{
  "hospital_name": "The Pavilion at Williamsburg Place, Inc.",
  "location_name": [
    "The Pavilion at Williamsburg Place, Inc."
  ],
  "hospital_address": [
    "5483 Mooretown Road, Williamsburg, VA 23188"
  ],
  "type_2_npi": [
    "1427326289"
  ],
  "license_information": {
    "license_number": "131",
    "state": "VA"
  },
  "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": "Lisa Evans"
  },
  "standard_charge_information": [
    {
      "description": "Adult Psych IOP 3 Hrs",
      "code_information": [
        {
          "code": "90853",
          "type": "CPT"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "gross_charge": 325.8,
          "discounted_cash_price": 325.8,
          "payer_specific_negotiated_charges": [
            {
              "payer_name": "ACMG",
              "plan_name": "All Plans",
              "negotiated_rate": 150.0
            },
            {
              "payer_name": "AETNA",
              "plan_name": "All Plans",
              "negotiated_rate": 231.0
            },
            {
              "payer_name": "AETNA",
              "plan_name": "All Plans",
              "negotiated_rate": 237.0
            },
            {
              "payer_name": "ANTHEM BCBS EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "ANTHEM BCBS EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "ANTHEM CCC PLUS MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "Anthem HealthKeepers Commercial HMO",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "Anthem HealthKeepers Commercial HMO",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "Anthem HealthKeepers Medicaid",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "BCBS FEP",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "BCBS FEP",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "BCBS OUT OF STATE EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "BCBS OUT OF STATE EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "BCBS OUT OF STATE HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "BCBS OUT OF STATE HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "CIGNA",
              "plan_name": "All Plans",
              "negotiated_rate": 256.0
            },
            {
              "payer_name": "CIGNA",
              "plan_name": "All Plans",
              "negotiated_rate": 262.0
            },
            {
              "payer_name": "CIGNA GLOBAL HEALTH",
              "plan_name": "All Plans",
              "negotiated_rate": 256.0
            },
            {
              "payer_name": "CIGNA GLOBAL HEALTH",
              "plan_name": "All Plans",
              "negotiated_rate": 262.0
            },
            {
              "payer_name": "COMPSYCH",
              "plan_name": "All Plans",
              "negotiated_rate": 280.0
            },
            {
              "payer_name": "HUMANA",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "OPTIMA COMM CARE MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "Optima-VP-VA PREM CCC MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "OPTUM",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 186.0
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 191.0
            },
            {
              "payer_name": "TRICARE EAST REGION",
              "plan_name": "All Plans",
              "negotiated_rate": 325.8
            },
            {
              "payer_name": "UHC",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "UHC COMM PLAN MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "UHC MANAGED MEDICARE ADVANTAGE",
              "plan_name": "All Plans",
              "negotiated_rate": 244.0
            },
            {
              "payer_name": "UHC OXFORD",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "UHC STUDENT RES",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "UMR",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "UMWA",
              "plan_name": "All Plans",
              "negotiated_rate": 150.0
            },
            {
              "payer_name": "UNITED HEALTHCARE SHARED SERVICES",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "WPAS",
              "plan_name": "All Plans",
              "negotiated_rate": 150.0
            }
          ],
          "minimum": 150.0,
          "maximum": 325.8
        }
      ]
    },
    {
      "description": "Telehealth PHP Psych Adult Daily",
      "code_information": [
        {
          "code": "H0035",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "gross_charge": 500.0,
          "discounted_cash_price": 500.0,
          "payer_specific_negotiated_charges": [
            {
              "payer_name": "AETNA",
              "plan_name": "All Plans",
              "negotiated_rate": 448.0
            },
            {
              "payer_name": "ANTHEM BCBS EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "ANTHEM CCC PLUS MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "Anthem HealthKeepers Medicaid",
              "plan_name": "All Plans",
              "negotiated_rate": 139.0
            },
            {
              "payer_name": "HUMANA MEDICAID",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "HUMANA MEDICARE",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "OPTIMA COMM CARE MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "Optima-VP-VA PREM CCC MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 425.0
            },
            {
              "payer_name": "TRICARE EAST REGION",
              "plan_name": "All Plans",
              "negotiated_rate": 433.8
            },
            {
              "payer_name": "UHC",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "UHC COMM PLAN MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            },
            {
              "payer_name": "UMR",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            }
          ],
          "minimum": 139.0,
          "maximum": 500.0
        }
      ]
    },
    {
      "description": "PHP Psych Adult Daily",
      "code_information": [
        {
          "code": "H0035",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "gross_charge": 500.0,
          "discounted_cash_price": 500.0,
          "payer_specific_negotiated_charges": [
            {
              "payer_name": "AETNA",
              "plan_name": "All Plans",
              "negotiated_rate": 448.0
            },
            {
              "payer_name": "AETNA",
              "plan_name": "All Plans",
              "negotiated_rate": 461.0
            },
            {
              "payer_name": "ANTHEM BCBS EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "ANTHEM BCBS EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 472.88
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 472.88
            },
            {
              "payer_name": "ANTHEM CCC PLUS MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "Anthem HealthKeepers Commercial HMO",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "Anthem HealthKeepers Commercial HMO",
              "plan_name": "All Plans",
              "negotiated_rate": 472.88
            },
            {
              "payer_name": "Anthem HealthKeepers Medicaid",
