hospital_Erlanger Behavioral Health last_updated_ 2023-12-31 version_1 "hospital_Chattanooga, Tennessee" hospital_address 804 N. Holtzclaw Avenue license_ L000000033091 | 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_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 MANAGED MEDICARE|MANAGED MEDICARE] standard_charge|[payer_AETNA MANAGED MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MANAGED MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MANAGED MEDICARE|MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE SUPPLE|COMMERCIAL] standard_charge|[payer_AETNA MEDICARE SUPPLE|COMMERCIAL] |percent standard_charge|[payer_AETNA MEDICARE SUPPLE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE SUPPLE|COMMERCIAL] standard_charge|[payer_ALL SAVERS UNITED HEALTH|COMMERCIAL] standard_charge|[payer_ALL SAVERS UNITED HEALTH|COMMERCIAL] |percent standard_charge|[payer_ALL SAVERS UNITED HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ALL SAVERS UNITED HEALTH|COMMERCIAL] standard_charge|[payer_ALLEGIANCE BENEFIT|COMMERCIAL] standard_charge|[payer_ALLEGIANCE BENEFIT|COMMERCIAL] |percent standard_charge|[payer_ALLEGIANCE BENEFIT|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ALLEGIANCE BENEFIT|COMMERCIAL] standard_charge|[payer_ALLEGIANCE BENEFIT|HMO/PPO] standard_charge|[payer_ALLEGIANCE BENEFIT|HMO/PPO] |percent standard_charge|[payer_ALLEGIANCE BENEFIT|HMO/PPO] |contracting_method additional_payer_notes |[payer_ALLEGIANCE BENEFIT|HMO/PPO] standard_charge|[payer_ALLIANT HEALTH CARE|COMMERCIAL] standard_charge|[payer_ALLIANT HEALTH CARE|COMMERCIAL] |percent standard_charge|[payer_ALLIANT HEALTH CARE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ALLIANT HEALTH CARE|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_AMERIVANTAGE MGD MCR|MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE MGD MCR|MANAGED MEDICARE] |percent standard_charge|[payer_AMERIVANTAGE MGD MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AMERIVANTAGE MGD MCR|MANAGED MEDICARE] 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_BCBS TENNESSEE|BLUE CROSS] standard_charge|[payer_BCBS TENNESSEE|BLUE CROSS] |percent standard_charge|[payer_BCBS TENNESSEE|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS TENNESSEE|BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS|COMMERCIAL] standard_charge|[payer_BEACON HEALTH OPTIONS|COMMERCIAL] |percent standard_charge|[payer_BEACON HEALTH OPTIONS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS|COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|COMMERCIAL] |percent standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS|COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] |percent standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] |contracting_method additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] 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 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_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 MM|MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING MM|MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA HEALTHSPRING MM|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA HEALTHSPRING MM|MANAGED MEDICARE] standard_charge|[payer_GEHA FEHB UHC|COMMERCIAL] standard_charge|[payer_GEHA FEHB UHC|COMMERCIAL] |percent standard_charge|[payer_GEHA FEHB UHC|COMMERCIAL] |contracting_method additional_payer_notes |[payer_GEHA FEHB