"hospital_PHC of Utah, LLC" last_updated_ 2023-12-31 version_1 "hospital_Midvale, Utah" hospital_address 7309 S. 180W license_ 2022-HOSP-184 | UT "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_AARP MCR SUPPLEMENT COMMERCIAL] standard_charge|[payer_AARP MCR SUPPLEMENT COMMERCIAL] |percent standard_charge|[payer_AARP MCR SUPPLEMENT COMMERCIAL] |contracting_method additional_payer_notes |[payer_AARP MCR SUPPLEMENT COMMERCIAL] standard_charge|[payer_AARP MCR SUPPLEMENT HMO/PPO] standard_charge|[payer_AARP MCR SUPPLEMENT HMO/PPO] |percent standard_charge|[payer_AARP MCR SUPPLEMENT HMO/PPO] |contracting_method additional_payer_notes |[payer_AARP MCR SUPPLEMENT HMO/PPO] 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 ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE ADVANTAGE MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE ADVANTAGE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_ALLEGIANCE HMO/PPO] standard_charge|[payer_ALLEGIANCE HMO/PPO] |percent standard_charge|[payer_ALLEGIANCE HMO/PPO] |contracting_method additional_payer_notes |[payer_ALLEGIANCE HMO/PPO] standard_charge|[payer_AMERIBEN HMO/PPO] standard_charge|[payer_AMERIBEN HMO/PPO] |percent standard_charge|[payer_AMERIBEN HMO/PPO] |contracting_method additional_payer_notes |[payer_AMERIBEN HMO/PPO] standard_charge|[payer_BCBS FEP BLUE CROSS] standard_charge|[payer_BCBS FEP BLUE CROSS] |percent standard_charge|[payer_BCBS FEP BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS FEP BLUE CROSS] standard_charge|[payer_BCBS MEDICARE ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE ADVANTAGE MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MEDICARE ADVANTAGE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MEDICARE ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_BCBS OF UTAH BLUE CROSS] standard_charge|[payer_BCBS OF UTAH BLUE CROSS] |percent standard_charge|[payer_BCBS OF UTAH BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF UTAH BLUE CROSS] standard_charge|[payer_BCBS OOS BLUE CROSS] standard_charge|[payer_BCBS OOS BLUE CROSS] |percent standard_charge|[payer_BCBS OOS BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OOS BLUE CROSS] standard_charge|[payer_BEACON HMO/PPO] standard_charge|[payer_BEACON HMO/PPO] |percent standard_charge|[payer_BEACON HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HMO/PPO] standard_charge|[payer_CHAMPVA VETERANS ADMIN] standard_charge|[payer_CHAMPVA VETERANS ADMIN] |percent standard_charge|[payer_CHAMPVA VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_CHAMPVA VETERANS ADMIN] standard_charge|[payer_CIGNA BEHAVIORAL HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL HMO/PPO] standard_charge|[payer_CIGNA GREAT WEST HMO/PPO] standard_charge|[payer_CIGNA GREAT WEST HMO/PPO] |percent standard_charge|[payer_CIGNA GREAT WEST HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA GREAT WEST HMO/PPO] standard_charge|[payer_CIGNA SUPPLEMENTAL COMMERCIAL] standard_charge|[payer_CIGNA SUPPLEMENTAL COMMERCIAL] |percent standard_charge|[payer_CIGNA SUPPLEMENTAL COMMERCIAL] |contracting_method additional_payer_notes |[payer_CIGNA SUPPLEMENTAL COMMERCIAL] standard_charge|[payer_CNIC HMO/PPO] standard_charge|[payer_CNIC HMO/PPO] |percent standard_charge|[payer_CNIC HMO/PPO] |contracting_method additional_payer_notes |[payer_CNIC HMO/PPO] 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_COVENTRY HMO/PPO] standard_charge|[payer_COVENTRY HMO/PPO] |percent standard_charge|[payer_COVENTRY HMO/PPO] |contracting_method additional_payer_notes |[payer_COVENTRY HMO/PPO] standard_charge|[payer_CRIME VICTIMS COMMERCIAL] standard_charge|[payer_CRIME VICTIMS COMMERCIAL] |percent standard_charge|[payer_CRIME VICTIMS COMMERCIAL] |contracting_method additional_payer_notes |[payer_CRIME VICTIMS COMMERCIAL] standard_charge|[payer_DESERET MUTUAL BEN ADMIN HMO/PPO] standard_charge|[payer_DESERET MUTUAL BEN ADMIN HMO/PPO] |percent standard_charge|[payer_DESERET MUTUAL BEN ADMIN HMO/PPO] |contracting_method additional_payer_notes |[payer_DESERET MUTUAL BEN ADMIN HMO/PPO] standard_charge|[payer_DIRECT CARE ADMINISTRATOR HMO/PPO] standard_charge|[payer_DIRECT CARE ADMINISTRATOR HMO/PPO] |percent standard_charge|[payer_DIRECT CARE ADMINISTRATOR HMO/PPO] |contracting_method additional_payer_notes |[payer_DIRECT CARE ADMINISTRATOR HMO/PPO] standard_charge|[payer_EBMS COMMERCIAL] standard_charge|[payer_EBMS COMMERCIAL] |percent standard_charge|[payer_EBMS COMMERCIAL] |contracting_method additional_payer_notes |[payer_EBMS COMMERCIAL] standard_charge|[payer_EBMS COMMERCIAL PHYSICIAN] standard_charge|[payer_EBMS COMMERCIAL PHYSICIAN] |percent standard_charge|[payer_EBMS COMMERCIAL PHYSICIAN] |contracting_method additional_payer_notes |[payer_EBMS COMMERCIAL PHYSICIAN] standard_charge|[payer_EIGHTH DISTRICT ELECTRICA HMO/PPO] standard_charge|[payer_EIGHTH DISTRICT ELECTRICA HMO/PPO] |percent standard_charge|[payer_EIGHTH DISTRICT ELECTRICA HMO/PPO] |contracting_method additional_payer_notes |[payer_EIGHTH DISTRICT ELECTRICA HMO/PPO] standard_charge|[payer_EMI HMO/PPO] standard_charge|[payer_EMI HMO/PPO] |percent standard_charge|[payer_EMI HMO/PPO] |contracting_method additional_payer_notes |[payer_EMI HMO/PPO] standard_charge|[payer_FIRST HEALTH HMO/PPO] standard_charge|[payer_FIRST HEALTH HMO/PPO] |percent standard_charge|[payer_FIRST HEALTH HMO/PPO] |contracting_method additional_payer_notes |[payer_FIRST HEALTH HMO/PPO] standard_charge|[payer_GEHA HMO/PPO] standard_charge|[payer_GEHA HMO/PPO] |percent standard_charge|[payer_GEHA HMO/PPO] |contracting_method additional_payer_notes |[payer_GEHA HMO/PPO] standard_charge|[payer_HEALTH EZ HMO/PPO] standard_charge|[payer_HEALTH EZ HMO/PPO] |percent standard_charge|[payer_HEALTH EZ HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTH EZ HMO/PPO] standard_charge|[payer_HEALTH PARTNERS HMO/PPO] standard_charge|[payer_HEALTH PARTNERS HMO/PPO] |percent standard_charge|[payer_HEALTH PARTNERS HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTH PARTNERS HMO/PPO] standard_charge|[payer_HEALTH UTAH HMO/PPO] standard_charge|[payer_HEALTH UTAH HMO/PPO] |percent standard_charge|[payer_HEALTH UTAH HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTH UTAH HMO/PPO] standard_charge|[payer_HEALTHY ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_HEALTHY ADVANTAGE MANAGED MEDICARE] |percent standard_charge|[payer_HEALTHY ADVANTAGE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HEALTHY ADVANTAGE MANAGED MEDICARE] 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 MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE MANAGED MEDICARE] standard_charge|[payer_IBEW HMO/PPO] standard_charge|[payer_IBEW HMO/PPO] |percent standard_charge|[payer_IBEW HMO/PPO] |contracting_method additional_payer_notes |[payer_IBEW HMO/PPO] standard_charge|[payer_IRONWORKERS TRUST FUND HMO/PPO] standard_charge|[payer_IRONWORKERS TRUST FUND HMO/PPO] |percent standard_charge|[payer_IRONWORKERS TRUST FUND HMO/PPO] |contracting_method additional_payer_notes |[payer_IRONWORKERS TRUST FUND HMO/PPO] standard_charge|[payer_JAS HMO/PPO] standard_charge|[payer_JAS HMO/PPO] |percent standard_charge|[payer_JAS HMO/PPO] |contracting_method additional_payer_notes |[payer_JAS HMO/PPO] standard_charge|[payer_JJS HMO/PPO] standard_charge|[payer_JJS HMO/PPO] |percent standard_charge|[payer_JJS HMO/PPO] |contracting_method additional_payer_notes |[payer_JJS HMO/PPO] standard_charge|[payer_KAISER HMO/PPO] standard_charge|[payer_KAISER HMO/PPO] |percent standard_charge|[payer_KAISER