              "plan_name": "All Plans",
              "negotiated_rate": 139.0
            },
            {
              "payer_name": "BCBS FEP",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "BCBS FEP",
              "plan_name": "All Plans",
              "negotiated_rate": 472.88
            },
            {
              "payer_name": "BCBS OUT OF STATE EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "BCBS OUT OF STATE EXCHANGE",
              "plan_name": "All Plans",
              "negotiated_rate": 472.88
            },
            {
              "payer_name": "BCBS OUT OF STATE HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 461.25
            },
            {
              "payer_name": "BCBS OUT OF STATE HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 472.88
            },
            {
              "payer_name": "CIGNA",
              "plan_name": "All Plans",
              "negotiated_rate": 423.0
            },
            {
              "payer_name": "CIGNA",
              "plan_name": "All Plans",
              "negotiated_rate": 431.0
            },
            {
              "payer_name": "CIGNA GLOBAL HEALTH",
              "plan_name": "All Plans",
              "negotiated_rate": 423.0
            },
            {
              "payer_name": "CIGNA GLOBAL HEALTH",
              "plan_name": "All Plans",
              "negotiated_rate": 431.0
            },
            {
              "payer_name": "COMPSYCH",
              "plan_name": "All Plans",
              "negotiated_rate": 465.0
            },
            {
              "payer_name": "HUMANA MEDICAID",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "OPTIMA COMM CARE MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "OPTUM",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 439.0
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 451.0
            },
            {
              "payer_name": "TRICARE EAST REGION",
              "plan_name": "All Plans",
              "negotiated_rate": 433.8
            },
            {
              "payer_name": "UHC",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "UHC COMM PLAN MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "UHC MANAGED MEDICARE ADVANTAGE",
              "plan_name": "All Plans",
              "negotiated_rate": 390.0
            },
            {
              "payer_name": "UHC OXFORD",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "UHC STUDENT RES",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "UMR",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            },
            {
              "payer_name": "UNITED HEALTHCARE SHARED SERVICES",
              "plan_name": "All Plans",
              "negotiated_rate": 500.0
            }
          ],
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          "maximum": 500.0
        }
      ]
    },
    {
      "description": "Telehealth Adult Psych IOP 3 hrs",
      "code_information": [
        {
          "code": "90853",
          "type": "CPT"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "gross_charge": 325.8,
          "discounted_cash_price": 325.8,
          "payer_specific_negotiated_charges": [
            {
              "payer_name": "AETNA",
              "plan_name": "All Plans",
              "negotiated_rate": 231.0
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "ANTHEM CCC PLUS MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "Anthem HealthKeepers Commercial HMO",
              "plan_name": "All Plans",
              "negotiated_rate": 245.0
            },
            {
              "payer_name": "Anthem HealthKeepers Medicaid",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "HUMANA MEDICAID",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "OPTIMA COMM CARE MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 266.25
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 180.0
            },
            {
              "payer_name": "TRICARE EAST REGION",
              "plan_name": "All Plans",
              "negotiated_rate": 325.8
            },
            {
              "payer_name": "UMR",
              "plan_name": "All Plans",
              "negotiated_rate": 250.0
            }
          ],
          "minimum": 180.0,
          "maximum": 325.8
        }
      ]
    },
    {
      "description": "SUBSEQ HOSP (15 MIN)",
      "code_information": [
        {
          "code": "99231",
          "type": "CPT"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "gross_charge": 40.0,
          "discounted_cash_price": 40.0,
          "payer_specific_negotiated_charges": [
            {
              "payer_name": "Alignment Health Plan Medicare Advantage",
              "plan_name": "All Plans",
              "negotiated_rate": 25.94
            },
            {
              "payer_name": "ANTHEM BCBS HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 34.39
            },
            {
              "payer_name": "ANTHEM CCC PLUS MCD",
              "plan_name": "All Plans",
              "negotiated_rate": 34.39
            },
            {
              "payer_name": "Anthem HealthKeepers Commercial HMO",
              "plan_name": "All Plans",
              "negotiated_rate": 34.39
            },
            {
              "payer_name": "Anthem HealthKeepers Medicaid",
              "plan_name": "All Plans",
              "negotiated_rate": 34.39
            },
            {
              "payer_name": "BCBS FEP",
              "plan_name": "All Plans",
              "negotiated_rate": 38.22
            },
            {
              "payer_name": "BCBS MEDICARE ADV",
              "plan_name": "All Plans",
              "negotiated_rate": 25.94
            },
            {
              "payer_name": "BCBS OUT OF STATE HMO/PPO/PAR",
              "plan_name": "All Plans",
              "negotiated_rate": 38.22
            },
            {
              "payer_name": "CIGNA",
              "plan_name": "All Plans",
              "negotiated_rate": 36.0
            },
            {
              "payer_name": "CIGNA GLOBAL HEALTH",
              "plan_name": "All Plans",
              "negotiated_rate": 40.0
            },
            {
              "payer_name": "HUMANA MEDICARE",
              "plan_name": "All Plans",
              "negotiated_rate": 38.38
            },
            {
              "payer_name": "OPTIMA COMM CARE MCD Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 27.72
            },
            {
              "payer_name": "OPTIMA FAMILY CARE Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 20.26
            },
            {
              "payer_name": "OPTIMA MEDICARE Sentara",
              "plan_name": "All Plans",
              "negotiated_rate": 20.26
            },
            {
              "payer_name": "Sentara Optima Commercial",
              "plan_name": "All Plans",
              "negotiated_rate": 37.98
            },
            {
              "payer_name": "TRICARE EAST REGION",
              "plan_name": "All Plans",
              "negotiated_rate": 33.8
            }
          ],
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          "maximum": 40.0
        }
      ]
    }
  ]
}