UHC|COMMERCIAL] standard_charge|[payer_GOLDEN RULE|COMMERCIAL] standard_charge|[payer_GOLDEN RULE|COMMERCIAL] |percent standard_charge|[payer_GOLDEN RULE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_GOLDEN RULE|COMMERCIAL] standard_charge|[payer_HEALTH FIRST HEALTH PLANS|HMO/PPO] standard_charge|[payer_HEALTH FIRST HEALTH PLANS|HMO/PPO] |percent standard_charge|[payer_HEALTH FIRST HEALTH PLANS|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTH FIRST HEALTH PLANS|HMO/PPO] standard_charge|[payer_HEALTH MANAGEMENT ADMIN|HMO/PPO] standard_charge|[payer_HEALTH MANAGEMENT ADMIN|HMO/PPO] |percent standard_charge|[payer_HEALTH MANAGEMENT ADMIN|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTH MANAGEMENT ADMIN|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 MGD MCR|MANAGED MEDICARE] standard_charge|[payer_HUMANA MGD MCR|MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MGD MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MGD MCR|MANAGED MEDICARE] 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_MERITAIN|COMMERCIAL] standard_charge|[payer_MERITAIN|COMMERCIAL] |percent standard_charge|[payer_MERITAIN|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MERITAIN|COMMERCIAL] standard_charge|[payer_MOAA INSURANCE|HMO/PPO] standard_charge|[payer_MOAA INSURANCE|HMO/PPO] |percent standard_charge|[payer_MOAA INSURANCE|HMO/PPO] |contracting_method additional_payer_notes |[payer_MOAA INSURANCE|HMO/PPO] standard_charge|[payer_NETWORK 180|COMMERCIAL] standard_charge|[payer_NETWORK 180|COMMERCIAL] |percent standard_charge|[payer_NETWORK 180|COMMERCIAL] |contracting_method additional_payer_notes |[payer_NETWORK 180|COMMERCIAL] standard_charge|[payer_NEW ERA LIFE INSRUANCE|HMO/PPO] standard_charge|[payer_NEW ERA LIFE INSRUANCE|HMO/PPO] |percent standard_charge|[payer_NEW ERA LIFE INSRUANCE|HMO/PPO] |contracting_method additional_payer_notes |[payer_NEW ERA LIFE INSRUANCE|HMO/PPO] standard_charge|[payer_OPTUM BH|HMO/PPO] standard_charge|[payer_OPTUM BH|HMO/PPO] |percent standard_charge|[payer_OPTUM BH|HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM BH|HMO/PPO] standard_charge|[payer_PARAMOUNT INSURANCE|HMO/PPO] standard_charge|[payer_PARAMOUNT INSURANCE|HMO/PPO] |percent standard_charge|[payer_PARAMOUNT INSURANCE|HMO/PPO] |contracting_method additional_payer_notes |[payer_PARAMOUNT INSURANCE|HMO/PPO] standard_charge|[payer_PEACH STATE HEALTH PLAN|COMMERCIAL] standard_charge|[payer_PEACH STATE HEALTH PLAN|COMMERCIAL] |percent standard_charge|[payer_PEACH STATE HEALTH PLAN|COMMERCIAL] |contracting_method additional_payer_notes |[payer_PEACH STATE HEALTH PLAN|COMMERCIAL] standard_charge|[payer_PEACH STATE HEALTH PLAN|MANAGED MEDICAID] standard_charge|[payer_PEACH STATE HEALTH PLAN|MANAGED MEDICAID] |percent standard_charge|[payer_PEACH STATE HEALTH PLAN|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_PEACH STATE HEALTH PLAN|MANAGED MEDICAID] standard_charge|[payer_PERFORMCARE|MANAGED MEDICAID] standard_charge|[payer_PERFORMCARE|MANAGED MEDICAID] |percent standard_charge|[payer_PERFORMCARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_PERFORMCARE|MANAGED MEDICAID] standard_charge|[payer_PHYSICIANS LIFE INSURANCE|COMMERCIAL] standard_charge|[payer_PHYSICIANS LIFE INSURANCE|COMMERCIAL] |percent standard_charge|[payer_PHYSICIANS LIFE INSURANCE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_PHYSICIANS LIFE INSURANCE|COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH|COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH|COMMERCIAL] |percent