|
110001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,237.00
|
$900.00
27% off
|
$1,237.00
|
$1,237.00
|
$1,237.00
|
2026-05-18
|
|
110002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,423.00
|
$900.00
37% off
|
$1,423.00
|
$1,423.00
|
$1,423.00
|
2026-05-18
|
|
23926026
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$571.00
|
—
|
$571.00
|
$571.00
|
$571.00
|
2026-05-18
|
|
25000020
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$819.00
|
—
|
$819.00
|
$819.00
|
$819.00
|
2026-05-18
|
|
25000023
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$151.00
|
—
|
$151.00
|
$151.00
|
$151.00
|
2026-05-18
|
|
25000024
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$151.00
|
—
|
$151.00
|
$151.00
|
$151.00
|
2026-05-18
|
|
25000035
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$358.00
|
—
|
$358.00
|
$358.00
|
$358.00
|
2026-05-18
|
|
25000074
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$213.00
|
—
|
$213.00
|
$213.00
|
$213.00
|
2026-05-18
|
|
25000100
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$380.00
|
—
|
$380.00
|
$380.00
|
$380.00
|
2026-05-18
|
|
25000117
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,548.76
|
—
|
$1,548.76
|
$1,548.76
|
$1,548.76
|
2026-05-18
|
|
25000134
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$499.00
|
—
|
$499.00
|
$499.00
|
$499.00
|
2026-05-18
|
|
25000135
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$499.00
|
—
|
$499.00
|
$499.00
|
$499.00
|
2026-05-18
|
|
25000151
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,538.00
|
—
|
$1,538.00
|
$1,538.00
|
$1,538.00
|
2026-05-18
|
|
25000153
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$213.00
|
—
|
$213.00
|
$213.00
|
$213.00
|
2026-05-18
|
|
25000155
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$192.00
|
—
|
$192.00
|
$192.00
|
$192.00
|
2026-05-18
|
|
25000156
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$192.00
|
—
|
$192.00
|
$192.00
|
$192.00
|
2026-05-18
|
|
25000258
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$447.00
|
—
|
$447.00
|
$447.00
|
$447.00
|
2026-05-18
|
|
25000259
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$349.00
|
—
|
$349.00
|
$349.00
|
$349.00
|
2026-05-18
|
|
25000260
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$185.00
|
—
|
$185.00
|
$185.00
|
$185.00
|
2026-05-18
|
|
25000277
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$233.00
|
—
|
$233.00
|
$233.00
|
$233.00
|
2026-05-18
|
|
25000345
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$386.00
|
—
|
$386.00
|
$386.00
|
$386.00
|
2026-05-18
|
|
25000346
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$386.00
|
—
|
$386.00
|
$386.00
|
$386.00
|
2026-05-18
|
|
25000409
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$279.00
|
—
|
$279.00
|
$279.00
|
$279.00
|
2026-05-18
|
|
25000410
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$279.00
|
—
|
$279.00
|
$279.00
|
$279.00
|
2026-05-18
|
|
25000411
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$279.00
|
—
|
$279.00
|
$279.00
|
$279.00
|
2026-05-18
|
|
25000412
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$279.00
|
—
|
$279.00
|
$279.00
|
$279.00
|
2026-05-18
|
|
25000413
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$279.00
|
—
|
$279.00
|
$279.00
|
$279.00
|
2026-05-18
|
|
25000438
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$263.00
|
—
|
$263.00
|
$263.00
|
$263.00
|
2026-05-18
|
|
25000467
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$654.00
|
—
|
$654.00
|
$654.00
|
$654.00
|
2026-05-18
|
|
25000602
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$239.00
|
—
|
$239.00
|
$239.00
|
$239.00
|
2026-05-18
|
|
25000603
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$236.00
|
—
|
$236.00
|
$236.00
|
$236.00
|
2026-05-18
|
|
25000654
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$519.00
|
—
|
$519.00
|
$519.00
|
$519.00
|
2026-05-18
|
|
25000655
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$519.00
|
—
|
$519.00
|
$519.00
|
$519.00
|
2026-05-18
|
|
25000682
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$453.00
|
—
|
$453.00
|
$453.00
|
$453.00
|
2026-05-18
|
|
25000720
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$425.00
|
—
|
$425.00
|
$425.00
|
$425.00
|
2026-05-18
|
|
25000804
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$226.00
|
—
|
$226.00
|
$226.00
|
$226.00
|
2026-05-18
|
|
25000805
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$226.00
|
—
|
$226.00
|
$226.00
|
$226.00
|
2026-05-18
|
|
25000806
