"hospital_Ten Broeck Tampa, LLC""" last_updated_ 2023-12-31 version_1 "hospital_Wesley Chapel, Florida" hospital_address 29910 State Road 56 license_ 4514 | FL "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded in this machine-readable file is true, accurate, and complete as of the date indicated in this file" description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_ADVENTHEALTH DADECITY SCA ]|[plan_INDUSTRIAL] standard_charge|[payer_ADVENTHEALTH DADECITY SCA ]|[plan_INDUSTRIAL] |percent standard_charge|[payer_ADVENTHEALTH DADECITY SCA ]|[plan_INDUSTRIAL] |contracting_method additional_payer_notes |[payer_ADVENTHEALTH DADECITY SCA ]|[plan_INDUSTRIAL] standard_charge|[payer_ADVENTHEALTH ZPHYHLLS SCA ]|[plan_INDUSTRIAL] standard_charge|[payer_ADVENTHEALTH ZPHYHLLS SCA ]|[plan_INDUSTRIAL]|percent standard_charge|[payer_ADVENTHEALTH ZPHYHLLS SCA ]|[plan_INDUSTRIAL] |contracting_method additional_payer_notes |[payer_ADVENTHEALTH ZPHYHLLS SCA ]|[plan_INDUSTRIAL] standard_charge|[payer_AETNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_AETNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |percent standard_charge|[payer_AETNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_AETNA BETTER HEALTH OF FL ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH OF FL ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH OF FL ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH OF FL ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AETNA MEDICARE PPO ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE PPO ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE PPO ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE PPO ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_ALL SAVERS/UHC ]|[plan_ HMO/PPO] standard_charge|[payer_ALL SAVERS/UHC ]|[plan_ HMO/PPO] |percent standard_charge|[payer_ALL SAVERS/UHC ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_ALL SAVERS/UHC ]|[plan_ HMO/PPO] standard_charge|[payer_ALLWELL SUNSHINE MCR ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL SUNSHINE MCR ADV]|[plan_MANAGED MEDICARE] |percent standard_charge|[payer_ALLWELL SUNSHINE MCR ADV]|[plan_MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ALLWELL SUNSHINE MCR ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMBETTER SUNSHINE HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_AMBETTER SUNSHINE HEALTH ]|[plan_ HMO/PPO] |percent standard_charge|[payer_AMBETTER SUNSHINE HEALTH ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_AMBETTER SUNSHINE HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_BAYCARE PLUS MEDICARE ADV ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BAYCARE PLUS MEDICARE ADV ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_BAYCARE PLUS MEDICARE ADV ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BAYCARE PLUS MEDICARE ADV ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BLUE CROSS BLUE SHIELD ]|[plan_ BLUE CROSS] standard_charge|[payer_BLUE CROSS BLUE SHIELD ]|[plan_ BLUE CROSS] |percent standard_charge|[payer_BLUE CROSS BLUE SHIELD ]|[plan_ BLUE CROSS] |contracting_method additional_payer_notes |[payer_BLUE CROSS BLUE SHIELD ]|[plan_ BLUE CROSS] standard_charge|[payer_CARELON BEHAVIORAL HS COM ]|[plan_ HMO/PPO] standard_charge|[payer_CARELON BEHAVIORAL HS COM ]|[plan_ HMO/PPO] |percent standard_charge|[payer_CARELON BEHAVIORAL HS COM ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_CARELON BEHAVIORAL HS COM ]|[plan_ HMO/PPO] standard_charge|[payer_CARELON BEHAVIORAL HS MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_CARELON BEHAVIORAL HS MCD ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_CARELON BEHAVIORAL HS MCD ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CARELON BEHAVIORAL HS MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_CARELON BEHAVIORAL HS MCR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CARELON BEHAVIORAL HS MCR ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_CARELON BEHAVIORAL HS MCR ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CARELON BEHAVIORAL HS MCR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] standard_charge|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] |percent standard_charge|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_CIGNA OF HEALTH SPRINGS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CIGNA OF HEALTH SPRINGS ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA OF HEALTH SPRINGS ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA OF HEALTH SPRINGS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_FLORIDA COMMUNITY CARE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_FLORIDA COMMUNITY CARE ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_FLORIDA