standard_charge|[payer_PRIORITY HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_PRIORITY HEALTH|COMMERCIAL] standard_charge|[payer_SIGNATURE ADVANTAGE PLA|MANAGED MEDICARE] standard_charge|[payer_SIGNATURE ADVANTAGE PLA|MANAGED MEDICARE] |percent standard_charge|[payer_SIGNATURE ADVANTAGE PLA|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_SIGNATURE ADVANTAGE PLA|MANAGED MEDICARE] standard_charge|[payer_STUDENT RESOURCES|COMMERCIAL] standard_charge|[payer_STUDENT RESOURCES|COMMERCIAL] |percent standard_charge|[payer_STUDENT RESOURCES|COMMERCIAL] |contracting_method additional_payer_notes |[payer_STUDENT RESOURCES|COMMERCIAL] standard_charge|[payer_TNCARE AMERIGROUP|MANAGED MEDICAID] standard_charge|[payer_TNCARE AMERIGROUP|MANAGED MEDICAID] |percent standard_charge|[payer_TNCARE AMERIGROUP|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TNCARE AMERIGROUP|MANAGED MEDICAID] standard_charge|[payer_TNCARE BLUE CARE|MANAGED MEDICAID] standard_charge|[payer_TNCARE BLUE CARE|MANAGED MEDICAID] |percent standard_charge|[payer_TNCARE BLUE CARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TNCARE BLUE CARE|MANAGED MEDICAID] standard_charge|[payer_TNCARE COVERKIDS BLUECARE|MANAGED MEDICAID] standard_charge|[payer_TNCARE COVERKIDS BLUECARE|MANAGED MEDICAID] |percent standard_charge|[payer_TNCARE COVERKIDS BLUECARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TNCARE COVERKIDS BLUECARE|MANAGED MEDICAID] standard_charge|[payer_TNCARE UHC COMM|MANAGED MEDICAID] standard_charge|[payer_TNCARE UHC COMM|MANAGED MEDICAID] |percent standard_charge|[payer_TNCARE UHC COMM|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TNCARE UHC COMM|MANAGED MEDICAID] 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 OVERSEAS|TRICARE] standard_charge|[payer_TRICARE OVERSEAS|TRICARE] |percent standard_charge|[payer_TRICARE OVERSEAS|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE OVERSEAS|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_TRUSTMARK|COMMERCIAL] standard_charge|[payer_TRUSTMARK|COMMERCIAL] |percent standard_charge|[payer_TRUSTMARK|COMMERCIAL] |contracting_method additional_payer_notes |[payer_TRUSTMARK|COMMERCIAL] standard_charge|[payer_TRUSTMARK|HMO/PPO] standard_charge|[payer_TRUSTMARK|HMO/PPO] |percent standard_charge|[payer_TRUSTMARK|HMO/PPO] |contracting_method additional_payer_notes |[payer_TRUSTMARK|HMO/PPO] standard_charge|[payer_UHC DUAL COMPLETE|MANAGED MEDICARE] standard_charge|[payer_UHC DUAL COMPLETE|MANAGED MEDICARE] |percent standard_charge|[payer_UHC DUAL COMPLETE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC DUAL COMPLETE|MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE SUPPLEMENT|COMMERCIAL] standard_charge|[payer_UHC MEDICARE SUPPLEMENT|COMMERCIAL] |percent standard_charge|[payer_UHC MEDICARE SUPPLEMENT|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UHC MEDICARE SUPPLEMENT|COMMERCIAL] standard_charge|[payer_UHC MGD MCR|MANAGED MEDICARE] standard_charge|[payer_UHC MGD MCR|MANAGED MEDICARE] |percent standard_charge|[payer_UHC MGD MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC MGD MCR|MANAGED MEDICARE] standard_charge|[payer_UHIS UNITED HEALTH INTER|HMO/PPO] standard_charge|[payer_UHIS UNITED HEALTH INTER|HMO/PPO] |percent standard_charge|[payer_UHIS UNITED HEALTH INTER|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHIS UNITED HEALTH INTER|HMO/PPO] standard_charge|[payer_UHSS