HMO/PPO] |contracting_method additional_payer_notes |[payer_KAISER HMO/PPO] standard_charge|[payer_LDS SOCIAL SERVICES HMO/PPO] standard_charge|[payer_LDS SOCIAL SERVICES HMO/PPO] |percent standard_charge|[payer_LDS SOCIAL SERVICES HMO/PPO] |contracting_method additional_payer_notes |[payer_LDS SOCIAL SERVICES HMO/PPO] standard_charge|[payer_LINE CO HMO/PPO] standard_charge|[payer_LINE CO HMO/PPO] |percent standard_charge|[payer_LINE CO HMO/PPO] |contracting_method additional_payer_notes |[payer_LINE CO HMO/PPO] 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_MAILHANDLERS HMO/PPO] standard_charge|[payer_MAILHANDLERS HMO/PPO] |percent standard_charge|[payer_MAILHANDLERS HMO/PPO] |contracting_method additional_payer_notes |[payer_MAILHANDLERS HMO/PPO] standard_charge|[payer_MANAGED HEALTH NETWORK HMO/PPO] standard_charge|[payer_MANAGED HEALTH NETWORK HMO/PPO] |percent standard_charge|[payer_MANAGED HEALTH NETWORK HMO/PPO] |contracting_method additional_payer_notes |[payer_MANAGED HEALTH NETWORK HMO/PPO] standard_charge|[payer_MEDICAID BEAR RIVER MANAGED MEDICAID] standard_charge|[payer_MEDICAID BEAR RIVER MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID BEAR RIVER MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID BEAR RIVER MANAGED MEDICAID] standard_charge|[payer_MEDICAID CENTRAL UTAH MANAGED MEDICAID] standard_charge|[payer_MEDICAID CENTRAL UTAH MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID CENTRAL UTAH MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID CENTRAL UTAH MANAGED MEDICAID] standard_charge|[payer_MEDICAID DAVIS MANAGED MEDICAID] standard_charge|[payer_MEDICAID DAVIS MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID DAVIS MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID DAVIS MANAGED MEDICAID] standard_charge|[payer_MEDICAID FOUR CORNERS MANAGED MEDICAID] standard_charge|[payer_MEDICAID FOUR CORNERS MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID FOUR CORNERS MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID FOUR CORNERS MANAGED MEDICAID] standard_charge|[payer_MEDICAID NORTHEASTERN MANAGED MEDICAID] standard_charge|[payer_MEDICAID NORTHEASTERN MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID NORTHEASTERN MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID NORTHEASTERN MANAGED MEDICAID] standard_charge|[payer_MEDICAID OPTUM MANAGED MEDICAID] standard_charge|[payer_MEDICAID OPTUM MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID OPTUM MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID OPTUM MANAGED MEDICAID] standard_charge|[payer_MEDICAID PENDING PENDING MEDICAID] standard_charge|[payer_MEDICAID PENDING PENDING MEDICAID] |percent standard_charge|[payer_MEDICAID PENDING PENDING MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID PENDING PENDING MEDICAID] standard_charge|[payer_MEDICAID SOUTHWEST MANAGED MEDICAID] standard_charge|[payer_MEDICAID SOUTHWEST MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID SOUTHWEST MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID SOUTHWEST MANAGED MEDICAID] standard_charge|[payer_MEDICAID WASATCH MANAGED MEDICAID] standard_charge|[payer_MEDICAID WASATCH MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID WASATCH MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID WASATCH MANAGED MEDICAID] standard_charge|[payer_MEDICAID WEBER MANAGED MEDICAID] standard_charge|[payer_MEDICAID WEBER MANAGED MEDICAID] |percent standard_charge|[payer_MEDICAID WEBER MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID WEBER MANAGED 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_MEDICARE MEDICARE PHYSICIAN] standard_charge|[payer_MEDICARE MEDICARE PHYSICIAN] |percent standard_charge|[payer_MEDICARE MEDICARE PHYSICIAN] |contracting_method additional_payer_notes |[payer_MEDICARE MEDICARE PHYSICIAN] standard_charge|[payer_MEDICARE AARP MANAGED MEDICARE] standard_charge|[payer_MEDICARE AARP MANAGED MEDICARE] |percent standard_charge|[payer_MEDICARE AARP MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE AARP MANAGED MEDICARE] standard_charge|[payer_MEDICARE CIGNA ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_MEDICARE CIGNA ADVANTAGE MANAGED MEDICARE] |percent standard_charge|[payer_MEDICARE CIGNA ADVANTAGE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE CIGNA ADVANTAGE MANAGED MEDICARE] standard_charge|[payer_MEDICARE MHNET MANAGED MEDICARE] standard_charge|[payer_MEDICARE MHNET MANAGED MEDICARE] |percent standard_charge|[payer_MEDICARE MHNET MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE MHNET MANAGED MEDICARE] standard_charge|[payer_MEDICARE MOLINA MANAGED MEDICARE] standard_charge|[payer_MEDICARE MOLINA MANAGED MEDICARE] |percent standard_charge|[payer_MEDICARE MOLINA MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE MOLINA MANAGED MEDICARE] 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_MHNET HMO/PPO] standard_charge|[payer_MHNET HMO/PPO] |percent standard_charge|[payer_MHNET HMO/PPO] |contracting_method additional_payer_notes |[payer_MHNET HMO/PPO] standard_charge|[payer_MOLINA MARKET PLACE HMO/PPO] standard_charge|[payer_MOLINA MARKET PLACE HMO/PPO] |percent standard_charge|[payer_MOLINA MARKET PLACE HMO/PPO] |contracting_method additional_payer_notes |[payer_MOLINA MARKET PLACE HMO/PPO] standard_charge|[payer_MOTIV HEALTH HMO/PPO] standard_charge|[payer_MOTIV HEALTH HMO/PPO] |percent standard_charge|[payer_MOTIV HEALTH HMO/PPO] |contracting_method additional_payer_notes |[payer_MOTIV HEALTH HMO/PPO] standard_charge|[payer_MULTIPLAN HMO/PPO] standard_charge|[payer_MULTIPLAN HMO/PPO] |percent standard_charge|[payer_MULTIPLAN HMO/PPO] |contracting_method additional_payer_notes |[payer_MULTIPLAN HMO/PPO] standard_charge|[payer_OXFORD HEALTH PLANS HMO/PPO] standard_charge|[payer_OXFORD HEALTH PLANS HMO/PPO] |percent standard_charge|[payer_OXFORD HEALTH PLANS HMO/PPO] |contracting_method additional_payer_notes |[payer_OXFORD HEALTH PLANS HMO/PPO] standard_charge|[payer_PACIFICSOURCE MEDICARE MANAGED MEDICARE] standard_charge|[payer_PACIFICSOURCE MEDICARE MANAGED MEDICARE] |percent standard_charge|[payer_PACIFICSOURCE MEDICARE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_PACIFICSOURCE MEDICARE MANAGED MEDICARE] standard_charge|[payer_PEHP ADVANTAGE HMO/PPO] standard_charge|[payer_PEHP ADVANTAGE HMO/PPO] |percent standard_charge|[payer_PEHP ADVANTAGE HMO/PPO] |contracting_method additional_payer_notes |[payer_PEHP ADVANTAGE HMO/PPO] standard_charge|[payer_PEHP ADVANTAGE PLAN HMO/PPO] standard_charge|[payer_PEHP ADVANTAGE PLAN HMO/PPO] |percent standard_charge|[payer_PEHP ADVANTAGE PLAN HMO/PPO] |contracting_method additional_payer_notes |[payer_PEHP ADVANTAGE PLAN HMO/PPO] standard_charge|[payer_PEHP PREFERRED PLAN HMO/PPO] standard_charge|[payer_PEHP PREFERRED PLAN HMO/PPO] |percent standard_charge|[payer_PEHP PREFERRED PLAN HMO/PPO] |contracting_method additional_payer_notes |[payer_PEHP PREFERRED PLAN HMO/PPO] standard_charge|[payer_PEHP SUMMIT HMO/PPO] standard_charge|[payer_PEHP SUMMIT HMO/PPO] |percent standard_charge|[payer_PEHP SUMMIT HMO/PPO] |contracting_method additional_payer_notes |[payer_PEHP SUMMIT HMO/PPO] standard_charge|[payer_RECOVERY WAYS HMO/PPO] standard_charge|[payer_RECOVERY WAYS HMO/PPO] |percent standard_charge|[payer_RECOVERY WAYS HMO/PPO] |contracting_method additional_payer_notes |[payer_RECOVERY WAYS HMO/PPO] standard_charge|[payer_SELECT HEALTH MEDICARE MANAGED MEDICARE] standard_charge|[payer_SELECT HEALTH MEDICARE MANAGED MEDICARE] |percent standard_charge|[payer_SELECT HEALTH