COMMUNITY CARE ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FLORIDA COMMUNITY CARE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |percent standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MAGELLAN MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MAGELLAN MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_MAGELLAN MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MAGELLAN MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |percent standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE ]|[plan_ MEDICARE] standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] |percent standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_MOLINA HEALTHCARE OF FL ]|[plan_ HMO/PPO] standard_charge|[payer_MOLINA HEALTHCARE OF FL ]|[plan_ HMO/PPO] |percent standard_charge|[payer_MOLINA HEALTHCARE OF FL ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[MOLINA HEALTHCARE OF FL ]|[plan_ HMO/PPO] standard_charge|[payer_MOLINA MCD MCC ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA MCD MCC ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA MCD MCC ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA MCD MCC ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_PASCO/PINELLAS COUNTY ]|[plan_ COMMERCIAL] standard_charge|[payer_PASCO/PINELLAS COUNTY ]|[plan_ COMMERCIAL] |percent standard_charge|[payer_PASCO/PINELLAS COUNTY ]|[plan_ COMMERCIAL] |contracting_method additional_payer_notes |[payer_PASCO/PINELLAS COUNTY ]|[plan_ COMMERCIAL] standard_charge|[payer_SUNSHINE HEALTH MEDICAID ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUNSHINE HEALTH MEDICAID ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_SUNSHINE HEALTH MEDICAID ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUNSHINE HEALTH MEDICAID ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUREST/CURRAN ]|[plan_ HMO/PPO] standard_charge|[payer_SUREST/CURRAN ]|[plan_ HMO/PPO] |percent standard_charge|[payer_SUREST/CURRAN ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_SUREST/CURRAN ]|[plan_ HMO/PPO] standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] |percent standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE EAST REGION ]|[plan_ TRICARE] standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] |percent standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] standard_charge|[payer_TRICARE WEST ]|[plan_ TRICARE] standard_charge|[payer_TRICARE WEST ]|[plan_ TRICARE] |percent standard_charge|[payer_TRICARE WEST ]|[plan_ TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE WEST ]|[plan_ TRICARE] standard_charge|[payer_UBH MEDICARE COMPLETE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE COMPLETE ]|[plan_ MANAGED MEDICARE] |percent standard_charge|[payer_UBH MEDICARE COMPLETE ]|[plan_ MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UBH MEDICARE COMPLETE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UMR ]|[plan_ HMO/PPO] standard_charge|[payer_UMR ]|[plan_ HMO/PPO] |percent standard_charge|[payer_UMR ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_UMR ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |percent standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL MEDICAI ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UNITED BEHAVIORAL MEDICAI ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_UNITED BEHAVIORAL MEDICAI ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UNITED BEHAVIORAL MEDICAI ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UNITED HEALTH OXFORD ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH OXFORD ]|[plan_ HMO/PPO] |percent standard_charge|[payer_UNITED HEALTH OXFORD ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTH OXFORD ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED STUDENT RESOURCES ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED STUDENT RESOURCES ]|[plan_ HMO/PPO] |percent standard_charge|[payer_UNITED STUDENT RESOURCES ]|[plan_ HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED STUDENT RESOURCES ]|[plan_ HMO/PPO] standard_charge|[payer_VA CCN OPTUM VETERANS ]|[plan_ ADMIN] standard_charge|[payer_VA CCN OPTUM VETERANS ]|[plan_ ADMIN] |percent standard_charge|[payer_VA CCN OPTUM VETERANS ]|[plan_ ADMIN] |contracting_method additional_payer_notes |[payer_VA CCN OPTUM VETERANS ]|[plan_ ADMIN] standard_charge|[payer_WELLCARE STAYWELL ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_WELLCARE STAYWELL ]|[plan_ MANAGED MEDICAID] |percent standard_charge|[payer_WELLCARE STAYWELL ]|[plan_ MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_WELLCARE STAYWELL ]|[plan_ MANAGED MEDICAID] PSYCH ADOL UNIT M 124 RC facility inpatient 2400 650 450 1155 450 per diem 450 