hospital_Mount Carmel Behavioral Healthcare last_updated_ 2023-12-31 version_1 "hospital_Columbus, Ohio" hospital_address 4646 Hilton Corporate Drive license_ 07-7524 | OH "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_ADAMH ADAMS LAWRENC SCIOT|LOCAL GOVT] standard_charge|[payer_ADAMH ADAMS LAWRENC SCIOT|LOCAL GOVT] |percent standard_charge|[payer_ADAMH ADAMS LAWRENC SCIOT|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH ADAMS LAWRENC SCIOT|LOCAL GOVT] standard_charge|[payer_ADAMH CHAMPAIGN CO|LOCAL GOVT] standard_charge|[payer_ADAMH CHAMPAIGN CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH CHAMPAIGN CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH CHAMPAIGN CO|LOCAL GOVT] standard_charge|[payer_ADAMH CRAWFORD MARION|LOCAL GOVT] standard_charge|[payer_ADAMH CRAWFORD MARION|LOCAL GOVT] |percent standard_charge|[payer_ADAMH CRAWFORD MARION|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH CRAWFORD MARION|LOCAL GOVT] standard_charge|[payer_ADAMH DELAWARE MORROW|LOCAL GOVT] standard_charge|[payer_ADAMH DELAWARE MORROW|LOCAL GOVT] |percent standard_charge|[payer_ADAMH DELAWARE MORROW|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH DELAWARE MORROW|LOCAL GOVT] standard_charge|[payer_ADAMH FAIRFIELD CO|LOCAL GOVT] standard_charge|[payer_ADAMH FAIRFIELD CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH FAIRFIELD CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH FAIRFIELD CO|LOCAL GOVT] standard_charge|[payer_ADAMH FRANKLIN CO|LOCAL GOVT] standard_charge|[payer_ADAMH FRANKLIN CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH FRANKLIN CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH FRANKLIN CO|LOCAL GOVT] standard_charge|[payer_ADAMH GUERNSEY CO|LOCAL GOVT] standard_charge|[payer_ADAMH GUERNSEY CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH GUERNSEY CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH GUERNSEY CO|LOCAL GOVT] standard_charge|[payer_ADAMH LICKING KNOX CO|LOCAL GOVT] standard_charge|[payer_ADAMH LICKING KNOX CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH LICKING KNOX CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH LICKING KNOX CO|LOCAL GOVT] standard_charge|[payer_ADAMH LOGAN COUNTY|LOCAL GOVT] standard_charge|[payer_ADAMH LOGAN COUNTY|LOCAL GOVT] |percent standard_charge|[payer_ADAMH LOGAN COUNTY|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH LOGAN COUNTY|LOCAL GOVT] standard_charge|[payer_ADAMH MUSKINGUM AREA|LOCAL GOVT] standard_charge|[payer_ADAMH MUSKINGUM AREA|LOCAL GOVT] |percent standard_charge|[payer_ADAMH MUSKINGUM AREA|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH MUSKINGUM AREA|LOCAL GOVT] standard_charge|[payer_ADAMH NOBLE CO|LOCAL GOVT] standard_charge|[payer_ADAMH NOBLE CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH NOBLE CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH NOBLE CO|LOCAL GOVT] standard_charge|[payer_ADAMH NOT LISTED|LOCAL GOVT] standard_charge|[payer_ADAMH NOT LISTED|LOCAL GOVT] |percent standard_charge|[payer_ADAMH NOT LISTED|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH NOT LISTED|LOCAL GOVT] standard_charge|[payer_ADAMH PAINT VALLEY|LOCAL GOVT] standard_charge|[payer_ADAMH PAINT VALLEY|LOCAL GOVT] |percent standard_charge|[payer_ADAMH PAINT VALLEY|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH PAINT VALLEY|LOCAL GOVT] standard_charge|[payer_ADAMH UNION COUNTY|LOCAL GOVT] standard_charge|[payer_ADAMH UNION COUNTY|LOCAL GOVT] |percent standard_charge|[payer_ADAMH UNION COUNTY|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH UNION COUNTY|LOCAL GOVT] standard_charge|[payer_ADAMH WARREN CLINTON CO|LOCAL GOVT] standard_charge|[payer_ADAMH WARREN CLINTON CO|LOCAL GOVT] |percent