UMR|COMMERCIAL] standard_charge|[payer_UHSS UMR|COMMERCIAL] |percent standard_charge|[payer_UHSS UMR|COMMERCIAL] |contracting_method additional_payer_notes |[payer_UHSS UMR|COMMERCIAL] 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 HEALTHCARE|HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE|HMO/PPO] |percent standard_charge|[payer_UNITED HEALTHCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE|HMO/PPO] standard_charge|[payer_WEBTPA|HMO/PPO] standard_charge|[payer_WEBTPA|HMO/PPO] |percent standard_charge|[payer_WEBTPA|HMO/PPO] |contracting_method additional_payer_notes |[payer_WEBTPA|HMO/PPO] ROOM AND BOARD ADULT PSYCH 124 RC facility inpatient 2106.00 845.00 575.00 1950.00 1190.00 per diem 1190.00 per diem 1250.00 per diem 1133.00 per diem 927.00 per diem 1125.00 per diem 1125.00 per diem 1125.00 per diem 950.00 per diem 1125.00 per diem 700.00 per diem 1133.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem 1020.00 per diem 1190.00 per diem 1190.00 per diem 675.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 801.00 per diem 575.00 per diem 675.00 per diem 1133.00 per diem 1191.54 per diem 675.00 per diem 675.00 per diem 700.00 per diem 700.00 per diem 750.00 per diem 1085.59 per diem 1005.10 per diem 1005.10 per diem 1950.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem ROOM AND BOARD GERI PSYCH 124 RC facility inpatient 2106.00 845.00 575.00 1950.00 1190.00 per diem 1190.00 per diem 1250.00 per diem 1133.00 per diem 927.00 per diem 1125.00 per diem 1125.00 per diem 1125.00 per diem 950.00 per diem 1125.00 per diem 700.00 per diem 1133.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem 1020.00 per diem 1190.00 per diem 1190.00 per diem 675.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 801.00 per diem 575.00 per diem 675.00 per diem 1133.00 per diem 1191.54 per diem 675.00 per diem 675.00 per diem 700.00 per diem 700.00 per diem 750.00 per diem 1085.59 per diem 1005.10 per diem 1005.10 per diem 1950.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem ROOM AND BOARD PSYCH ADULT UNIT 124 RC facility inpatient 2106.00 845.00 575.00 1950.00 1190.00 per diem 1190.00 per diem 1250.00 per diem 1133.00 per diem 927.00 per diem 1125.00 per diem 1125.00 per diem 1125.00 per diem 950.00 per diem 1125.00 per diem 700.00 per diem 1133.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem 1020.00 per diem 1190.00 per diem 1190.00 per diem 675.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 801.00 per diem 575.00 per diem 675.00 per diem 1133.00 per diem 1191.54 per diem 675.00 per diem 675.00 per diem 700.00 per diem 700.00 per diem 750.00 per diem 1085.59 per diem 1005.10 per diem 1005.10 per diem 1950.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem ROOM AND BOARD PSYCH ADULT UNIT 124 RC facility inpatient 2106.00 845.00 575.00 1950.00 1190.00 per diem 1190.00 per diem 1250.00 per diem 1133.00 per diem 927.00 per diem 1125.00 per diem 1125.00 per diem 1125.00 per diem 950.00 per diem 1125.00 per diem 700.00 per diem 1133.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem 1020.00 per diem 1190.00 per diem 1190.00 per diem 675.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 801.00 per diem 575.00 per diem 675.00 per diem 1133.00 per diem 1191.54 per diem 675.00 per diem 675.00 per diem 700.00 per diem 700.00 per diem 750.00 per diem 1085.59 per diem 1005.10 per diem 1005.10 per diem 1950.