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$226.00
|
—
|
$226.00
|
$226.00
|
$226.00
|
2026-05-18
|
|
25000859
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$271.00
|
—
|
$271.00
|
$271.00
|
$271.00
|
2026-05-18
|
|
25000860
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$368.00
|
—
|
$368.00
|
$368.00
|
$368.00
|
2026-05-18
|
|
25000861
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$368.00
|
—
|
$368.00
|
$368.00
|
$368.00
|
2026-05-18
|
|
25000864
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$304.74
|
—
|
$304.74
|
$304.74
|
$304.74
|
2026-05-18
|
|
25000865
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$304.74
|
—
|
$304.74
|
$304.74
|
$304.74
|
2026-05-18
|
|
25000866
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$304.74
|
—
|
$304.74
|
$304.74
|
$304.74
|
2026-05-18
|
|
25000869
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$155.00
|
—
|
$155.00
|
$155.00
|
$155.00
|
2026-05-18
|
|
25000872
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$155.00
|
—
|
$155.00
|
$155.00
|
$155.00
|
2026-05-18
|
|
25000886
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$195.80
|
—
|
$195.80
|
$195.80
|
$195.80
|
2026-05-18
|
|
25000887
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$195.80
|
—
|
$195.80
|
$195.80
|
$195.80
|
2026-05-18
|
|
25001000
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$167.00
|
—
|
$167.00
|
$167.00
|
$167.00
|
2026-05-18
|
|
25001050
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$184.68
|
—
|
$184.68
|
$184.68
|
$184.68
|
2026-05-18
|
|
25001051
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$184.68
|
—
|
$184.68
|
$184.68
|
$184.68
|
2026-05-18
|
|
25001052
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$184.68
|
—
|
$184.68
|
$184.68
|
$184.68
|
2026-05-18
|
|
25001053
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$184.68
|
—
|
$184.68
|
$184.68
|
$184.68
|
2026-05-18
|
|
25001054
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$184.68
|
—
|
$184.68
|
$184.68
|
$184.68
|
2026-05-18
|
|
25001056
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$946.00
|
—
|
$946.00
|
$946.00
|
$946.00
|
2026-05-18
|
|
25001115
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$429.00
|
—
|
$429.00
|
$429.00
|
$429.00
|
2026-05-18
|
|
25001149
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$300.00
|
—
|
$300.00
|
$300.00
|
$300.00
|
2026-05-18
|
|
25001179
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$323.00
|
—
|
$323.00
|
$323.00
|
$323.00
|
2026-05-18
|
|
25001208
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$172.00
|
—
|
$172.00
|
$172.00
|
$172.00
|
2026-05-18
|
|
25001209
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$172.00
|
—
|
$172.00
|
$172.00
|
$172.00
|
2026-05-18
|
|
25001224
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$252.00
|
—
|
$252.00
|
$252.00
|
$252.00
|
2026-05-18
|
|
25001255
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$188.88
|
—
|
$188.88
|
$188.88
|
$188.88
|
2026-05-18
|
|
25001256
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$167.00
|
—
|
$167.00
|
$167.00
|
$167.00
|
2026-05-18
|
|
27000017
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$375.00
|
—
|
$375.00
|
$375.00
|
$375.00
|
2026-05-18
|
|
27000027
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$151.00
|
—
|
$151.00
|
$151.00
|
$151.00
|
2026-05-18
|
|
27000275
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$822.00
|
—
|
$822.00
|
$822.00
|
$822.00
|
2026-05-18
|
|
27000354
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$412.00
|
—
|
$412.00
|
$412.00
|
$412.00
|
2026-05-18
|
|
27000375
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$659.00
|
—
|
$659.00
|
$659.00
|
$659.00
|
2026-05-18
|
|
27000384
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$587.00
|
—
|
$587.00
|
$587.00
|
$587.00
|
2026-05-18
|
|
27000403
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$189.00
|
—
|
$189.00
|
$189.00
|
$189.00
|
2026-05-18
|
|
27000484
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$268.00
|
—
|
$268.00
|
$268.00
|
$268.00
|
2026-05-18
|
|
27000796
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,713.00
|
—
|
$2,713.00
|
$2,713.00
|
$2,713.00
|
2026-05-18
|
|
30000001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$161.00
|
—
|
$161.00
|
$161.00
|
$161.00
|
2026-05-18
|
|
30000005
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$185.00
|
—
|
$185.00
|
$185.00
|
$185.00
|
2026-05-18
|
|
30000006
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$401.00
|
—
|
$401.00
|
$401.00
|
$401.00
|
