hospital_San Juan Capestrano Hospital 	last_updated_ 2023-12-31	version_1	"hospital_Rio Piedras, Puerto Rico"	hospital_address State Road 877 km1.6		license_55 | PR	"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_ACAA|Local Government]	standard_charge|[payer_ACAA|Local Government] |percent	standard_charge|[payer_ACAA|Local Government] |contracting_method	additional_payer_notes |[payer_ACAA|Local Government]	standard_charge|[payer_AETNA LIFE INSURANCE|Commercial]	standard_charge|[payer_AETNA LIFE INSURANCE|Commercial] |percent	standard_charge|[payer_AETNA LIFE INSURANCE|Commercial] |contracting_method	additional_payer_notes |[payer_AETNA LIFE INSURANCE|Commercial]	standard_charge|[payer_APS ADULTS|Managed Medicaid]	standard_charge|[payer_APS ADULTS|Managed Medicaid] |percent	standard_charge|[payer_APS ADULTS|Managed Medicaid] |contracting_method	additional_payer_notes |[payer_APS ADULTS|Managed Medicaid]	standard_charge|[payer_APS ADOLESCENTS|Managed Medicaid]	standard_charge|[payer_APS ADOLESCENTS|Managed Medicaid] |percent	standard_charge|[payer_APS ADOLESCENTS|Managed Medicaid] |contracting_method	additional_payer_notes |[payer_APS ADOLESCENTS|Managed Medicaid]	standard_charge|[payer_ASOCIACION DE MAESTROS|HMO/PPO]	standard_charge|[payer_ASOCIACION DE MAESTROS|HMO/PPO] |percent	standard_charge|[payer_ASOCIACION DE MAESTROS|HMO/PPO] |contracting_method	additional_payer_notes |[payer_ASOCIACION DE MAESTROS|HMO/PPO]	standard_charge|[payer_BLUE CROSS BLUE SHIELD|BC/BS]	standard_charge|[payer_BLUE CROSS BLUE SHIELD|BC/BS] |percent	standard_charge|[payer_BLUE CROSS BLUE SHIELD|BC/BS] |contracting_method	additional_payer_notes |[payer_BLUE CROSS BLUE SHIELD|BC/BS]	standard_charge|[payer_FHC (ELA / AXIS)|HMO/PPO]	standard_charge|[payer_FHC (ELA / AXIS)|HMO/PPO] |percent	standard_charge|[payer_FHC (ELA / AXIS)|HMO/PPO] |contracting_method	additional_payer_notes |[payer_FHC (ELA / AXIS)|HMO/PPO]	standard_charge|[payer_FONDO DEL SEGURO DEL ESTA|Workers Comp]	standard_charge|[payer_FONDO DEL SEGURO DEL ESTA|Workers Comp] |percent	standard_charge|[payer_FONDO DEL SEGURO DEL ESTA|Workers Comp] |contracting_method	additional_payer_notes |[payer_FONDO DEL SEGURO DEL ESTA|Workers Comp]	standard_charge|[payer_HUMANA GOLD PLUS (APS)|Managed Medicare]	standard_charge|[payer_HUMANA GOLD PLUS (APS)|Managed Medicare] |percent	standard_charge|[payer_HUMANA GOLD PLUS (APS)|Managed Medicare] |contracting_method	additional_payer_notes |[payer_HUMANA GOLD PLUS (APS)|Managed Medicare]	standard_charge|[payer_HUMANA INSURANCE (APS)|HMO/PPO]	standard_charge|[payer_HUMANA INSURANCE (APS)|HMO/PPO] |percent	standard_charge|[payer_HUMANA INSURANCE (APS)|HMO/PPO] |contracting_method	additional_payer_notes |[payer_HUMANA INSURANCE (APS)|HMO/PPO]	standard_charge|[payer_INTERNATIONAL MEDICAL CRD|HMO/PPO]	standard_charge|[payer_INTERNATIONAL MEDICAL CRD|HMO/PPO] |percent	standard_charge|[payer_INTERNATIONAL MEDICAL CRD|HMO/PPO] |contracting_method	additional_payer_notes |[payer_INTERNATIONAL MEDICAL CRD|HMO/PPO]	standard_charge|[payer_MAPFRE|HMO/PPO]	standard_charge|[payer_MAPFRE|HMO/PPO] |percent	standard_charge|[payer_MAPFRE|HMO/PPO] |contracting_method	additional_payer_notes |[payer_MAPFRE|HMO/PPO]	standard_charge|[payer_MCS|HMO/PPO]	standard_charge|[payer_MCS|HMO/PPO] |percent	standard_charge|[payer_MCS|HMO/PPO] |contracting_method	additional_payer_notes |[payer_MCS|HMO/PPO]	standard_charge|[payer_MCS CLASSICARE|Managed Medicare]	standard_charge|[payer_MCS CLASSICARE|Managed Medicare] |percent	standard_charge|[payer_MCS