standard_charge|[payer_ADAMH WARREN CLINTON CO|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_ADAMH WARREN CLINTON CO|LOCAL GOVT] standard_charge|[payer_AETNA|HMO/PPO] standard_charge|[payer_AETNA|HMO/PPO] |percent standard_charge|[payer_AETNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA|HMO/PPO] standard_charge|[payer_AETNA BETTE MCD|MANAGED MEDICAID] standard_charge|[payer_AETNA BETTE MCD|MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTE MCD|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTE MCD|MANAGED MEDICAID] standard_charge|[payer_AETNA BETTE MCR|MANAGED MEDICARE] standard_charge|[payer_AETNA BETTE MCR|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA BETTE MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA BETTE MCR|MANAGED MEDICARE] standard_charge|[payer_AETNA BH MCD OH RISE|MANAGED MEDICAID] standard_charge|[payer_AETNA BH MCD OH RISE|MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BH MCD OH RISE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BH MCD OH RISE|MANAGED MEDICAID] standard_charge|[payer_AETNA MCR ADV PPO|MANAGED MEDICARE] standard_charge|[payer_AETNA MCR ADV PPO|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MCR ADV PPO|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MCR ADV PPO|MANAGED MEDICARE] standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN|COMMERCIAL] standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN|COMMERCIAL] |percent standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ALLIED BENEFIT SYSTEMS IN|COMMERCIAL] standard_charge|[payer_AMBETTER|MANAGED MEDICARE] standard_charge|[payer_AMBETTER|MANAGED MEDICARE] |percent standard_charge|[payer_AMBETTER|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AMBETTER|MANAGED MEDICARE] standard_charge|[payer_AMERIHEALTH CARITAS OHIO|MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS OHIO|MANAGED MEDICAID] |percent standard_charge|[payer_AMERIHEALTH CARITAS OHIO|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIHEALTH CARITAS OHIO|MANAGED MEDICAID] standard_charge|[payer_ANTHEM OHIO MEDICAID|MANAGED MEDICAID] standard_charge|[payer_ANTHEM OHIO MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_ANTHEM OHIO MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_ANTHEM OHIO MEDICAID|MANAGED MEDICAID] standard_charge|[payer_ANTHEM SENIOR|MANAGED MEDICARE] standard_charge|[payer_ANTHEM SENIOR|MANAGED MEDICARE] |percent standard_charge|[payer_ANTHEM SENIOR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ANTHEM SENIOR|MANAGED MEDICARE] standard_charge|[payer_AULTCARE|HMO/PPO] standard_charge|[payer_AULTCARE|HMO/PPO] |percent standard_charge|[payer_AULTCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_AULTCARE|HMO/PPO] standard_charge|[payer_BCBS OUT OF STATE|BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE|BLUE CROSS] |percent standard_charge|[payer_BCBS OUT OF STATE|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OUT OF STATE|BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS|HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS|HMO/PPO] |percent standard_charge|[payer_BEACON HEALTH OPTIONS|HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS|HMO/PPO] standard_charge|[payer_BLUE CROSS BLUE SHIELD|BLUE CROSS] standard_charge|[payer_BLUE CROSS BLUE SHIELD|BLUE CROSS] |percent standard_charge|[payer_BLUE CROSS BLUE SHIELD|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BLUE CROSS BLUE SHIELD|BLUE CROSS] standard_charge|[payer_BUCKEYE COMMUNITY HEALTH|MANAGED MEDICAID] standard_charge|[payer_BUCKEYE COMMUNITY HEALTH|MANAGED MEDICAID] |percent standard_charge|[payer_BUCKEYE COMMUNITY HEALTH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BUCKEYE COMMUNITY