 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 2895.00 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 1476.25 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 2895.00 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 2895.00 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 2895.00 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 529.00 0 529 577.5 577.5 per diem 577.5 per diem 529 per diem 529 per diem 529 per diem 529 per diem 577.5 per diem 577.5 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT PSYCH 905 RC facility outpatient 725.00 500 115.09 725 624 per diem 292 per diem 386 per diem 386 per diem 386 386 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 391.4 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 115.09 per diem 725 per diem 363 per diem 330 per diem INTENSIVE OUTPATIENT PROGRAM ADULT/GERIACTRIC PSYCH 905 RC facility outpatient 725.00 500 115.09 725 624 per diem 292 per diem 386 per diem 386 per diem 386 386 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 391.4 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 115.09 per diem 725 per diem 363 per diem 330 per diem INTENSIVE OUTPATIENT PROGRAM TELE ADULT PSYCH 905 RC facility outpatient 725.00 500 115.09 725 624 per diem 292 per diem 386 per diem 386 per diem 386 386 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 391.4 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 115.09 per diem 725 per diem 363 per diem 330 per diem SCRUZ INTENSIVE OUTPATIENT PROGRAM ADULT/GERIACTRIC 905 RC facility outpatient 725.00 500 115.09 725 624 per diem 292 per diem 386 per diem 386 per diem 386 386 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 391.4 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 115.09 per diem 725 per diem 363 per diem 330 per diem PARTIAL HOSPITAL PROGRAM TRI PROCESS GROUP 912 RC facility outpatient 300.00 800 350 1450 858 per diem 611 per diem 611 per diem 611 611 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 612.85 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 1450.00 800 350 1450 858 per diem 611 per diem 611 per diem 611 611 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 612.85 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 1450.00 800 350 1450 858 per diem 611 per diem 611 per diem 611 611 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 612.85 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 1450.00 800 350 1450 858 per diem 611 per diem 611 per diem 611 611 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 612.85 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 1450.00 800 350 1450 858 per diem 611 per diem 611 per diem 611 611 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 612.85 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 1450.00 800 350 1450 858 per diem 611 per diem 611 per diem 611 611 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 612.85 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 195.00 0 408.99 584 584 per diem 408.99 per diem PARTIAL HOSPITAL PROGRAM MOTORIC CONGNITIVE RISK/TREATMENT PROCESS 915 RC facility outpatient 300.00 0 408.99 584 584 per diem 408.99 per diem PARTIAL HOSPITAL PROGRAM TRICARE ADOLESCENT 915 RC facility outpatient 300.00 0 408.99 584 584 per diem 408.99 per diem SCRUZ PROCESS GROUP 915 RC facility outpatient 300.00 0 408.99 584 584 per diem 408.99 per diem