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem ROOM AND BOARD SUBSTANCE UNIT 126 RC facility inpatient 2106.00 845.00 700.00 1250.00 1190.00 per diem 1190.00 per diem 1250.00 per diem 1133.00 per diem 927.00 per diem 1125.00 per diem 1125.00 per diem 950.00 per diem 1125.00 per diem 700.00 per diem 1133.00 per diem 1250.00 per diem 1190.00 per diem 1020.00 per diem 1190.00 per diem 1250.00 per diem 1250.00 per diem 801.00 per diem 1133.00 per diem 959.73 per diem 700.00 per diem 700.00 per diem 750.00 per diem 1085.59 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1250.00 per diem 1190.00 per diem ROOM AND BOARD PSYCH ADolescent UNIT 124 RC facility inpatient 2106.00 845.00 750.00 1296.00 1190.00 per diem 1190.00 per diem 1133.00 per diem 927.00 per diem 1296.00 per diem 1296.00 per diem 950.00 per diem 750.00 per diem 750.00 per diem 750.00 per diem 750.00 per diem ELECTOCONVULSIVE THERAPY - INPATIENT ANC 901 RC facility inpatient 1200.00 600.00 300.00 1004.70 796.00 per diem 796.00 per diem 796.00 per diem 848.00 per diem 669.50 per diem 422.46 per diem 440.34 per diem 788.00 per diem 788.00 per diem 450.00 per diem 450.00 per diem 788.00 per diem 475.00 per diem 440.34 per diem 658.00 per diem 440.34 per diem 743.00 per diem 796.00 per diem 796.00 per diem 650.00 per diem 422.46 per diem 422.46 per diem 796.00 per diem 848.00 per diem 743.00 per diem 848.00 per diem 500.00 per diem 300.00 per diem 1004.70 per diem 375.00 per diem 475.00 per diem 470.00 per diem 440.34 per diem 796.00 per diem 714.00 per diem 848.00 per diem 832.00 per diem 848.00 per diem 743.00 848.00 per diem 848.00 per diem 796.00 per diem ELECTOCONVULSIVE THERAPY - OUTPATIENT 901 RC facility outpatient 1200.00 600.00 300.00 1004.70 796.00 per diem 796.00 per diem 796.00 per diem 743.00 per diem 669.50 per diem 422.46 per diem 440.34 per diem 788.00 per diem 788.00 per diem 450.00 per diem 450.00 per diem 788.00 per diem 475.00 per diem 440.34 per diem 658.00 per diem 440.34 per diem 743.00 per diem 796.00 per diem 796.00 per diem 650.00 per diem 422.46 per diem 422.46 per diem 796.00 per diem 848.00 per diem 743.00 per diem 848.00 per diem 500.00 per diem 300.00 per diem 1004.70 per diem 375.00 per diem 475.00 per diem 470.00 per diem 440.34 per diem 796.00 per diem 714.00 per diem 743.00 per diem 728.00 per diem 743.00 per diem 743.00 743.00 per diem 743.00 per diem 796.00 per diem INTENSIVE OUTPATIENT PROGRAM PROGRAM 905 RC facility outpatient 600.00 300.00 130.00 350.00 276.00 per diem 302.00 per diem 283.25 per diem 228.47 per diem 228.47 per diem 282.00 per diem 282.00 per diem 200.00 per diem 282.00 per diem 160.00 per diem 228.47 per diem 302.00 per diem 228.47 per diem 350.00 per diem 276.00 per diem 200.00 per diem 228.47 per diem 228.47 per diem 350.00 per diem 350.00 per diem 203.00 per diem 130.00 per diem 160.00 per diem 160.00 per diem 140.00 per diem 228.47 per diem 276.00 per diem 235.00 per diem 235.00 per diem 350.00 per diem 350.00 350.00 per diem 350.00 per diem PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC facility outpatient 900.00 450.00 242.00 583.00 583.00 per diem 489.00 per diem 463.50 per diem 550.00 per diem 550.00 per diem 550.00 per diem 242.00 per diem 489.00 per diem 557.00 per diem 583.00 per diem 525.00 per diem 557.00 per diem 557.00 per diem 364.00 per diem 260.00 per diem 242.00 per diem 242.00 per diem 260.00 per diem 469.20 per diem 583.00 per diem 468.00 per diem 468.00 per diem 557.00 per