HEALTH|MANAGED MEDICAID] standard_charge|[payer_CARESOURCE MCR ADV|MANAGED MEDICARE] standard_charge|[payer_CARESOURCE MCR ADV|MANAGED MEDICARE] |percent standard_charge|[payer_CARESOURCE MCR ADV|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CARESOURCE MCR ADV|MANAGED MEDICARE] standard_charge|[payer_CARESOURCE OF OHIO|MANAGED MEDICAID] standard_charge|[payer_CARESOURCE OF OHIO|MANAGED MEDICAID] |percent standard_charge|[payer_CARESOURCE OF OHIO|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CARESOURCE OF OHIO|MANAGED MEDICAID] standard_charge|[payer_CIGNA|HMO/PPO] standard_charge|[payer_CIGNA|HMO/PPO] |percent standard_charge|[payer_CIGNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA|HMO/PPO] standard_charge|[payer_CORESOURCE|HMO/PPO] standard_charge|[payer_CORESOURCE|HMO/PPO] |percent standard_charge|[payer_CORESOURCE|HMO/PPO] |contracting_method additional_payer_notes |[payer_CORESOURCE|HMO/PPO] standard_charge|[payer_DELAWARE MORROW BOARD|LOCAL GOVT] standard_charge|[payer_DELAWARE MORROW BOARD|LOCAL GOVT] |percent standard_charge|[payer_DELAWARE MORROW BOARD|LOCAL GOVT] |contracting_method additional_payer_notes |[payer_DELAWARE MORROW BOARD|LOCAL GOVT] standard_charge|[payer_HEALTHSMART|HMO/PPO] standard_charge|[payer_HEALTHSMART|HMO/PPO] |percent standard_charge|[payer_HEALTHSMART|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHSMART|HMO/PPO] standard_charge|[payer_HUMANA|HMO/PPO] standard_charge|[payer_HUMANA|HMO/PPO] |percent standard_charge|[payer_HUMANA|HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA|HMO/PPO] standard_charge|[payer_HUMANA MCR|MANAGED MEDICARE] standard_charge|[payer_HUMANA MCR|MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MCR|MANAGED MEDICARE] standard_charge|[payer_MED BEN|HMO/PPO] standard_charge|[payer_MED BEN|HMO/PPO] |percent standard_charge|[payer_MED BEN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MED BEN|HMO/PPO] standard_charge|[payer_MEDICAID|MEDICAID ] standard_charge|[payer_MEDICAID|MEDICAID ] |percent standard_charge|[payer_MEDICAID|MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID|MEDICAID ] standard_charge|[payer_MEDICAL MUTUAL|HMO/PPO] standard_charge|[payer_MEDICAL MUTUAL|HMO/PPO] |percent standard_charge|[payer_MEDICAL MUTUAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_MEDICAL MUTUAL|HMO/PPO] 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_MEDIGOLD|MANAGED MEDICARE] standard_charge|[payer_MEDIGOLD|MANAGED MEDICARE] |percent standard_charge|[payer_MEDIGOLD|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MEDIGOLD|MANAGED MEDICARE] standard_charge|[payer_MERITAIN HEALTH|COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH|COMMERCIAL] |percent standard_charge|[payer_MERITAIN HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH|COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL|COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL|COMMERCIAL] |percent standard_charge|[payer_MISC COMMERCIAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MISC COMMERCIAL|COMMERCIAL] standard_charge|[payer_MOLINA COMMERCIAL|COMMERCIAL] standard_charge|[payer_MOLINA COMMERCIAL|COMMERCIAL] |percent standard_charge|[payer_MOLINA COMMERCIAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MOLINA COMMERCIAL|COMMERCIAL] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO|MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO|MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA HEALTHCARE OF OHIO|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA HEALTHCARE OF OHIO|MANAGED MEDICAID] standard_charge|[payer_MOLINA MYCARE MEDICARE|MANAGED MEDICARE] standard_charge|[payer_MOLINA MYCARE MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_MOLINA