MEDICARE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_SELECT HEALTH MEDICARE MANAGED MEDICARE] standard_charge|[payer_TALL TREE HMO/PPO] standard_charge|[payer_TALL TREE HMO/PPO] |percent standard_charge|[payer_TALL TREE HMO/PPO] |contracting_method additional_payer_notes |[payer_TALL TREE HMO/PPO] standard_charge|[payer_TEAMSTERS GROUP BENEFITS HMO/PPO] standard_charge|[payer_TEAMSTERS GROUP BENEFITS HMO/PPO] |percent standard_charge|[payer_TEAMSTERS GROUP BENEFITS HMO/PPO] |contracting_method additional_payer_notes |[payer_TEAMSTERS GROUP BENEFITS HMO/PPO] standard_charge|[payer_TRICARE TRICARE] standard_charge|[payer_TRICARE TRICARE] |percent standard_charge|[payer_TRICARE TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE TRICARE] standard_charge|[payer_TRIWEST VETERANS ADMIN] standard_charge|[payer_TRIWEST VETERANS ADMIN] |percent standard_charge|[payer_TRIWEST VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_TRIWEST VETERANS ADMIN] standard_charge|[payer_UBH HMO/PPO] standard_charge|[payer_UBH HMO/PPO] |percent standard_charge|[payer_UBH HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH HMO/PPO] standard_charge|[payer_UH1 HMO/PPO] standard_charge|[payer_UH1 HMO/PPO] |percent standard_charge|[payer_UH1 HMO/PPO] |contracting_method additional_payer_notes |[payer_UH1 HMO/PPO] standard_charge|[payer_UHC MEDICARE COMPLETE MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE COMPLETE MANAGED MEDICARE] |percent standard_charge|[payer_UHC MEDICARE COMPLETE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC MEDICARE COMPLETE MANAGED MEDICARE] standard_charge|[payer_UNI BEHAV HEALTH NETWORK COMMERCIAL] standard_charge|[payer_UNI BEHAV HEALTH NETWORK COMMERCIAL] |percent standard_charge|[payer_UNI BEHAV HEALTH NETWORK COMMERCIAL] |contracting_method additional_payer_notes |[payer_UNI BEHAV HEALTH NETWORK COMMERCIAL] standard_charge|[payer_UNITED MEDICAL RESOURCES HMO/PPO] standard_charge|[payer_UNITED MEDICAL RESOURCES HMO/PPO] |percent standard_charge|[payer_UNITED MEDICAL RESOURCES HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED MEDICAL RESOURCES HMO/PPO] standard_charge|[payer_UTAH LABORERS HMO/PPO] standard_charge|[payer_UTAH LABORERS HMO/PPO] |percent standard_charge|[payer_UTAH LABORERS HMO/PPO] |contracting_method additional_payer_notes |[payer_UTAH LABORERS HMO/PPO] standard_charge|[payer_UTAH PIPE TRADES HMO/PPO] standard_charge|[payer_UTAH PIPE TRADES HMO/PPO] |percent standard_charge|[payer_UTAH PIPE TRADES HMO/PPO] |contracting_method additional_payer_notes |[payer_UTAH PIPE TRADES HMO/PPO] standard_charge|[payer_WEB TPA HMO/PPO] standard_charge|[payer_WEB TPA HMO/PPO] |percent standard_charge|[payer_WEB TPA HMO/PPO] |contracting_method additional_payer_notes |[payer_WEB TPA HMO/PPO] standard_charge|[payer_WISE HMO/PPO] standard_charge|[payer_WISE HMO/PPO] |percent standard_charge|[payer_WISE HMO/PPO] |contracting_method additional_payer_notes |[payer_WISE HMO/PPO] standard_charge|[payer_WORKERS COMPENSATION FUND WORKERS COMP] standard_charge|[payer_WORKERS COMPENSATION FUND WORKERS COMP] |percent standard_charge|[payer_WORKERS COMPENSATION FUND WORKERS COMP] |contracting_method additional_payer_notes |[payer_WORKERS COMPENSATION FUND WORKERS COMP] ROOM AND BOARD PSYCH ADOLES 124 RC facility inpatient 2200.00 800 479 2200 956 per diem 894 per diem 894 per diem 993 per diem 894 per diem 845 per diem 845 per diem 845 per diem 1000 per diem 929.78 per diem 993 per diem 993 per diem 993 per diem 709 per diem 850 per diem 894 per diem 2200 per diem 900 per diem 900 per diem 2200 per diem 993 per diem 950 per diem 894 per diem 956 per diem 900 per diem 993 per diem 900 per diem 800 per diem 993 per diem 993 per diem 709 per diem 2200 per diem 2200 per diem 800 per