2026-05-18
|
|
30000010
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$185.00
|
—
|
$185.00
|
$185.00
|
$185.00
|
2026-05-18
|
|
30000018
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$546.00
|
—
|
$546.00
|
$546.00
|
$546.00
|
2026-05-18
|
|
30000021
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$701.00
|
—
|
$701.00
|
$701.00
|
$701.00
|
2026-05-18
|
|
30000028
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$550.00
|
—
|
$550.00
|
$550.00
|
$550.00
|
2026-05-18
|
|
30000029
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$369.00
|
—
|
$369.00
|
$369.00
|
$369.00
|
2026-05-18
|
|
30000034
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$345.00
|
—
|
$345.00
|
$345.00
|
$345.00
|
2026-05-18
|
|
30000043
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$913.00
|
—
|
$913.00
|
$913.00
|
$913.00
|
2026-05-18
|
|
30000044
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$719.00
|
—
|
$719.00
|
$719.00
|
$719.00
|
2026-05-18
|
|
30000050
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$294.00
|
—
|
$294.00
|
$294.00
|
$294.00
|
2026-05-18
|
|
30000056
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$648.00
|
—
|
$648.00
|
$648.00
|
$648.00
|
2026-05-18
|
|
30000062
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$349.00
|
—
|
$349.00
|
$349.00
|
$349.00
|
2026-05-18
|
|
30000064
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$240.00
|
—
|
$240.00
|
$240.00
|
$240.00
|
2026-05-18
|
|
30000065
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$286.00
|
—
|
$286.00
|
$286.00
|
$286.00
|
2026-05-18
|
|
30000069
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$415.00
|
—
|
$415.00
|
$415.00
|
$415.00
|
2026-05-18
|
|
30000075
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$163.00
|
—
|
$163.00
|
$163.00
|
$163.00
|
2026-05-18
|
|
30000081
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$393.00
|
—
|
$393.00
|
$393.00
|
$393.00
|
2026-05-18
|
|
30000090
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$163.00
|
—
|
$163.00
|
$163.00
|
$163.00
|
2026-05-18
|
|
30000096
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$913.00
|
—
|
$913.00
|
$913.00
|
$913.00
|
2026-05-18
|
|
30000098
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$309.00
|
—
|
$309.00
|
$309.00
|
$309.00
|
2026-05-18
|
|
30000100
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$839.00
|
—
|
$839.00
|
$839.00
|
$839.00
|
2026-05-18
|
|
30000104
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$398.00
|
—
|
$398.00
|
$398.00
|
$398.00
|
2026-05-18
|
|
30000108
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$220.00
|
—
|
$220.00
|
$220.00
|
$220.00
|
2026-05-18
|
|
30100002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$157.00
|
—
|
$157.00
|
$157.00
|
$157.00
|
2026-05-18
|
|
30100005
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$150.00
|
—
|
$150.00
|
$150.00
|
$150.00
|
2026-05-18
|
|
30100016
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$195.00
|
—
|
$195.00
|
$195.00
|
$195.00
|
2026-05-18
|
|
30100018
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$328.00
|
—
|
$328.00
|
$328.00
|
$328.00
|
2026-05-18
|
|
30100021
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$165.00
|
—
|
$165.00
|
$165.00
|
$165.00
|
2026-05-18
|
|
30100039
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$238.00
|
—
|
$238.00
|
$238.00
|
$238.00
|
2026-05-18
|
|
30100041
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$164.00
|
—
|
$164.00
|
$164.00
|
$164.00
|
2026-05-18
|
|
30100059
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$198.00
|
—
|
$198.00
|
$198.00
|
$198.00
|
2026-05-18
|
|
30100072
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$401.00
|
—
|
$401.00
|
$401.00
|
$401.00
|
2026-05-18
|
|
30100077
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$186.00
|
—
|
$186.00
|
$186.00
|
$186.00
|
2026-05-18
|
|
30100082
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$163.00
|
—
|
$163.00
|
$163.00
|
$163.00
|
2026-05-18
|
|
30100090
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$186.00
|
—
|
$186.00
|
$186.00
|
$186.00
|
2026-05-18
|
|
30100092
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$208.00
|
—
|
$208.00
|
$208.00
|
$208.00
|
2026-05-18
|
|
30100095
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$271.00
|
—
|
$271.00
|
$271.00
|
$271.00
|
2026-05-18
|
|
30100103
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$278.00
|
—
|
$278.00
|
$278.00
|
$278.00
|
2026-05-18
|
|
30100105
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$243.00
|
—