MYCARE MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MOLINA MYCARE MEDICARE|MANAGED MEDICARE] standard_charge|[payer_NGS AMERICAN INSURANCE|COMMERCIAL] standard_charge|[payer_NGS AMERICAN INSURANCE|COMMERCIAL] |percent standard_charge|[payer_NGS AMERICAN INSURANCE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_NGS AMERICAN INSURANCE|COMMERCIAL] standard_charge|[payer_OHIO HEALTHY|COMMERCIAL] standard_charge|[payer_OHIO HEALTHY|COMMERCIAL] |percent standard_charge|[payer_OHIO HEALTHY|COMMERCIAL] |contracting_method additional_payer_notes |[payer_OHIO HEALTHY|COMMERCIAL] standard_charge|[payer_OHIO PPO CONNECT|COMMERCIAL] standard_charge|[payer_OHIO PPO CONNECT|COMMERCIAL] |percent standard_charge|[payer_OHIO PPO CONNECT|COMMERCIAL] |contracting_method additional_payer_notes |[payer_OHIO PPO CONNECT|COMMERCIAL] standard_charge|[payer_OPTUM|HMO/PPO] standard_charge|[payer_OPTUM|HMO/PPO] |percent standard_charge|[payer_OPTUM|HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM|HMO/PPO] standard_charge|[payer_OSCAR HEALTH|COMMERCIAL] standard_charge|[payer_OSCAR HEALTH|COMMERCIAL] |percent standard_charge|[payer_OSCAR HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_OSCAR HEALTH|COMMERCIAL] 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_TRICARE EAST|TRICARE] standard_charge|[payer_TRICARE EAST|TRICARE] |percent standard_charge|[payer_TRICARE EAST|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE EAST|TRICARE] standard_charge|[payer_TRICARE FOR LIFE|TRICARE] standard_charge|[payer_TRICARE FOR LIFE|TRICARE] |percent standard_charge|[payer_TRICARE FOR LIFE|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE FOR LIFE|TRICARE] standard_charge|[payer_TRUSTMARK|COMMERCIAL] standard_charge|[payer_TRUSTMARK|COMMERCIAL] |percent standard_charge|[payer_TRUSTMARK|COMMERCIAL] |contracting_method additional_payer_notes |[payer_TRUSTMARK|COMMERCIAL] standard_charge|[payer_UHC COMMERCIAL HMO|HMO/PPO] standard_charge|[payer_UHC COMMERCIAL HMO|HMO/PPO] |percent standard_charge|[payer_UHC COMMERCIAL HMO|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC COMMERCIAL HMO|HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES (GEHA|HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES (GEHA|HMO/PPO] |percent standard_charge|[payer_UHC SHARED SERVICES (GEHA|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC SHARED SERVICES (GEHA|HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCES|HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCES|HMO/PPO] |percent standard_charge|[payer_UHC STUDENT RESOURCES|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC STUDENT RESOURCES|HMO/PPO] standard_charge|[payer_UHCCP MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UHCCP MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_UHCCP MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHCCP MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UMR|COMMERCIAL] standard_charge|[payer_UMR|COMMERCIAL] |percent standard_charge|[payer_UMR|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UMR|COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE MCR|MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE MCR|MANAGED MEDICARE] |percent standard_charge|[payer_UNITED HEALTHCARE MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE MCR|MANAGED MEDICARE] standard_charge|[payer_VA CCN OPTUM|VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM|VETERANS ADMIN] |percent standard_charge|[payer_VA CCN OPTUM|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA CCN OPTUM|VETERANS ADMIN] standard_charge|[payer_WELLCARE BY ALLWELL|MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWELL|MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE BY ALLWELL|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE BY ALLWELL|MANAGED MEDICARE] ROOM AND BOARD PSYCH ADULT RECO 124 RC facility Inpatient 3300.00 750 800.00 1146.00 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 945.00 per diem 945.00 per diem 800.00 per diem 1025.00 per diem 1020.00 per diem 988.00 per diem 1020.00 per diem 955.00 per diem 1025.00 per diem 800.00 per diem 1025.00 per diem 980.00 per diem 1025.00 per diem 1080.00 per diem 945.