diem 557.00 per diem 557.00 per diem INTENSIVE OUTPATIENT PROGRAM GROUP 1 915 RC facility outpatient 200.00 0.00 235.00 302.00 276.00 per diem 235.15 per diem 302.00 per diem 235.15 per diem 235.15 per diem 235.15 per diem 235.15 per diem 235.00 per diem PARTIAL HOSPITAL PROGRAM PROCESS GROUP 1 915 RC facility outpatient 180.00 0.00 235.00 583.00 583.00 per diem 235.15 per diem 302.00 per diem 235.15 per diem 235.15 per diem 235.15 per diem 235.15 per diem 235.00 per diem Electroconvulsive therapy 90870 RC facility inpatient 210.00 84.00 62.00 165.00 165.00 fee schedule 150.00 fee schedule 115.00 fee schedule 120.00 fee schedule 120.00 fee schedule 120.00 fee schedule 94.00 fee schedule 150.00 fee schedule 165.00 fee schedule 165.00 fee schedule 100.00 fee schedule 80.00 fee schedule 165.00 fee schedule 165.00 fee schedule 165.00 fee schedule 150.00 fee schedule 82.00 fee schedule 62.00 fee schedule 95.00 fee schedule 165.00 fee schedule 165.00 fee schedule 165.00 fee schedule 165.00 fee schedule Initial Hospital Care 30 min 99221 RC facility inpatient 240.00 96.00 47.50 93.71 93.71 fee schedule 50.13 fee schedule 65.20 fee schedule 65.20 fee schedule 65.20 fee schedule 65.20 fee schedule 60.16 fee schedule 93.71 fee schedule 65.05 fee schedule 58.60 fee schedule 93.71 fee schedule 74.01 fee schedule 60.16 fee schedule 60.16 fee schedule 65.55 fee schedule 66.38 fee schedule 66.38 fee schedule 66.38 fee schedule 47.50 fee schedule 47.50 fee schedule Initial Hospital Care 50 min 99222 RC facility inpatient 260.00 104.00 75.73 202.64 120.31 fee schedule 120.31 fee schedule 112.75 fee schedule 89.75 fee schedule 202.64 fee schedule 90.89 fee schedule 121.47 fee schedule 121.47 fee schedule 121.47 fee schedule 121.47 fee schedule 81.04 fee schedule 89.75 fee schedule 102.60 fee schedule 112.75 fee schedule 112.75 fee schedule 120.31 fee schedule 102.60 fee schedule 81.38 fee schedule 120.31 fee schedule 120.31 fee schedule 112.75 fee schedule 112.75 fee schedule 112.75 fee schedule 89.75 fee schedule 96.79 fee schedule 81.04 fee schedule 81.04 fee schedule 75.73 fee schedule 113.93 fee schedule 113.93 fee schedule 113.93 fee schedule 88.05 fee schedule 112.75 fee schedule 88.05 fee schedule 112.75 fee schedule 112.75 fee schedule 112.75 fee schedule 120.31 fee schedule Initial Hospital Care 70 min 99223 RC facility inpatient 280.00 112.00 80.73 219.00 219.00 fee schedule 219.00 fee schedule 173.30 fee schedule 118.70 fee schedule 175.02 fee schedule 131.39 fee schedule 103.59 fee schedule 103.59 fee schedule 103.59 fee schedule 103.59 fee schedule 99.00 fee schedule 118.70 fee schedule 161.38 fee schedule 173.30 fee schedule 173.30 fee schedule 219.00 fee schedule 161.38 fee schedule 126.69 fee schedule 219.00 fee schedule 219.00 fee schedule 173.30 fee schedule 173.30 fee schedule 173.30 fee schedule 118.70 fee schedule 152.12 fee schedule 99.00 fee schedule 99.00 fee schedule 80.73 fee schedule 124.00 fee schedule 124.00 fee schedule 124.00 fee schedule 100.75 fee schedule 173.30 fee schedule 100.75 fee schedule 173.30 fee schedule 173.30 fee schedule 173.30 fee schedule 219.00 fee schedule Subseq Care 15 min 99231 RC facility inpatient 140.00 56.00 29.09 70.66 70.66 fee schedule 70.66 fee schedule 39.36 fee schedule 29.09 fee schedule 45.20 fee schedule 31.89 fee schedule 53.49 fee schedule 53.49 fee schedule 53.49 fee schedule 53.49 fee schedule 30.37 fee schedule 29.09 fee schedule 31.98 fee