diem 1000 per diem 900 per diem 956 per diem 717 per diem 850 per diem 770 per diem 479 per diem 1085 per diem 925 per diem 756 per diem 850 per diem 754 per diem 700 per diem 956 per diem 750 per diem 894 per diem 750 per diem 743.73 per diem 900 per diem 792 per diem 956 per diem 864 per diem 864 per diem 864 per diem 800 per diem 709 per diem 993 per diem 1274.9 per diem 956 per diem 956 per diem 956 per diem 850 per diem 956 per diem 709 per diem 709 per diem 709 per diem 709 per diem 2200 per diem ROOM AND BOARD PSYCH ADULT 124 RC facility inpatient 2200.00 800 479 2200 956 per diem 894 per diem 894 per diem 993 per diem 894 per diem 845 per diem 845 per diem 845 per diem 1000 per diem 929.78 per diem 993 per diem 993 per diem 993 per diem 709 per diem 850 per diem 894 per diem 2200 per diem 900 per diem 900 per diem 2200 per diem 993 per diem 950 per diem 894 per diem 956 per diem 900 per diem 993 per diem 900 per diem 800 per diem 993 per diem 993 per diem 709 per diem 2200 per diem 2200 per diem 800 per diem 1000 per diem 900 per diem 956 per diem 717 per diem 850 per diem 770 per diem 479 per diem 1085 per diem 925 per diem 756 per diem 850 per diem 754 per diem 700 per diem 956 per diem 750 per diem 894 per diem 750 per diem 743.73 per diem 900 per diem 792 per diem 956 per diem 864 per diem 864 per diem 864 per diem 800 per diem 709 per diem 993 per diem 1274.9 per diem 956 per diem 956 per diem 956 per diem 850 per diem 956 per diem 709 per diem 709 per diem 709 per diem 709 per diem 2200 per diem ROOM AND BOARD PSYCH GERI 124 RC facility inpatient 2200.00 800 479 2200 956 per diem 894 per diem 894 per diem 993 per diem 894 per diem 845 per diem 845 per diem 845 per diem 1000 per diem 929.78 per diem 993 per diem 993 per diem 993 per diem 709 per diem 850 per diem 894 per diem 2200 per diem 900 per diem 900 per diem 2200 per diem 993 per diem 950 per diem 894 per diem 956 per diem 900 per diem 993 per diem 900 per diem 800 per diem 993 per diem 993 per diem 709 per diem 2200 per diem 2200 per diem 800 per diem 1000 per diem 900 per diem 956 per diem 717 per diem 850 per diem 770 per diem 479 per diem 1085 per diem 925 per diem 756 per diem 850 per diem 754 per diem 700 per diem 956 per diem 750 per diem 894 per diem 750 per diem 743.73 per diem 900 per diem 792 per diem 956 per diem 864 per diem 864 per diem 864 per diem 800 per diem 709 per diem 993 per diem 1274.9 per diem 956 per diem 956 per diem 956 per diem 850 per diem 956 per diem 709 per diem 709 per diem 709 per diem 709 per diem 2200 per diem ROOM AND BOARD DETOX ADULT 126 RC facility inpatient 2200.00 800 709 2200 956 per diem 739 per diem 739 per diem 993 per diem 739 per diem 845 per diem 845 per diem 845 per diem 1000 per diem 929.78 per diem 993 per diem 993 per diem 993 per diem 709 per diem 850 per diem 739 per diem 2200 per diem 950 per diem 900 per diem 2200 per diem 993 per diem 725 per diem 793 per diem 956 per diem 900 per diem 993 per diem 900 per diem 800 per diem 993 per diem 993 per diem 709 per diem 2200 per diem 800 per diem 1000 per diem 715 per diem 956 per diem 717 per diem 956 per diem 750 per diem 739 per diem 750 per diem 743.73 per diem 900 per diem 792 per diem 956 per diem 783 per diem 783 per diem 783 per diem 800 per diem 709 per diem 993 per diem 1274.9 per diem 956 per diem 956 per diem 956 per diem 850 per diem 956 per diem 709 per diem 709 per diem 709 per diem 709 per diem 2200 per diem ROOM AND BOARD REHAB ADULT 128 RC facility inpatient 2200.00 700 645 2200 956 per diem 701 per diem 701 per diem 862 per diem 701 per diem 845 per diem 845 per diem 1000 per diem 862 per diem 862 per diem 862 per diem 709 per diem 725 per diem 701 per diem 900 per diem 900 per diem 2200 per diem 862 per diem 701 per