CLASSICARE|Managed Medicare] |contracting_method	additional_payer_notes |[payer_MCS CLASSICARE|Managed Medicare]	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_MENONITA|HMO/PPO]	standard_charge|[payer_MENONITA|HMO/PPO] |percent	standard_charge|[payer_MENONITA|HMO/PPO] |contracting_method	additional_payer_notes |[payer_MENONITA|HMO/PPO]	standard_charge|[payer_MMM|Managed Medicare]	standard_charge|[payer_MMM|Managed Medicare] |percent	standard_charge|[payer_MMM|Managed Medicare] |contracting_method	additional_payer_notes |[payer_MMM|Managed Medicare]	standard_charge|[payer_MMM MULTI HEALTH PLAN GOB|Managed Medicaid]	standard_charge|[payer_MMM MULTI HEALTH PLAN GOB|Managed Medicaid] |percent	standard_charge|[payer_MMM MULTI HEALTH PLAN GOB|Managed Medicaid] |contracting_method	additional_payer_notes |[payer_MMM MULTI HEALTH PLAN GOB|Managed Medicaid]	standard_charge|[payer_PANAMERICAN LIFE|HMO/PPO]	standard_charge|[payer_PANAMERICAN LIFE|HMO/PPO] |percent	standard_charge|[payer_PANAMERICAN LIFE|HMO/PPO] |contracting_method	additional_payer_notes |[payer_PANAMERICAN LIFE|HMO/PPO]	standard_charge|[payer_PLAN DE BIENESTAR (UTM)|HMO/PPO]	standard_charge|[payer_PLAN DE BIENESTAR (UTM)|HMO/PPO] |percent	standard_charge|[payer_PLAN DE BIENESTAR (UTM)|HMO/PPO] |contracting_method	additional_payer_notes |[payer_PLAN DE BIENESTAR (UTM)|HMO/PPO]	standard_charge|[payer_PLAN DE BIENESTAR CARPINTEROS|HMO/PPO]	standard_charge|[payer_PLAN DE BIENESTAR CARPINTEROS|HMO/PPO] |percent	standard_charge|[payer_PLAN DE BIENESTAR CARPINTEROS|HMO/PPO] |contracting_method	additional_payer_notes |[payer_PLAN DE BIENESTAR CARPINTEROS|HMO/PPO]	standard_charge|[payer_PLAN DE SALUD BELLA VISTA|HMO/PPO]	standard_charge|[payer_PLAN DE SALUD BELLA VISTA|HMO/PPO] |percent	standard_charge|[payer_PLAN DE SALUD BELLA VISTA|HMO/PPO] |contracting_method	additional_payer_notes |[payer_PLAN DE SALUD BELLA VISTA|HMO/PPO]	standard_charge|[payer_PMC|Managed Medicare]	standard_charge|[payer_PMC|Managed Medicare] |percent	standard_charge|[payer_PMC|Managed Medicare] |contracting_method	additional_payer_notes |[payer_PMC|Managed Medicare]	standard_charge|[payer_SELF PAY|Self Pay]	standard_charge|[payer_SELF PAY|Self Pay] |percent	standard_charge|[payer_SELF PAY|Self Pay] |contracting_method	additional_payer_notes |[payer_SELF PAY|Self Pay]	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_TRIPLE S (PPO)|HMO/PPO]	standard_charge|[payer_TRIPLE S (PPO)|HMO/PPO] |percent	standard_charge|[payer_TRIPLE S (PPO)|HMO/PPO] |contracting_method	additional_payer_notes |[payer_TRIPLE S (PPO)|HMO/PPO]	standard_charge|[payer_TRIPLE S (FHC)|HMO/PPO]	standard_charge|[payer_TRIPLE S (FHC)|HMO/PPO] |percent	standard_charge|[payer_TRIPLE S (FHC)|HMO/PPO] |contracting_method	additional_payer_notes |[payer_TRIPLE S (FHC)|HMO/PPO]	standard_charge|[payer_TRIPLE S (OPTIMO)|Managed Medicare]	standard_charge|[payer_TRIPLE S (OPTIMO)|Managed Medicare] |percent	standard_charge|[payer_TRIPLE S (OPTIMO)|Managed Medicare] |contracting_method	additional_payer_notes |[payer_TRIPLE S (OPTIMO)|Managed Medicare]	standard_charge|[payer_UNITED HEALTHCARE|Commercial]	standard_charge|[payer_UNITED HEALTHCARE|Commercial] |percent	standard_charge|[payer_UNITED HEALTHCARE|Commercial] |contracting_method	additional_payer_notes |[payer_UNITED HEALTHCARE|Commercial]	standard_charge|[payer_VA CCN OPTUM|Veterans]	standard_charge|[payer_VA CCN OPTUM|Veterans] |percent	standard_charge|[payer_VA CCN OPTUM|Veterans] |contracting_method	additional_payer_notes |[payer_VA CCN OPTUM|Veterans]