schedule 39.36 fee schedule 39.36 fee schedule 70.66 fee schedule 39.02 fee schedule 29.15 fee schedule 70.66 fee schedule 70.66 fee schedule 39.36 fee schedule 39.36 fee schedule 39.36 fee schedule 29.09 fee schedule 30.50 fee schedule 30.37 fee schedule 30.37 fee schedule 31.51 fee schedule 39.82 fee schedule 39.82 fee schedule 39.82 fee schedule 34.47 fee schedule 39.36 fee schedule 34.47 fee schedule 39.36 fee schedule 39.36 fee schedule 39.36 fee schedule 70.66 fee schedule Subseq Care 25 min 99232 RC facility inpatient 160.00 64.00 32.31 93.67 73.83 fee schedule 32.31 fee schedule 93.67 fee schedule 54.16 fee schedule 65.24 fee schedule 65.24 fee schedule 65.24 fee schedule 65.24 fee schedule 35.43 fee schedule 32.31 fee schedule 70.62 fee schedule 73.83 fee schedule 73.83 fee schedule 68.47 fee schedule 50.79 fee schedule 73.83 fee schedule 73.83 fee schedule 73.83 fee schedule 32.31 fee schedule 55.61 fee schedule 35.43 fee schedule 35.43 fee schedule 38.72 fee schedule 63.81 fee schedule 63.81 fee schedule 63.81 fee schedule 47.92 fee schedule 73.83 fee schedule 47.92 fee schedule 73.83 fee schedule 73.83 fee schedule 73.83 fee schedule Subseq Care 35 min 99233 RC facility inpatient 180.00 72.00 43.43 122.30 112.43 fee schedule 112.43 fee schedule 113.00 fee schedule 56.34 fee schedule 122.30 fee schedule 81.41 fee schedule 104.18 fee schedule 104.18 fee schedule 104.18 fee schedule 104.18 fee schedule 43.43 fee schedule 56.34 fee schedule 82.44 fee schedule 113.00 fee schedule 113.00 fee schedule 112.43 fee schedule 106.56 fee schedule 81.79 fee schedule 112.43 fee schedule 112.43 fee schedule 113.00 fee schedule 113.00 fee schedule 113.00 fee schedule 56.34 fee schedule 80.74 fee schedule 43.43 fee schedule 43.43 fee schedule 44.90 fee schedule 101.67 fee schedule 101.67 fee schedule 101.67 fee schedule 67.24 fee schedule 113.00 fee schedule 67.24 fee schedule 113.00 fee schedule 113.00 fee schedule 113.00 fee schedule 112.43 fee schedule Discharge Day Mgmt <30min 99238 RC facility inpatient 160.00 64.00 34.90 94.42 65.00 fee schedule 68.58 fee schedule 94.42 fee schedule 55.40 fee schedule 62.43 fee schedule 62.43 fee schedule 62.43 fee schedule 62.43 fee schedule 56.03 fee schedule 68.58 fee schedule 66.34 fee schedule 65.00 fee schedule 65.00 fee schedule 74.86 fee schedule 54.05 fee schedule 65.00 fee schedule 65.00 fee schedule 65.00 fee schedule 68.58 fee schedule 56.39 fee schedule 56.03 fee schedule 56.03 fee schedule 34.90 fee schedule 70.66 fee schedule 70.66 fee schedule 70.66 fee schedule 85.38 fee schedule 65.00 fee schedule 85.38 fee schedule 65.00 fee schedule 65.00 fee schedule 65.00 fee schedule Discharge Day Mgmt >30min 99239 RC facility inpatient 160.00 64.00 21.00 125.76 115.81 fee schedule 115.81 fee schedule 78.85 fee schedule 100.00 fee schedule 125.76 fee schedule 95.49 fee schedule 81.51 fee schedule 81.51 fee schedule 81.51 fee schedule 81.51 fee schedule 55.60 fee schedule 100.00 fee schedule 78.85 fee schedule 78.85 fee schedule 115.81 fee schedule 102.91 fee schedule 67.56 fee schedule 115.81 fee schedule 115.81 fee schedule 78.85 fee schedule 78.85 fee schedule 78.85 fee schedule 100.00 fee schedule 83.26 fee schedule 55.60 fee schedule 55.60 fee schedule 21.00 fee schedule 92.02 fee schedule 92.02 fee schedule 92.02 fee schedule 88.63 fee schedule 78.85 fee schedule 88.63 fee schedule 78.85 fee schedule 78.85 fee schedule 78.85 fee schedule 115.81 fee schedule