|
$243.00
|
$243.00
|
$243.00
|
2026-05-18
|
|
30100112
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$157.00
|
—
|
$157.00
|
$157.00
|
$157.00
|
2026-05-18
|
|
30100118
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$164.00
|
—
|
$164.00
|
$164.00
|
$164.00
|
2026-05-18
|
|
30100120
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$149.00
|
—
|
$149.00
|
$149.00
|
$149.00
|
2026-05-18
|
|
30100125
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$255.00
|
—
|
$255.00
|
$255.00
|
$255.00
|
2026-05-18
|
|
30100146
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$285.00
|
—
|
$285.00
|
$285.00
|
$285.00
|
2026-05-18
|
|
30100147
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$523.00
|
—
|
$523.00
|
$523.00
|
$523.00
|
2026-05-18
|
|
30100148
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$247.00
|
—
|
$247.00
|
$247.00
|
$247.00
|
2026-05-18
|
|
30100149
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$150.00
|
—
|
$150.00
|
$150.00
|
$150.00
|
2026-05-18
|
|
30100150
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$334.00
|
—
|
$334.00
|
$334.00
|
$334.00
|
2026-05-18
|
|
30100152
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$443.00
|
—
|
$443.00
|
$443.00
|
$443.00
|
2026-05-18
|
|
30100154
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$324.00
|
—
|
$324.00
|
$324.00
|
$324.00
|
2026-05-18
|
|
30100168
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$477.00
|
—
|
$477.00
|
$477.00
|
$477.00
|
2026-05-18
|
|
30100170
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$259.00
|
—
|
$259.00
|
$259.00
|
$259.00
|
2026-05-18
|
|
30100173
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$253.00
|
—
|
$253.00
|
$253.00
|
$253.00
|
2026-05-18
|
|
30100196
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$347.00
|
—
|
$347.00
|
$347.00
|
$347.00
|
2026-05-18
|
|
30100200
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$209.00
|
—
|
$209.00
|
$209.00
|
$209.00
|
2026-05-18
|
|
30100223
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$432.00
|
—
|
$432.00
|
$432.00
|
$432.00
|
2026-05-18
|
|
30100237
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$151.00
|
—
|
$151.00
|
$151.00
|
$151.00
|
2026-05-18
|
|
30100245
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$165.00
|
—
|
$165.00
|
$165.00
|
$165.00
|
2026-05-18
|
|
30100247
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$149.00
|
—
|
$149.00
|
$149.00
|
$149.00
|
2026-05-18
|
|
30100248
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$164.00
|
—
|
$164.00
|
$164.00
|
$164.00
|
2026-05-18
|
|
30100254
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$473.00
|
—
|
$473.00
|
$473.00
|
$473.00
|
2026-05-18
|
|
30100264
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$256.00
|
—
|
$256.00
|
$256.00
|
$256.00
|
2026-05-18
|
|
30100265
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$150.00
|
—
|
$150.00
|
$150.00
|
$150.00
|
2026-05-18
|
|
30100275
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$732.00
|
—
|
$732.00
|
$732.00
|
$732.00
|
2026-05-18
|
|
30100277
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$397.00
|
—
|
$397.00
|
$397.00
|
$397.00
|
2026-05-18
|
|
30100279
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$174.00
|
—
|
$174.00
|
$174.00
|
$174.00
|
2026-05-18
|
|
30100286
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$227.00
|
—
|
$227.00
|
$227.00
|
$227.00
|
2026-05-18
|
|
30100287
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$522.00
|
—
|
$522.00
|
$522.00
|
$522.00
|
2026-05-18
|
|
30100291
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$192.00
|
—
|
$192.00
|
$192.00
|
$192.00
|
2026-05-18
|
|
30100300
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$283.00
|
—
|
$283.00
|
$283.00
|
$283.00
|
2026-05-18
|
|
30100309
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$173.00
|
—
|
$173.00
|
$173.00
|
$173.00
|
2026-05-18
|
|
30100313
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$151.00
|
—
|
$151.00
|
$151.00
|
$151.00
|
2026-05-18
|
|
30100319
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,085.44
|
—
|
$1,085.44
|
$1,085.44
|
$1,085.44
|
2026-05-18
|
|
30100321
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$157.00
|
—
|
$157.00
|
$157.00
|
$157.00
|
2026-05-18
|
|
30100325
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$217.00
|
—
|
$217.00
|
$217.00
|
$217.00
|
2026-05-18
|
|
30200044
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$161.00
|
—
|
$161.00
|
$161.00
|
$161.00
|
2026-05-18
|
|
30200046
