"hospital_Cumberland Behavioral Health, LLC" last_updated_ 2023-12-31 version_1 "hospital_Nashville, Tennessee" hospital_address 300 Great Circle Road license_ L00000032043 | TN "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_AARP SUPPLEMENT|COMMERCIAL] standard_charge|[payer_AARP SUPPLEMENT|COMMERCIAL] |percent standard_charge|[payer_AARP SUPPLEMENT|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AARP SUPPLEMENT|COMMERCIAL] standard_charge|[payer_ACS BENEFIT SERVICES- CIG|HMO/PPO] standard_charge|[payer_ACS BENEFIT SERVICES- CIG|HMO/PPO] |percent standard_charge|[payer_ACS BENEFIT SERVICES- CIG|HMO/PPO] |contracting_method additional_payer_notes |[payer_ACS BENEFIT SERVICES- CIG|HMO/PPO] 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 BETTER HEALTH OF KY|MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER HEALTH OF KY|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA BETTER HEALTH OF KY|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH OF KY|MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE|MANAGED MEDICARE] standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL|COMMERCIAL] standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL|COMMERCIAL] |percent standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AETNA SENIOR SUPPLEMENTAL|COMMERCIAL] standard_charge|[payer_AITHER HEALTH|COMMERCIAL] standard_charge|[payer_AITHER HEALTH|COMMERCIAL] |percent standard_charge|[payer_AITHER HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AITHER HEALTH|COMMERCIAL] standard_charge|[payer_ALL SAVERS- UHC|HMO/PPO] standard_charge|[payer_ALL SAVERS- UHC|HMO/PPO] |percent standard_charge|[payer_ALL SAVERS- UHC|HMO/PPO] |contracting_method additional_payer_notes |[payer_ALL SAVERS- UHC|HMO/PPO] standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA|HMO/PPO] standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA|HMO/PPO] |percent standard_charge|[payer_ALLEGIANCE BENEFIT- CIGNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_ALLEGIANCE BENEFIT- CIGNA|HMO/PPO] standard_charge|[payer_ALLIED BENEFIT SYSTEMS|COMMERCIAL] standard_charge|[payer_ALLIED BENEFIT SYSTEMS|COMMERCIAL] |percent standard_charge|[payer_ALLIED BENEFIT SYSTEMS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ALLIED BENEFIT SYSTEMS|COMMERCIAL] standard_charge|[payer_AMBETTER|COMMERCIAL] standard_charge|[payer_AMBETTER|COMMERCIAL] |percent standard_charge|[payer_AMBETTER|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AMBETTER|COMMERCIAL] standard_charge|[payer_AMERIGROUP|MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP|MANAGED MEDICAID] |percent standard_charge|[payer_AMERIGROUP|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIGROUP|MANAGED MEDICAID] standard_charge|[payer_AMERIVANTAGE|MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_AMERIVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AMERIVANTAGE|MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR|MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR|MANAGED MEDICARE] |percent standard_charge|[payer_ANTHEM MEDIBLUE GA MDCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ANTHEM MEDIBLUE GA MDCR|MANAGED MEDICARE] standard_charge|[payer_BCBS FEDERAL|BLUE CROSS] standard_charge|[payer_BCBS FEDERAL|BLUE CROSS] |percent standard_charge|[payer_BCBS FEDERAL|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS FEDERAL|BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE|BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE|BLUE CROSS] |percent standard_charge|[payer_BCBS OF TENNESSEE|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF TENNESSEE|BLUE CROSS] 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_BHS|COMMERCIAL] standard_charge|[payer_BHS|COMMERCIAL] |percent standard_charge|[payer_BHS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_BHS|COMMERCIAL] standard_charge|[payer_BLUE ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_BLUE ADVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_BLUE ADVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BLUE ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_BLUECARE|MANAGED MEDICAID] standard_charge|[payer_BLUECARE|MANAGED MEDICAID] |percent standard_charge|[payer_BLUECARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BLUECARE|MANAGED MEDICAID] standard_charge|[payer_BLUECARE PLUS|MANAGED MEDICARE] standard_charge|[payer_BLUECARE PLUS|MANAGED MEDICARE] |percent standard_charge|[payer_BLUECARE PLUS|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BLUECARE PLUS|MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH MEDICARE|MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_BRIGHT HEALTH MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BRIGHT HEALTH MEDICARE|MANAGED MEDICARE] standard_charge|[payer_CARELON BEHAVIORAL HEALTH|COMMERCIAL] standard_charge|[payer_CARELON BEHAVIORAL HEALTH|COMMERCIAL] |percent standard_charge|[payer_CARELON BEHAVIORAL HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_CARELON BEHAVIORAL HEALTH|COMMERCIAL] standard_charge|[payer_CBH|MEDICAID: OUT OF STATE] standard_charge|[payer_CBH|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_CBH|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_CBH|MEDICAID: OUT OF STATE] standard_charge|[payer_CHAMPVA|VETERANS ADMIN] standard_charge|[payer_CHAMPVA|VETERANS ADMIN] |percent standard_charge|[payer_CHAMPVA|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_CHAMPVA|VETERANS ADMIN] 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_CIGNA HEALTHSPRING|MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING|MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA HEALTHSPRING|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA HEALTHSPRING|MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH PLAN|MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH PLAN|MANAGED MEDICARE] |percent standard_charge|[payer_DEVOTED HEALTH PLAN|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_DEVOTED HEALTH PLAN|MANAGED MEDICARE] standard_charge|[payer_GEHA- UHC|HMO/PPO] standard_charge|[payer_GEHA- UHC|HMO/PPO] |percent standard_charge|[payer_GEHA- UHC|HMO/PPO] |contracting_method additional_payer_notes |[payer_GEHA- UHC|HMO/PPO] standard_charge|[payer_GTL|COMMERCIAL] standard_charge|[payer_GTL|COMMERCIAL] |percent standard_charge|[payer_GTL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_GTL|COMMERCIAL] standard_charge|[payer_HEALTHY BLUE MISSOURI|MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE MISSOURI|MANAGED MEDICAID] |percent standard_charge|[payer_HEALTHY BLUE MISSOURI|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HEALTHY BLUE MISSOURI|MANAGED MEDICAID] 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 MEDICARE ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE ADVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE|COMMERCIAL] standard_charge|[payer_KAISER PERMANENTE|COMMERCIAL] |percent standard_charge|[payer_KAISER PERMANENTE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_KAISER PERMANENTE|COMMERCIAL] standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS|MANAGED MEDICARE] standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS|MANAGED MEDICARE] |percent standard_charge|[payer_KY ANTHEM MEDIBLUE ACCESS|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_KY ANTHEM MEDIBLUE ACCESS|MANAGED MEDICARE] standard_charge|[payer_KY UHC COMMUNITY PLAN|MEDICAID: OUT OF STATE] standard_charge|[payer_KY UHC COMMUNITY PLAN|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_KY UHC COMMUNITY PLAN|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_KY UHC COMMUNITY PLAN|MEDICAID: OUT OF STATE] standard_charge|[payer_LUCENT HEALTH|COMMERCIAL] standard_charge|[payer_LUCENT HEALTH|COMMERCIAL] |percent