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 888.00 per diem 888.00 per diem 888.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem ROOM AND BOARD PSYCH ADULT RENE 124 RC facility Inpatient 3300.00 750 800.00 1146.00 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 945.00 per diem 945.00 per diem 800.00 per diem 1025.00 per diem 1020.00 per diem 988.00 per diem 1020.00 per diem 955.00 per diem 1025.00 per diem 800.00 per diem 1025.00 per diem 980.00 per diem 1025.00 per diem 1080.00 per diem 945.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 888.00 per diem 888.00 per diem 888.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem ROOM AND BOARD PSYCH ADULT REST 124 RC facility Inpatient 3300.00 750 800.00 1146.00 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 945.00 per diem 945.00 per diem 800.00 per diem 1025.00 per diem 1020.00 per diem 988.00 per diem 1020.00 per diem 955.00 per diem 1025.00 per diem 800.00 per diem 1025.00 per diem 980.00 per diem 1025.00 per diem 1080.00 per diem 945.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 888.00 per diem 888.00 per diem 888.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem ROOM AND BOARD PSYCH ADULT REVI 124 RC facility Inpatient 3300.00 750 800.00 1146.00 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 945.00 per diem 945.00 per diem 800.00 per diem 1025.00 per diem 1020.00 per diem 988.00 per diem 1020.00 per diem 955.00 per diem 1025.00 per diem 800.00 per diem 1025.00 per diem 980.00 per diem 1025.00 per diem 1080.00 per diem 945.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 888.00 per diem 888.00 per diem 888.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem ROOM AND BOARD PSYCH DUAL DIAG 124 RC facility Inpatient 3300.00 750 800.00 1146.00 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 800.00 per diem 945.00 per diem 945.00 per diem 800.00 per diem 1025.00 per diem 1020.00 per diem 988.00 per diem 1020.00 per diem 955.00 per diem 1025.00 per diem 800.00 per diem 1025.00 per diem 980.00 per diem 1025.00 per diem 1080.00 per diem 945.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 888.00 per diem 888.00 per diem 888.00 per diem 1025.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem 1146.00 per diem INTENSIVE OUTPATIENT PROGRAM ADULT PSYCH 905 RC facility Outpatient 600.00 250 136.44 600.00 231.00 per diem 231.00 per diem 146.27 per diem 260.00 per diem 188.00 per diem 224.00 per diem 425.00 per diem 275.00 per diem 172.80 per diem 425.00 per diem 240.00 per diem 172.80 per diem 172.80 per diem 231.00 per diem 600.00 per diem 182.66 per diem 172.80 per diem 600.00 per diem 328.00 per diem 328.00 per diem 136.44 per diem 136.44 per diem 136.44 per diem 328.00 per diem 328.00 per diem 328.00 per diem 328.00 per diem 328.00 per diem 600.00 per diem INTENSIVE OUTPATIENT PROGRAM ADULT PSYCH (MGD MCD) 907 RC facility Outpatient 600.00 250 135.92 182.66 182.66 per diem 135.92 per diem 135.92 per diem 135.92 per diem 135.92 per diem 135.92 per diem INTENSIVE OUTPATIENT PROGRAM GROUP 1 915 RC facility Outpatient 200.00 83.33 36.53 275.00 182.66 per diem 146.27 per diem 275.00 per diem 36.53 per diem 146.27 per diem 182.66 per diem 146.27 per diem 136.44 per diem 