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$163.00
|
—
|
$163.00
|
$163.00
|
$163.00
|
2026-05-18
|
|
30200113
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$153.00
|
—
|
$153.00
|
$153.00
|
$153.00
|
2026-05-18
|
|
30200118
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$150.00
|
—
|
$150.00
|
$150.00
|
$150.00
|
2026-05-18
|
|
30200119
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$215.00
|
—
|
$215.00
|
$215.00
|
$215.00
|
2026-05-18
|
|
30500001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$147.00
|
—
|
$147.00
|
$147.00
|
$147.00
|
2026-05-18
|
|
30500012
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$380.00
|
—
|
$380.00
|
$380.00
|
$380.00
|
2026-05-18
|
|
30500015
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$264.00
|
—
|
$264.00
|
$264.00
|
$264.00
|
2026-05-18
|
|
30500036
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$215.00
|
—
|
$215.00
|
$215.00
|
$215.00
|
2026-05-18
|
|
30500059
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$606.00
|
—
|
$606.00
|
$606.00
|
$606.00
|
2026-05-18
|
|
30500061
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$205.00
|
—
|
$205.00
|
$205.00
|
$205.00
|
2026-05-18
|
|
30500082
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$258.00
|
—
|
$258.00
|
$258.00
|
$258.00
|
2026-05-18
|
|
31100004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$532.00
|
—
|
$532.00
|
$532.00
|
$532.00
|
2026-05-18
|
|
32000001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$206.00
|
—
|
$206.00
|
$206.00
|
$206.00
|
2026-05-18
|
|
32000007
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$262.00
|
—
|
$262.00
|
$262.00
|
$262.00
|
2026-05-18
|
|
32000011
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$167.00
|
—
|
$167.00
|
$167.00
|
$167.00
|
2026-05-18
|
|
32000012
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$248.00
|
—
|
$248.00
|
$248.00
|
$248.00
|
2026-05-18
|
|
32000022
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$836.00
|
—
|
$836.00
|
$836.00
|
$836.00
|
2026-05-18
|
|
32000039
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$337.00
|
—
|
$337.00
|
$337.00
|
$337.00
|
2026-05-18
|
|
32000042
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$223.00
|
—
|
$223.00
|
$223.00
|
$223.00
|
2026-05-18
|
|
32000043
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$506.00
|
—
|
$506.00
|
$506.00
|
$506.00
|
2026-05-18
|
|
32000044
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$538.00
|
—
|
$538.00
|
$538.00
|
$538.00
|
2026-05-18
|
|
32000045
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$151.00
|
—
|
$151.00
|
$151.00
|
$151.00
|
2026-05-18
|
|
32000047
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$470.00
|
—
|
$470.00
|
$470.00
|
$470.00
|
2026-05-18
|
|
32000050
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$412.00
|
—
|
$412.00
|
$412.00
|
$412.00
|
2026-05-18
|
|
32000053
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$161.00
|
—
|
$161.00
|
$161.00
|
$161.00
|
2026-05-18
|
|
32000054
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$337.00
|
—
|
$337.00
|
$337.00
|
$337.00
|
2026-05-18
|
|
32000055
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$337.00
|
—
|
$337.00
|
$337.00
|
$337.00
|
2026-05-18
|
|
32000062
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$387.00
|
—
|
$387.00
|
$387.00
|
$387.00
|
2026-05-18
|
|
32000063
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$240.00
|
—
|
$240.00
|
$240.00
|
$240.00
|
2026-05-18
|
|
32000065
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$210.00
|
—
|
$210.00
|
$210.00
|
$210.00
|
2026-05-18
|
|
32000067
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$264.00
|
—
|
$264.00
|
$264.00
|
$264.00
|
2026-05-18
|
|
32000069
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$240.00
|
—
|
$240.00
|
$240.00
|
$240.00
|
2026-05-18
|
|
32000071
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$299.00
|
—
|
$299.00
|
$299.00
|
$299.00
|
2026-05-18
|
|
32000075
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$405.00
|
—
|
$405.00
|
$405.00
|
$405.00
|
2026-05-18
|
|
32000077
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$323.00
|
—
|
$323.00
|
$323.00
|
$323.00
|
2026-05-18
|
|
32000083
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$356.00
|
—
|
$356.00
|
$356.00
|
$356.00
|
2026-05-18
|
|
32000086
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$306.00
|
—
|
$306.00
|
$306.00
|
$306.00
|
2026-05-18
|
|
32000088
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$241.00
|
—
|
$241.00
|
$241.00
|
$241.00
|
2026-05-18