diem 956 per diem 800 per diem 862 per diem 800 per diem 700 per diem 862 per diem 862 per diem 709 per diem 2200 per diem 700 per diem 664 per diem 677 per diem 956 per diem 645 per diem 956 per diem 745 per diem 701 per diem 745 per diem 800 per diem 792 per diem 956 per diem 700 per diem 709 per diem 862 per diem 1274.9 per diem 956 per diem 956 per diem 956 per diem 850 per diem 956 per diem 709 per diem 709 per diem 709 per diem 709 per diem INTENSIVE OUTPATIENT PROGRAM ADULT MH 905 RC facility outpatient 500.00 125 120 1050 146 per diem 146 per diem 211 per diem 146 per diem 164 per diem 164 per diem 164 per diem 350 per diem 211 per diem 211 per diem 422 per diem 137 per diem 180 per diem 292 per diem 500 per diem 190 per diem 500 per diem 422 per diem 150 per diem 292 per diem 195 per diem 190 per diem 422 per diem 190 per diem 200 per diem 422 per diem 422 per diem 700 per diem 183 per diem 144 per diem 230 per diem 230 per diem 292 per diem 210 per diem 120 per diem 450 per diem 1050 per diem 195 per diem 151 per diem 151 per diem 151 per diem 137 per diem 422 per diem 195 per diem 195 per diem 195 per diem 230 per diem 195 per diem 137 per diem 137 per diem 137 per diem 137 per diem INTENSIVE OUTPATIENT PROGRAM MENTAL HEALTH 905 RC facility outpatient 500.00 125 120 1050 146 per diem 146 per diem 211 per diem 146 per diem 164 per diem 164 per diem 164 per diem 350 per diem 211 per diem 211 per diem 422 per diem 137 per diem 180 per diem 292 per diem 500 per diem 190 per diem 500 per diem 422 per diem 150 per diem 292 per diem 195 per diem 190 per diem 422 per diem 190 per diem 200 per diem 422 per diem 422 per diem 700 per diem 183 per diem 144 per diem 230 per diem 230 per diem 292 per diem 210 per diem 120 per diem 450 per diem 1050 per diem 195 per diem 151 per diem 151 per diem 151 per diem 137 per diem 422 per diem 195 per diem 195 per diem 195 per diem 230 per diem 195 per diem 137 per diem 137 per diem 137 per diem 137 per diem INTENSIVE OUTPATIENT PROGRAM CHEM DEP PROGRAM 906 RC facility outpatient 500.00 125 120 1050 194 per diem 146 per diem 146 per diem 211 per diem 146 per diem 164 per diem 164 per diem 164 per diem 350 per diem 211 per diem 211 per diem 422 per diem 137 per diem 160 per diem 292 per diem 500 per diem 250 per diem 190 per diem 500 per diem 422 per diem 150 per diem 292 per diem 185 per diem 190 per diem 422 per diem 340 per diem 200 per diem 422 per diem 422 per diem 125 per diem 700 per diem 183 per diem 185 per diem 144 per diem 230 per diem 230 per diem 185 per diem 292 per diem 210 per diem 120 per diem 190 per diem 1050 per diem 185 per diem 151 per diem 151 per diem 151 per diem 137 per diem 422 per diem 185 per diem 185 per diem 185 per diem 230 per diem 185 per diem 137 per diem 137 per diem 137 per diem 137 per diem PARTIAL HOSPITAL PROGRAM CHEM DEP PROGRAM 912 RC facility outpatient 875.00 275 204.44 7260 389 per diem 483 per diem 483 per diem 471 per diem 483 per diem 383 per diem 216.79 per diem 383 per diem 383 per diem 500 per diem 471 per diem 471 per diem 942 per diem 328 per diem 350 per diem 966 per diem 875 per diem 300 per diem 450 per diem 875 per diem 942 per diem 350 per diem 966 per diem 740 per diem 450 per diem 942 per diem 850 per diem 216.79 per diem 300 per diem 216.79 per diem 942 per diem 942 per diem 275 per diem 1000 per diem 386 per diem 370 per diem 331 per diem 810 per diem 810 per diem 740 per diem 216.79 per diem 395 per diem 216.79 per diem 966 per diem 395 per diem 250 per diem 450 per diem 7260 per diem 740 per diem 216.79 per diem 324 per diem 324 per diem 324 per diem 294 per diem 328 per diem 942 per diem 204.44 per diem 740 per diem 740 per diem 370 per diem 810 per diem 740 per diem 328 per diem 328 per diem 328 per diem 