standard_charge|[payer_LUCENT HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_LUCENT HEALTH|COMMERCIAL] standard_charge|[payer_MAGELLAN|HMO/PPO] standard_charge|[payer_MAGELLAN|HMO/PPO] |percent standard_charge|[payer_MAGELLAN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN|HMO/PPO] standard_charge|[payer_MEDICAID KY|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID KY|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID KY|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID KY|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID TN|MEDICAID ] standard_charge|[payer_MEDICAID TN|MEDICAID ] |percent standard_charge|[payer_MEDICAID TN|MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID TN|MEDICAID ] 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_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_MUTUAL OF OMAHA|COMMERCIAL] standard_charge|[payer_MUTUAL OF OMAHA|COMMERCIAL] |percent standard_charge|[payer_MUTUAL OF OMAHA|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MUTUAL OF OMAHA|COMMERCIAL] standard_charge|[payer_OHIO STATE HEALTH PLAN|COMMERCIAL] standard_charge|[payer_OHIO STATE HEALTH PLAN|COMMERCIAL] |percent standard_charge|[payer_OHIO STATE HEALTH PLAN|COMMERCIAL] |contracting_method additional_payer_notes |[payer_OHIO STATE HEALTH PLAN|COMMERCIAL] standard_charge|[payer_OOS MEDICAID|MEDICAID: OUT OF STATE] standard_charge|[payer_OOS MEDICAID|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_OOS MEDICAID|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_OOS MEDICAID|MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH|HMO/PPO] standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH|HMO/PPO] |percent standard_charge|[payer_OPTUM BEHAVIORAL H HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM BEHAVIORAL H HEALTH|HMO/PPO] standard_charge|[payer_OSCAR- CIGNA|HMO/PPO] standard_charge|[payer_OSCAR- CIGNA|HMO/PPO] |percent standard_charge|[payer_OSCAR- CIGNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_OSCAR- CIGNA|HMO/PPO] standard_charge|[payer_SISCO BENEFITS|COMMERCIAL] standard_charge|[payer_SISCO BENEFITS|COMMERCIAL] |percent standard_charge|[payer_SISCO BENEFITS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_SISCO BENEFITS|COMMERCIAL] standard_charge|[payer_TN MEDICAID - SLMB|SELF PAY CHARITY] standard_charge|[payer_TN MEDICAID - SLMB|SELF PAY CHARITY] |percent standard_charge|[payer_TN MEDICAID - SLMB|SELF PAY CHARITY] |contracting_method additional_payer_notes |[payer_TN MEDICAID - SLMB|SELF PAY CHARITY] 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_TRICARE WEST|TRICARE] standard_charge|[payer_TRICARE WEST|TRICARE] |percent standard_charge|[payer_TRICARE WEST|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE WEST|TRICARE] standard_charge|[payer_UHC AARP ADVAN|MANAGED MEDICARE] standard_charge|[payer_UHC AARP ADVAN|MANAGED MEDICARE] |percent standard_charge|[payer_UHC AARP ADVAN|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC AARP ADVAN|MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_UHC ADVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN|MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN|MANAGED MEDICAID] |percent standard_charge|[payer_UHC COMMUNITY PLAN|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC COMMUNITY PLAN|MANAGED MEDICAID] standard_charge|[payer_UHC SHARED SERVICES|HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES|HMO/PPO] |percent standard_charge|[payer_UHC SHARED SERVICES|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC SHARED SERVICES|HMO/PPO] standard_charge|[payer_UMR|HMO/PPO] standard_charge|[payer_UMR|HMO/PPO] |percent standard_charge|[payer_UMR|HMO/PPO] |contracting_method additional_payer_notes |[payer_UMR|HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH|HMO/PPO] |percent standard_charge|[payer_UNITED BEHAVIORAL HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_UPMC HEALTH PLAN|COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN|COMMERCIAL] |percent standard_charge|[payer_UPMC HEALTH PLAN|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UPMC HEALTH PLAN|COMMERCIAL] 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_VA COMMUNITY CARE NETWORK|VETERANS ADMIN] standard_charge|[payer_VA COMMUNITY CARE NETWORK|VETERANS ADMIN] |percent standard_charge|[payer_VA COMMUNITY CARE NETWORK|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA COMMUNITY CARE NETWORK|VETERANS ADMIN] standard_charge|[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] standard_charge|[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] ROOM AND BOARD ADULT UNIT 1 124 RC facility inpatient 2700.00 1000 700 2700 2700 per diem 1224 per diem 1269 per diem 2700 per diem 1269 per diem 2700 per diem 2700 per diem 1000 per diem 1224 per diem 2700 per diem 2700 per diem 700 per diem 2600 per diem 1075 per diem 1075 per diem 1075 per diem 1075 per diem 1100 per diem 1100 per diem 1075 per diem 725 per diem 725 per diem 1239.68 per diem 1100 per diem 2700 per diem 2700 per diem 1224 per diem 2400 per diem 2400 per diem 1000 per diem 2700 per diem 1082.38 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1400 per diem 2700 per diem 2700 per diem 876.16 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1224 per diem 2700 per diem 2700 per diem 1087.43 per diem 2700 per diem 1087.43 per diem 1235 per diem 1235 per diem 750 per diem 1000 per diem 1000 per diem 1000 per diem 2700 per diem 2700 per diem 2700 per diem 937.18 per diem ROOM AND BOARD GERI UNIT 1 124 RC facility inpatient 2700.00 1000 700 2700 2700 per diem 1224 per diem 1269 per diem 2700 per diem 1269 per diem 2700 per diem 2700 per diem 1000 per diem 1224 per diem 2700 per diem 2700 per diem 700 per diem 2600 per diem 1075 per diem 1075 per diem 1075 per diem 1075 per diem 1100 per diem 1100 per diem 1075 per diem 725 per diem 725 per diem 1239.68 per diem 1100 per diem 2700 per diem 2700 per diem 1224 per diem 2400 per diem 2400 per diem 1000 per diem 2700 per diem 1082.38 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1400 per diem 2700 per diem 2700 per diem 876.16 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1224 per diem 2700 per diem 2700 per diem 1087.43 per diem 2700 per diem 1087.43 per diem 1235 per diem 1235 per diem 750 per diem 1000 per diem 1000 per diem 1000 per diem 2700 per diem 2700 per diem 2700 per diem 937.18 per diem ELECTROCONVULSIVE THERAPY - INPATIENT 901 RC facility outpatient 2600.00 1600 459.67 5200 2600 per diem 1588 per diem 2600 per diem 1588 per diem 2600 per diem 2600 per diem 1134 per diem 721 per diem 2600 per diem 5200 per diem 760 per diem 2600 per diem 788 per diem 1576 per diem 1576 per diem 1576 per diem 773 per diem 700 per diem 1576 per diem 950 per diem 950 per diem 1045.29 per diem 773 per diem 2600 per diem 2600 per diem 1442 per diem 459.67 per diem 1134 per diem 5200 per diem 1700 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem 1700 per diem 2600 per diem 5200 per diem 459.67 per diem 5200 per diem 2600 per diem 2600 per diem 773 per diem 1442 per diem 2600 per diem 2600 per diem 5200 per diem 2600 per diem 2600 per diem 1174 per diem 1174 per diem 940 per diem 1134 per diem 1134 per diem 1134 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem ELECTROCONVULSIVE THERAPY - OUTPATIENT 901 RC facility outpatient 2600.00 1600 459.67 5200 2600 per diem 1588 per diem 2600 per diem 1588 per diem 2600 per diem 2600 per diem 1134 per diem 721 per diem 2600 per diem 5200 per diem 760 per diem 2600 per diem 788 per diem 1576 per diem 1576 per diem 1576 per diem 773 per diem 700 per diem 1576 per diem 950 per diem 950 per diem 1045.29 per diem 773 per diem 2600 per diem 2600 per diem 1442 per diem 459.67 per diem 1134 per diem 5200 per