|
|
32000091
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$245.00
|
—
|
$245.00
|
$245.00
|
$245.00
|
2026-05-18
|
|
32000092
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$198.00
|
—
|
$198.00
|
$198.00
|
$198.00
|
2026-05-18
|
|
32000103
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$177.00
|
—
|
$177.00
|
$177.00
|
$177.00
|
2026-05-18
|
|
32000104
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$210.00
|
—
|
$210.00
|
$210.00
|
$210.00
|
2026-05-18
|
|
32000110
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$248.00
|
—
|
$248.00
|
$248.00
|
$248.00
|
2026-05-18
|
|
32000117
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$307.00
|
—
|
$307.00
|
$307.00
|
$307.00
|
2026-05-18
|
|
32000119
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$173.00
|
—
|
$173.00
|
$173.00
|
$173.00
|
2026-05-18
|
|
32000120
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$245.00
|
—
|
$245.00
|
$245.00
|
$245.00
|
2026-05-18
|
|
32000122
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$240.00
|
—
|
$240.00
|
$240.00
|
$240.00
|
2026-05-18
|
|
32000125
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$267.00
|
—
|
$267.00
|
$267.00
|
$267.00
|
2026-05-18
|
|
32000126
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$267.00
|
—
|
$267.00
|
$267.00
|
$267.00
|
2026-05-18
|
|
32000127
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$210.00
|
—
|
$210.00
|
$210.00
|
$210.00
|
2026-05-18
|
|
32000129
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$269.00
|
—
|
$269.00
|
$269.00
|
$269.00
|
2026-05-18
|
|
32000137
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$210.00
|
—
|
$210.00
|
$210.00
|
$210.00
|
2026-05-18
|
|
32000142
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$318.00
|
—
|
$318.00
|
$318.00
|
$318.00
|
2026-05-18
|
|
32000146
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$202.00
|
—
|
$202.00
|
$202.00
|
$202.00
|
2026-05-18
|
|
32000147
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$202.00
|
—
|
$202.00
|
$202.00
|
$202.00
|
2026-05-18
|
|
32000152
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$311.00
|
—
|
$311.00
|
$311.00
|
$311.00
|
2026-05-18
|
|
32000153
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$311.00
|
—
|
$311.00
|
$311.00
|
$311.00
|
2026-05-18
|
|
32000157
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,764.00
|
—
|
$1,764.00
|
$1,764.00
|
$1,764.00
|
2026-05-18
|
|
32000163
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$370.00
|
—
|
$370.00
|
$370.00
|
$370.00
|
2026-05-18
|
|
32000165
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$370.00
|
—
|
$370.00
|
$370.00
|
$370.00
|
2026-05-18
|
|
32000166
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$253.00
|
—
|
$253.00
|
$253.00
|
$253.00
|
2026-05-18
|
|
32000167
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$293.00
|
—
|
$293.00
|
$293.00
|
$293.00
|
2026-05-18
|
|
32000169
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$311.00
|
—
|
$311.00
|
$311.00
|
$311.00
|
2026-05-18
|
|
32000171
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$215.00
|
—
|
$215.00
|
$215.00
|
$215.00
|
2026-05-18
|
|
32000177
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$335.00
|
—
|
$335.00
|
$335.00
|
$335.00
|
2026-05-18
|
|
32000178
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$245.00
|
—
|
$245.00
|
$245.00
|
$245.00
|
2026-05-18
|
|
32000180
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$164.00
|
—
|
$164.00
|
$164.00
|
$164.00
|
2026-05-18
|
|
32000184
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$358.00
|
—
|
$358.00
|
$358.00
|
$358.00
|
2026-05-18
|
|
32000185
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$220.00
|
—
|
$220.00
|
$220.00
|
$220.00
|
2026-05-18
|
|
32000188
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$405.00
|
—
|
$405.00
|
$405.00
|
$405.00
|
2026-05-18
|
|
32000189
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$405.00
|
—
|
$405.00
|
$405.00
|
$405.00
|
2026-05-18
|
|
32000190
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$259.00
|
—
|
$259.00
|
$259.00
|
$259.00
|
2026-05-18
|
|
32000194
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$331.00
|
—
|
$331.00
|
$331.00
|
$331.00
|
2026-05-18
|
|
32000197
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$443.00
|
—
|
$443.00
|
$443.00
|
$443.00
|
2026-05-18
|
|
32000200
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$454.00
|
—
|
$454.00
|
$454.00
|
$454.00
|
2026-05-18
|
|
32000201
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$426.00