per diem 987 per diem 800 per diem 987 per diem 910 per diem DRG DRG based on diagnose 960 DRG DRG based on diagnose 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem DRG DRG based on diagnose 990 per diem DRG DRG based on diagnose per diem 925 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 987 per diem DRG DRG based on diagnose 800 per diem 450 per diem 775 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 815 per diem 910 per diem 910 per diem 750 per diem 910 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose "PSYCH ADULT UNIT A, B, C, G" 124 RC facility inpatient 2400 650 450 1155 450 per diem 450 per diem 987 per diem 800 per diem 987 per diem 910 per diem DRG DRG based on diagnose 960 DRG DRG based on diagnose 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem DRG DRG based on diagnose 961 per diem DRG DRG based on diagnose 800 per diem 925 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 987 per diem DRG DRG based on diagnose 800 per diem 450 per diem 775 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 815 per diem 910 per diem 910 per diem 750 per diem 910 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose R&B DETOX ADULT 126 RC facility inpatient 2400 650 450 1155 450 per diem 450 per diem 987 per diem 800 per diem 987 per diem 910 per diem DRG DRG based on diagnose 960 DRG DRG based on diagnose 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem DRG DRG based on diagnose 961 per diem DRG DRG based on diagnose 800 per diem 925 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 987 per diem DRG DRG based on diagnose 800 per diem 450 per diem 775 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 815 per diem 910 per diem 910 per diem 750 per diem 910 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose R&B REHAB ADULT 128 RC facility inpatient 2400 650 450 1155 987 per diem 987 per diem 910 per diem DRG DRG based on diagnose 960 DRG DRG based on diagnose 1155 per diem 1155 per diem 945 per diem 909 per diem 909 per diem DRG DRG based on diagnose 961 per diem DRG DRG based on diagnose per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 987 per diem DRG DRG based on diagnose 450 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 815 per diem 910 per diem 750 per diem 910 per diem 910 per diem DRG DRG based on diagnose DRG DRG based on diagnose IOP ADULT PSYCH 905 RC facility outpatient 540 225 170 265 217 per diem 250 per diem 217 per diem 196 per diem DRG DRG based on diagnose 220 DRG DRG based on diagnose 265 per diem 265 per diem 225 per diem 229 per diem 229 per diem DRG DRG based on diagnose 225 per diem DRG DRG based on diagnose per diem 193 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 217 per diem DRG DRG based on diagnose 200 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 210 per diem 215 per diem 215 per diem 170 per diem 215 per diem 215 per diem DRG DRG based on diagnose DRG DRG based on diagnose IOP ADULT CD 906 RC facility outpatient 540 225 193 265 217 per diem 217 per diem 196 per diem DRG DRG based on diagnose 220 DRG DRG based on diagnose 265 per diem 265 per diem 225 per diem 229 per diem 229 per diem DRG DRG based on diagnose 225 per diem DRG DRG based on diagnose per diem 193 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 217 per diem DRG DRG based on diagnose 200 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 210 per diem 215 per diem 215 per diem 215 per diem DRG DRG based on diagnose DRG DRG based on diagnose PHP ADULT PSYCH 912 RC facility outpatient 875 350 272 450 421 per diem 400 per diem 421 per diem 415 per diem DRG DRG based on diagnose 320 DRG DRG based on diagnose 425 per diem 425 per diem 435 per diem 399 per diem 399 per diem DRG DRG based on diagnose 450 per diem DRG DRG based on diagnose per diem 272 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 421 per diem DRG DRG based on diagnose 325 per diem 300 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose 430 per diem 440 per diem 440 per diem 377 per diem per diem 440 per diem DRG DRG based on diagnose DRG DRG based on diagnose PHP INDIVIDUAL THER 914 RC facility outpatient 175 0 421 421 421 per diem DRG DRG based on diagnose DRG DRG based on diagnose per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose IOP CD PROCESS GROUP 915 RC facility outpatient 180 0 0 425 421 per diem DRG DRG based on diagnose DRG DRG based on diagnose per diem 425 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose IOP CD PSYCHOTHERAPY 915 RC facility outpatient 180 0 0 425 421 per diem DRG DRG based on diagnose DRG DRG based on diagnose per diem 425 per diem DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose DRG DRG based on diagnose