328 per diem PARTIAL HOSPITAL PROGRAM PSYCH PROGRAM 913 RC facility outpatient 875.00 275 204.44 1320 483 per diem 483 per diem 471 per diem 483 per diem 383 per diem 216.79 per diem 383 per diem 383 per diem 500 per diem 471 per diem 471 per diem 942 per diem 328 per diem 380 per diem 966 per diem 875 per diem 300 per diem 450 per diem 875 per diem 942 per diem 350 per diem 966 per diem 740 per diem 450 per diem 942 per diem 850 per diem 216.79 per diem 300 per diem 216.79 per diem 942 per diem 942 per diem 275 per diem 1000 per diem 386 per diem 370 per diem 358 per diem 810 per diem 810 per diem 740 per diem 216.79 per diem 395 per diem 216.79 per diem 966 per diem 395 per diem 260 per diem 450 per diem 1320 per diem 740 per diem 216.79 per diem 324 per diem 324 per diem 324 per diem 294 per diem 328 per diem 942 per diem 204.44 per diem 740 per diem 740 per diem 370 per diem 810 per diem 740 per diem 328 per diem 328 per diem 328 per diem 328 per diem INTENSIVE OUTPATIENT PROGRAM CD MCR GRP THER 915 RC facility outpatient 190.00 0 204.44 710 469 per diem 216.79 per diem 216.79 per diem 216.79 per diem 439.45 per diem 710 per diem 216.79 per diem 216.79 per diem 216.79 per diem 204.44 per diem 204.44 per diem 216.79 per diem INTENSIVE OUTPATIENT PROGRAM MEDICARE PANEL 915 RC facility outpatient 190.00 0 204.44 710 469 per diem 216.79 per diem 216.79 per diem 216.79 per diem 439.45 per diem 710 per diem 216.79 per diem 216.79 per diem 216.79 per diem 204.44 per diem 204.44 per diem 216.79 per diem PARTIAL HOSPITAL PROGRAM CD MCR GRP THERA 915 RC facility outpatient 190.00 0 204.44 710 469 per diem 216.79 per diem 216.79 per diem 216.79 per diem 439.45 per diem 710 per diem 216.79 per diem 216.79 per diem 216.79 per diem 204.44 per diem 204.44 per diem 216.79 per diem PARTIAL HOSPITAL PROGRAM GRP THERAPY MCR 915 RC facility outpatient 180.00 0 204.44 710 469 per diem 216.79 per diem 216.79 per diem 216.79 per diem 439.45 per diem 710 per diem 216.79 per diem 216.79 per diem 216.79 per diem 204.44 per diem 204.44 per diem 216.79 per diem TRICARE INTENSIVE OUTPATIENT PROGRAM 915 RC facility outpatient 105.00 0 204.44 710 469 per diem 216.79 per diem 216.79 per diem 216.79 per diem 439.45 per diem 710 per diem 216.79 per diem 216.79 per diem 216.79 per diem 204.44 per diem 204.44 per diem 216.79 per diem PSYCH EVAL 961 RC facility outpatient 210.00 0 210 210 210 per diem INPATIENT H&P 30 MIN 5212 RC facility outpatient 200.00 0 80.91 80.91 80.91 per diem PARTIAL HOSPITAL PROGRAM H&P 30 MIN 5212 RC facility outpatient 200.00 0 80.91 80.91 80.91 per diem INPATIENT H&P 50 MIN 5213 RC facility outpatient 92.22 0 126.88 126.88 126.88 per diem PARTIAL HOSPITAL PROGRAM H&P 50 MIN 5213 RC facility outpatient 200.00 0 126.88 126.88 126.88 per diem INPATIENT H&P 70 MIN 5214 RC facility outpatient 992.23 0 169.22 169.22 169.22 per diem PARTIAL HOSPITAL PROGRAM H&P 70 MIN 5214 RC facility outpatient 300.00 0 169.22 169.22 169.22 per diem SUBSEQUENT HOSP 15 M 5215 RC facility outpatient 120.00 0 48.43 120 120 per diem 48.43 per diem SUBSEQUENT PARTIAL HOSPITAL PROGRAM 15 M 5215 RC facility outpatient 120.00 0 48.43 120 120 per diem 48.43 per diem SUBSEQUENT HOSP 25 M 5216 RC facility outpatient 160.00 0 77.17 160 160 per diem 77.17 per diem SUBSEQUENT PARTIAL HOSPITAL PROGRAM 25 M 5216 RC facility outpatient 140.00 0 77.17 160 160 per diem 77.17 per diem SUBSEQUENT HOSP 35 M 5217 RC facility outpatient 160.00 0 116.1 160 160 per diem 116.1 per diem SUBSEQUENT PARTIAL HOSPITAL PROGRAM 35 M 5217 RC facility outpatient 160.00 0 116.1 160 160 per diem 116.1 per diem HOSP D/C MNGMNT 5218 RC facility outpatient 110.00 0 116.1 180 180 per diem 116.1 per diem HOSPITAL DC 5218 RC facility outpatient 180.00 0 78.53 180 180 78.53