|
—
|
$426.00
|
$426.00
|
$426.00
|
2026-05-18
|
|
32000204
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$300.00
|
—
|
$300.00
|
$300.00
|
$300.00
|
2026-05-18
|
|
32000208
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$220.00
|
—
|
$220.00
|
$220.00
|
$220.00
|
2026-05-18
|
|
32000210
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$271.00
|
—
|
$271.00
|
$271.00
|
$271.00
|
2026-05-18
|
|
32000215
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$271.00
|
—
|
$271.00
|
$271.00
|
$271.00
|
2026-05-18
|
|
32000217
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$223.00
|
—
|
$223.00
|
$223.00
|
$223.00
|
2026-05-18
|
|
32000228
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$610.00
|
—
|
$610.00
|
$610.00
|
$610.00
|
2026-05-18
|
|
32000229
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$594.00
|
—
|
$594.00
|
$594.00
|
$594.00
|
2026-05-18
|
|
32000240
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$3,116.00
|
—
|
$3,116.00
|
$3,116.00
|
$3,116.00
|
2026-05-18
|
|
32000245
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$173.00
|
—
|
$173.00
|
$173.00
|
$173.00
|
2026-05-18
|
|
32000246
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$245.00
|
—
|
$245.00
|
$245.00
|
$245.00
|
2026-05-18
|
|
32000250
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$185.00
|
—
|
$185.00
|
$185.00
|
$185.00
|
2026-05-18
|
|
32200001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$648.00
|
—
|
$648.00
|
$648.00
|
$648.00
|
2026-05-18
|
|
32400001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$223.00
|
—
|
$223.00
|
$223.00
|
$223.00
|
2026-05-18
|
|
32400003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$352.00
|
—
|
$352.00
|
$352.00
|
$352.00
|
2026-05-18
|
|
32400006
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$223.00
|
—
|
$223.00
|
$223.00
|
$223.00
|
2026-05-18
|
|
32400010
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$272.00
|
—
|
$272.00
|
$272.00
|
$272.00
|
2026-05-18
|
|
32400011
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$279.00
|
—
|
$279.00
|
$279.00
|
$279.00
|
2026-05-18
|
|
35000001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$7,418.00
|
—
|
$7,418.00
|
$7,418.00
|
$7,418.00
|
2026-05-18
|
|
35000002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,976.00
|
—
|
$1,976.00
|
$1,976.00
|
$1,976.00
|
2026-05-18
|
|
35000003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,801.00
|
—
|
$1,801.00
|
$1,801.00
|
$1,801.00
|
2026-05-18
|
|
35000004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$4,469.00
|
—
|
$4,469.00
|
$4,469.00
|
$4,469.00
|
2026-05-18
|
|
35000006
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,697.00
|
—
|
$1,697.00
|
$1,697.00
|
$1,697.00
|
2026-05-18
|
|
35000011
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$4,138.00
|
—
|
$4,138.00
|
$4,138.00
|
$4,138.00
|
2026-05-18
|
|
35000012
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,737.00
|
—
|
$2,737.00
|
$2,737.00
|
$2,737.00
|
2026-05-18
|
|
35000013
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,752.00
|
—
|
$1,752.00
|
$1,752.00
|
$1,752.00
|
2026-05-18
|
|
35000014
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$3,340.00
|
—
|
$3,340.00
|
$3,340.00
|
$3,340.00
|
2026-05-18
|
|
35100003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,376.00
|
—
|
$2,376.00
|
$2,376.00
|
$2,376.00
|
2026-05-18
|
|
35100004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,461.00
|
—
|
$2,461.00
|
$2,461.00
|
$2,461.00
|
2026-05-18
|
|
35100005
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$3,387.00
|
—
|
$3,387.00
|
$3,387.00
|
$3,387.00
|
2026-05-18
|
|
35200005
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,543.00
|
—
|
$2,543.00
|
$2,543.00
|
$2,543.00
|
2026-05-18
|
|
35200006
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,360.00
|
—
|
$2,360.00
|
$2,360.00
|
$2,360.00
|
2026-05-18
|
|
35200007
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$4,469.00
|
—
|
$4,469.00
|
$4,469.00
|
$4,469.00
|
2026-05-18
|
|
40000001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,752.00
|
—
|
$1,752.00
|
$1,752.00
|
$1,752.00
|
2026-05-18
|
|
40000004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$2,414.00
|
—
|
$2,414.00
|
$2,414.00
|
$2,414.00
|
2026-05-18
|
|
40200030
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$1,867.00
|
—
|
$1,867.00
|
$1,867.00
|
$1,867.00
|
2026-05-18
|
|
41000012
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$392.00
|
—
|
$392.00
|
$392.00
|
$392.00
|
2026-05-18
|
|
41000035