136.44 per diem 136.44 per diem 182.66 per diem PSYCHIATRIC DIAG EVAL 90791 90791 RC facility Inpatient/Outpatient 310.00 0 73.47 73.47 73.47 fee schedule PSYCHIATRIC DIAG EVAL WITH MED SERVICES 90792 90792 RC facility Inpatient/Outpatient 310.00 0 71.80 212.90 212.90 fee schedule 131.18 fee schedule 83.14 fee schedule 94.10 fee schedule 86.17 fee schedule 71.80 fee schedule 121.61 fee schedule 83.14 fee schedule 188.73 fee schedule 83.14 fee schedule 125.81 fee schedule 134.78 fee schedule 173.21 fee schedule 114.86 fee schedule 113.62 fee schedule 141.88 fee schedule 141.87 fee schedule 83.14 fee schedule 141.87 fee schedule 155.00 fee schedule 142.72 fee schedule 99.53 fee schedule 154.18 fee schedule 99.53 fee schedule 83.14 fee schedule 157.29 fee schedule INITIAL HOSPITAL CARE (30 MIN)99221 99221 RC facility Inpatient/Outpatient 125.00 0 36.00 94.29 37.61 fee schedule 94.29 fee schedule 37.61 fee schedule 36.00 fee schedule 64.14 fee schedule 37.61 fee schedule 37.61 fee schedule 50.00 fee schedule 80.17 fee schedule 64.15 fee schedule 37.61 fee schedule 80.17 fee schedule 54.41 fee schedule 83.36 fee schedule 70.14 fee schedule 88.98 fee schedule 70.14 fee schedule 37.61 fee schedule 90.92 fee schedule INITIAL HOSPITAL CARE (50 MIN)99222 99222 RC facility Inpatient/Outpatient 125.00 0 47.35 122.50 55.71 fee schedule 55.71 fee schedule 47.35 fee schedule 55.71 fee schedule 55.71 fee schedule 88.77 fee schedule 122.50 fee schedule 55.71 fee schedule 106.51 fee schedule 101.18 fee schedule 101.18 fee schedule 55.71 fee schedule 87.50 fee schedule INITIAL HOSPITAL CARE (70 MIN)99223 99223 RC facility Inpatient/Outpatient 125.00 0 76.84 98.00 98.00 fee schedule 76.84 fee schedule SUBSEQ CARE (15 MIN)99231 99231 RC facility Inpatient/Outpatient 120.00 0 15.82 81.20 57.36 fee schedule 38.36 fee schedule 17.49 fee schedule 37.73 fee schedule 27.03 fee schedule 17.49 fee schedule 15.82 fee schedule 32.59 fee schedule 17.49 fee schedule 47.94 fee schedule 17.49 fee schedule 34.21 fee schedule 42.54 fee schedule 54.06 fee schedule 27.14 fee schedule 33.49 fee schedule 45.89 fee schedule 81.20 fee schedule 30.41 fee schedule 17.49 fee schedule 44.81 fee schedule 42.70 fee schedule 38.97 fee schedule 36.43 fee schedule 38.97 fee schedule 17.49 fee schedule 69.35 fee schedule 33.33 fee schedule SUBSEQ CARE (25 MIN)99232 99232 RC facility Inpatient/Outpatient 140.00 0 23.95 83.67 28.18 fee schedule 28.18 fee schedule 23.95 fee schedule 51.76 fee schedule 28.18 fee schedule 28.18 fee schedule 47.60 fee schedule 74.36 fee schedule 28.18 fee schedule 53.47 fee schedule 49.69 fee schedule 28.18 fee schedule 64.70 fee schedule 69.34 fee schedule 56.23 fee schedule 69.34 fee schedule 56.23 fee schedule 28.18 fee schedule 83.67 fee schedule SUBSEQ CARE (35 MIN)99233 99233 RC facility Inpatient/Outpatient 160.00 0 40.28 40.28 40.28 fee schedule DISCHARGE DAY MGMT <30 MIN99238 99238 RC facility Inpatient/Outpatient 160.00 0 28.13 106.40 83.32 fee schedule 61.86 fee schedule 31.62 fee schedule 61.03 fee schedule 67.29 fee schedule 31.62 fee schedule 28.13 fee schedule 55.79 fee schedule 31.62 fee schedule 77.32 fee schedule 31.62 fee schedule 62.92 fee schedule 67.07 fee schedule 87.18 fee schedule 50.08 fee schedule 53.83 fee schedule 73.45 fee schedule 106.40 fee schedule 31.62 fee schedule 70.37 fee schedule 80.00 fee schedule 72.50 fee schedule 70.33 fee schedule 62.34 fee schedule 69.67 fee schedule 70.33 fee schedule 31.62 fee schedule 86.83 fee schedule 61.35 fee schedule DISCHARGE DAY MANAGEMENT >30 MIN99239 99239 RC facility Inpatient/Outpatient 200.00 0 41.78 109.81 41.78 fee schedule 41.78 fee schedule 109.81 fee schedule 41.78 fee schedule 41.78 fee schedule