diem 1700 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem 1700 per diem 2600 per diem 5200 per diem 459.67 per diem 5200 per diem 2600 per diem 2600 per diem 773 per diem 1442 per diem 2600 per diem 2600 per diem 5200 per diem 2600 per diem 2600 per diem 1174 per diem 1174 per diem 940 per diem 1134 per diem 1134 per diem 1134 per diem 2600 per diem 2600 per diem 2600 per diem 2600 per diem INTENSIVE OUTPATIENT PROGRAM OP PROGRAM 905 RC facility outpatient 650.00 250 130 788 276 per diem 276 per diem 250 per diem 600 per diem 130 per diem 600 per diem 274 per diem 274 per diem 274 per diem 258 per diem 788 per diem 160 per diem 160 per diem 258 per diem 256 per diem 250 per diem 600 per diem 300 per diem 350 per diem 600 per diem 600 per diem 256 per diem 600 per diem 250 per diem 250 per diem 140 per diem 250 per diem 250 per diem 250 per diem 600 per diem 600 per diem PARTIAL HOSPITAL PROGRAM OP PROGRAM 912 RC facility outpatient 865.00 500 250 800 566 per diem 566 per diem 350 per diem 800 per diem 250 per diem 800 per diem 412 per diem 550 per diem 412 per diem 425 per diem 350 per diem 800 per diem 450 per diem 600 per diem 800 per diem 800 per diem 425 per diem 800 per diem 350 per diem 350 per diem 260 per diem 350 per diem 350 per diem 350 per diem 800 per diem 800 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GRP 1 915 RC facility outpatient 217.00 0 242 550 550 per diem 242 per diem 242 per diem Integrated Biopsychosocial Assessment 90791 RC facility inpatient 300.00 150 71.15 144.38 124.53 fee schedule 104.59 fee schedule 126.33 fee schedule 134.16 fee schedule 142.34 fee schedule 86.06 fee schedule 117.91 fee schedule 144.38 fee schedule 144.38 fee schedule 115.5 fee schedule 113.61 fee schedule 119.05 fee schedule 71.15 fee schedule Psychiatric Diagnostic Evaluation with Medical Services 90792 RC facility inpatient 350.00 150 0 234.36 163.22 fee schedule 234.36 fee schedule 118.68 fee schedule 124.05 fee schedule 0 159.09 fee schedule 156.14 fee schedule 128.25 fee schedule 159.14 fee schedule 73.63 fee schedule 183.21 fee schedule 166.12 fee schedule Initial Inpatient Consultation 99223 RC facility inpatient 280.00 140 103.31 223.22 161.38 fee schedule 156.82 fee schedule 191.15 fee schedule 145.25 fee schedule 107.76 fee schedule 223.22 fee schedule 161.38 fee schedule 161.38 fee schedule 172.02 fee schedule 153.31 fee schedule 103.31 fee schedule Initial Hospital Inpatient or Observation Care 99231 RC facility inpatient 140.00 70 20.86 54.03 27.09 fee schedule 53.04 fee schedule 45.29 fee schedule 29.11 fee schedule 33.4 fee schedule 54.03 fee schedule 36.91 fee schedule 31.54 fee schedule 38.79 fee schedule 43.17 fee schedule 42.47 fee schedule 31.7 fee schedule 38.86 fee schedule 35.42 fee schedule 20.86 fee schedule 47.77 fee schedule Level 2 Hospital Subsequent Care 99232 RC facility inpatient 160.00 80 34.43 140.31 73.57 fee schedule 84.46 fee schedule 140.31 fee schedule 56.34 fee schedule 58.86 fee schedule 65.84 fee schedule 62.53 fee schedule 34.43 fee schedule 53.16 fee schedule 71.8 fee schedule 79.86 fee schedule 73.57 fee schedule 41.15 fee schedule 64.03 fee schedule Level 3 Hospital Subsequent Care 99233 RC facility inpatient 180.00 90 70.13 114.59 110.72 fee schedule 100.32 fee schedule 70.13 fee schedule 114.59 fee schedule 110.71 fee schedule 110.71 fee schedule 108.87 fee schedule 81.55 fee schedule Observation Discharge Services 92238 RC facility inpatient 160.00 80 40.47 108.92 79.90 fee schedule 108.92 fee schedule 56.39 fee schedule 60.31 fee schedule 61.43 fee schedule 64.89 fee schedule 57.32 fee schedule 67.64 fee schedule 75.53 fee schedule 72.05 fee schedule 58.99 fee schedule 72.08 fee schedule 88.29 fee schedule 40.47 fee schedule Hospital Inpatient or Observation Discharge Day Management 99239 RC facility inpatient 160.00 80 71.56 84.88 71.56 84.88