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$159.00
|
—
|
$159.00
|
$159.00
|
$159.00
|
2026-05-18
|
|
41000036
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$293.00
|
—
|
$293.00
|
$293.00
|
$293.00
|
2026-05-18
|
|
41000037
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$255.00
|
—
|
$255.00
|
$255.00
|
$255.00
|
2026-05-18
|
|
41000038
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$255.00
|
—
|
$255.00
|
$255.00
|
$255.00
|
2026-05-18
|
|
41200001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$159.00
|
—
|
$159.00
|
$159.00
|
$159.00
|
2026-05-18
|
|
42000005
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$425.00
|
—
|
$425.00
|
$425.00
|
$425.00
|
2026-05-18
|
|
42000007
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$309.00
|
—
|
$309.00
|
$309.00
|
$309.00
|
2026-05-18
|
|
42000009
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$425.00
|
—
|
$425.00
|
$425.00
|
$425.00
|
2026-05-18
|
|
42000011
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$212.00
|
—
|
$212.00
|
$212.00
|
$212.00
|
2026-05-18
|
|
44200001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$618.00
|
—
|
$618.00
|
$618.00
|
$618.00
|
2026-05-18
|
|
44200002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$341.00
|
—
|
$341.00
|
$341.00
|
$341.00
|
2026-05-18
|
|
44400002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$464.00
|
—
|
$464.00
|
$464.00
|
$464.00
|
2026-05-18
|
|
44400003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$558.00
|
—
|
$558.00
|
$558.00
|
$558.00
|
2026-05-18
|
|
44400006
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$854.00
|
—
|
$854.00
|
$854.00
|
$854.00
|
2026-05-18
|
|
61100004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$3,012.00
|
—
|
$3,012.00
|
$3,012.00
|
$3,012.00
|
2026-05-18
|
|
61200004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$3,884.00
|
—
|
$3,884.00
|
$3,884.00
|
$3,884.00
|
2026-05-18
|
|
61400001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$838.00
|
—
|
$838.00
|
$838.00
|
$838.00
|
2026-05-18
|
|
73000001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$370.00
|
—
|
$370.00
|
$370.00
|
$370.00
|
2026-05-18
|
|
74000012
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$960.00
|
—
|
$960.00
|
$960.00
|
$960.00
|
2026-05-18
|
|
74000013
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$960.00
|
—
|
$960.00
|
$960.00
|
$960.00
|
2026-05-18
|
|
90000001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$390.00
|
—
|
$390.00
|
$390.00
|
$390.00
|
2026-05-18
|
|
90000002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$500.00
|
—
|
$500.00
|
$500.00
|
$500.00
|
2026-05-18
|
|
90000003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$500.00
|
—
|
$500.00
|
$500.00
|
$500.00
|
2026-05-18
|
|
90000004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$247.00
|
—
|
$247.00
|
$247.00
|
$247.00
|
2026-05-18
|
|
90400001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$327.00
|
—
|
$327.00
|
$327.00
|
$327.00
|
2026-05-18
|
|
91300001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$327.00
|
—
|
$327.00
|
$327.00
|
$327.00
|
2026-05-18
|
|
91400001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$249.00
|
—
|
$249.00
|
$249.00
|
$249.00
|
2026-05-18
|
|
91400002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$327.00
|
—
|
$327.00
|
$327.00
|
$327.00
|
2026-05-18
|
|
91400003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$500.00
|
—
|
$500.00
|
$500.00
|
$500.00
|
2026-05-18
|
|
91500001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$327.00
|
—
|
$327.00
|
$327.00
|
$327.00
|
2026-05-18
|
|
91500002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$350.00
|
—
|
$350.00
|
$350.00
|
$350.00
|
2026-05-18
|
|
91500003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$390.00
|
—
|
$390.00
|
$390.00
|
$390.00
|
2026-05-18
|
|
91500004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$327.00
|
—
|
$327.00
|
$327.00
|
$327.00
|
2026-05-18
|
|
91600001
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$155.00
|
—
|
$155.00
|
$155.00
|
$155.00
|
2026-05-18
|
|
91600002
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$392.00
|
—
|
$392.00
|
$392.00
|
$392.00
|
2026-05-18
|
|
91600003
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$233.00
|
—
|
$233.00
|
$233.00
|
$233.00
|
2026-05-18
|
|
91600004
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$419.00
|
—
|
$419.00
|
$419.00
|
$419.00
|
2026-05-18
|
|
91600005
|
OTHER
|
Inpatient Psychiatric Services
|
17
|
17
|
$500.00
|
—
|
$500.00
|
$500.00
|
$500.00
|
2026-05-18
|