{ "hospital_name": "SBH-Kingsport, LLC", "location_name": [ "SBH-Kingsport, LLC" ], "hospital_address": [ "1025 Executive Park Blvd, Kingsport, TN 37660" ], "type_2_npi": [ "1174038749" ], "license_information": { "license_number": "136", "state": "TN" }, "last_updated_on": "2026-03-31", "version": "3.0", "attestation": { "attestation": "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 is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Ric McAllister" }, "standard_charge_information": [ { "description": "PHP Psych Adult Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.0, "discounted_cash_price": 325.0, "payer_specific_negotiated_charges": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "ACS Benefits Serivces", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Administrative Concepts", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 572.0 }, { "payer_name": "Aetna Medicare PPO", "plan_name": "All Plans", "negotiated_rate": 505.0 }, { "payer_name": "Altrua Healthshare", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Ambetter", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "American Behavioral", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "BCBS HOME PLAN", "plan_name": "All Plans", "negotiated_rate": 420.0 }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 420.0 }, { "payer_name": "BCBS Virginia", "plan_name": "All Plans", "negotiated_rate": 360.0 }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "All Plans", "negotiated_rate": 419.0 }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "All Plans", "negotiated_rate": 205.0 }, { "payer_name": "Bright Health Plan", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Bureau Of TennCare", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Carelon", "plan_name": "All Plans", "negotiated_rate": 360.0 }, { "payer_name": "Carelon Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 419.0 }, { "payer_name": "Cigna", "plan_name": "All Plans", "negotiated_rate": 432.0 }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "ComPsych", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Health Cost Solutions", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Healthcomp", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Humana - Commerical", "plan_name": "All Plans", "negotiated_rate": 485.0 }, { "payer_name": "Humana Medicare Advantage Plan", "plan_name": "All Plans", "negotiated_rate": 230.09 }, { "payer_name": "Magellan Healthcare Commerical Plan", "plan_name": "All Plans", "negotiated_rate": 456.0 }, { "payer_name": "Medcost Benefit Services", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Meritain Health", "plan_name": "All Plans", "negotiated_rate": 518.0 }, { "payer_name": "OPTUM", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "PAI", "plan_name": "All Plans", "negotiated_rate": 175.0 }, { "payer_name": "Selman Co", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Sentara Commercial", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "All Plans", "negotiated_rate": 315.0 }, { "payer_name": "Sentara VA Medicaid - Optima", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "The Health Plan", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "TN MCO BCBS Cover Kids", "plan_name": "All Plans", "negotiated_rate": 228.0 }, { "payer_name": "TN MCO Blue Care", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "TN MCO BlueCare Plus", "plan_name": "All Plans", "negotiated_rate": 228.0 }, { "payer_name": "TN MCO UHC TN Dual SNP", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "TN MCO United Healthcare", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "TN MCO Wellpoint Medicaid", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "UHC GEHA", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "UHC Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "UMR", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "United Behavioral Health Claims", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 505.0 }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "All Plans", "negotiated_rate": 505.0 }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "All Plans", "negotiated_rate": 109.59 }, { "payer_name": "VA MCO Anthem HealthKeepers Plus", "plan_name": "All Plans", "negotiated_rate": 222.76 }, { "payer_name": "VA MCO Premier Elite Plus", "plan_name": "All Plans", "negotiated_rate": 315.0 }, { "payer_name": "VA MCO UnitedHealtcare Community Plan", "plan_name": "All Plans", "negotiated_rate": 222.76 }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "All Plans", "negotiated_rate": 315.0 }, { "payer_name": "VA Molina Complete Care", "plan_name": "All Plans", "negotiated_rate": 109.59 }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "All Plans", "negotiated_rate": 109.59 }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "WPS", "plan_name": "All Plans", "negotiated_rate": 518.0 } ], "minimum": 109.59, "maximum": 572.0 } ] }, { "description": "PHP CD Adult Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.0, "discounted_cash_price": 325.0, "payer_specific_negotiated_charges": [ { "payer_name": "90 Degree Benefits - 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Commerical", "plan_name": "All Plans", "negotiated_rate": 485.0 }, { "payer_name": "Humana Medicare Advantage Plan", "plan_name": "All Plans", "negotiated_rate": 230.09 }, { "payer_name": "Magellan Healthcare Commerical Plan", "plan_name": "All Plans", "negotiated_rate": 456.0 }, { "payer_name": "Medcost Benefit Services", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Meritain Health", "plan_name": "All Plans", "negotiated_rate": 518.0 }, { "payer_name": "OPTUM", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "PAI", "plan_name": "All Plans", "negotiated_rate": 325.0 }, { "payer_name": "Premier Access, INC", "plan_name": "All Plans", "negotiated_rate": 518.0 }, { "payer_name": "Selman Co", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Sentara Commercial", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "All Plans", "negotiated_rate": 315.0 }, { "payer_name": "Sentara VA Medicaid - 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