EAST-ROOM&BOARD PSYCH ADULT/ADOLESCENT	124 	RC	facility	inpatient				"1,400.00 "	500.00 	425.00 	"1,386.00 "	435.00 		per diem		980.00 		per diem		519.75 		per diem		519.75 		per diem		644.00 		per diem		698.00 		per diem		480.00 		per diem		492.00 		per diem		556.00 		per diem		486.00 		per diem		486.00 		per diem		563.00 		per diem		630.00 		per diem		612.00 		per diem		511.02 		per diem		593.00 		per diem		584.34 		per diem		615.57 		per diem		527.00 		per diem		630.00 		per diem		500.00 		per diem		425.00 		per diem		584.34 		per diem		500.00 		per diem		"1,388.00 "		per diem		590.00 		per diem		698.00 		per diem		556.00 		per diem		980.00 		per diem		501.58 		per diem	
OBS/23hrs	762	RC	facility	outpatient				810.00 	350.00 	350.00 	551.25 			  				  		551.25 		per diem		551.25 		per diem				  				  				  				  				  				  				  				  				  				  				  				  				  		551.25 		per diem				  				  				  				  				  		350.00 		per diem				  				  				  				  				  				  	
EVALUATION/NON ADMIT	900	RC	facility	outpatient				216.00 	0.00 	61.00 	131.00 			  				  		71.66 		per diem		71.66 		per diem		85.00 		per diem		131.00 		per diem				  		100.00 		per diem		66.00 		per diem		69.00 		per diem		69.00 		per diem		92.00 		per diem				  		61.00 		per diem				  				  				  				  				  		74.00 		per diem				  				  				  				  				  		131.00 		per diem		131.00 		per diem		66.00 		per diem				  				  	
OUTPATIENT ECT	901	RC	facility	outpatient				918.00 	650.00 	375.00 	650.00 			  				  				  				  		504.00 		per diem		465.00 		per diem				  		400.00 		per diem				  				  				  		525.00 		per diem		385.00 		per diem		416.00 		per diem		377.56 		per diem		420.00 		per diem		400.00 		per diem		400.00 		per diem		415.00 		per diem		405.00 		per diem				  		450.00 		per diem		400.00 		per diem		650.00 		per diem				  		465.00 		per diem		465.00 		per diem				  				  				  	
IOP ADULT PROGRAM	906	RC	facility	outpatient				325.00 	100.00 	87.00 	130.00 			  				  		99.23 		per diem				  		130.00 		per diem		98.00 		per diem				  		100.00 		per diem		87.00 		per diem		90.00 		per diem		90.00 		per diem		122.00 		per diem		104.00 		per diem		110.00 		per diem				  		120.00 		per diem		100.00 		per diem		99.23 		per diem		120.00 		per diem				  				  				  		100.00 		per diem		100.00 		per diem				  		98.00 		per diem		98.00 		per diem		87.00 		per diem				  				  	
PHP ADULT PROGRAM	912	RC	facility	outpatient				592.00 	200.00 	169.13 	414.40 	230.00 		per diem		414.40 		per diem		220.50 		per diem				  		257.00 		per diem		250.00 		per diem		200.00 		per diem		198.00 		per diem		230.00 		per diem		208.00 		per diem		208.00 		per diem		278.00 		per diem		223.00 		per diem		228.00 		per diem		202.72 		per diem		232.00 		per diem		210.00 		per diem		220.50 		per diem		231.00 		per diem		325.00 		per diem		190.00 		per diem		225.00 		per diem		210.00 		per diem		200.00 		per diem		169.13 		per diem		250.00 		per diem		250.00 		per diem		246.00 		per diem		414.40 		per diem		206.02 		per diem	
PHP ADOLESCENT PROGRAM	912	RC	facility	outpatient				702.00 	250.00 	169.13 	414.40 	230.00 		per diem		414.40 		per diem		N/A		#VALUE!		231.00 		per diem		334.00 		per diem		278.00 		per diem				  				  				  		235.00 		per diem		235.00 		per diem		321.00 		per diem		223.00 		per diem				  				  		320.00 		per diem				  		220.50 		per diem		252.00 		per diem		386.00 		per diem				  				  				  		250.00 		per diem		169.13 		per diem		278.00 		per diem		278.00 		per diem				  		414.40 		per diem