"hospital_Vermilion Hospital, LLC" last_updated_ 2023-12-31 version_1 "hospital_Lafayette, Louisiana" hospital_address 2520 North University Avenue license_ 2203783724 | LA "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 BETTER HEALTH|MNGD MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH|MNGD MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH|MNGD MEDICAID] standard_charge|[payer_AETNA MEDICARE ADVANTAGE|MNGD MEDICARE] standard_charge|[payer_AETNA MEDICARE ADVANTAGE|MNGD MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE ADVANTAGE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE ADVANTAGE|MNGD MEDICARE] 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|HMO/PPO] standard_charge|[payer_ALL SAVERS|HMO/PPO] |percent standard_charge|[payer_ALL SAVERS|HMO/PPO] |contracting_method additional_payer_notes |[payer_ALL SAVERS|HMO/PPO] standard_charge|[payer_ALLIED TRADES Commercial ] standard_charge|[payer_ALLIED TRADES Commercial ] |percent standard_charge|[payer_ALLIED TRADES Commercial ] |contracting_method additional_payer_notes |[payer_ALLIED TRADES Commercial ] standard_charge|[payer_AMERIHEALTH CARITAS|MNGD MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS|MNGD MEDICAID] |percent standard_charge|[payer_AMERIHEALTH CARITAS|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIHEALTH CARITAS|MNGD MEDICAID] standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC|MNGD MEDICARE] standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC|MNGD MEDICARE] |percent standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_ANTHEM MAINE HEALTH-MEDIC|MNGD MEDICARE] standard_charge|[payer_APS HEALTHCARE|HMO/PPO] standard_charge|[payer_APS HEALTHCARE|HMO/PPO] |percent standard_charge|[payer_APS HEALTHCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_APS HEALTHCARE|HMO/PPO] standard_charge|[payer_BCBS ADVANTAGE MEDICARE|MNGD MEDICARE] standard_charge|[payer_BCBS ADVANTAGE MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_BCBS ADVANTAGE MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS ADVANTAGE MEDICARE|MNGD 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 LOUISIANA|BLUE CROSS] standard_charge|[payer_BCBS LOUISIANA|BLUE CROSS] |percent standard_charge|[payer_BCBS LOUISIANA|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS LOUISIANA|BLUE CROSS] standard_charge|[payer_BEACON HEALTH STRATEGIES|MNGD MEDICARE] standard_charge|[payer_BEACON HEALTH STRATEGIES|MNGD MEDICARE] |percent standard_charge|[payer_BEACON HEALTH STRATEGIES|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_BEACON HEALTH STRATEGIES|MNGD MEDICARE] standard_charge|[payer_CARELON|HMO/PPO] standard_charge|[payer_CARELON|HMO/PPO] |percent standard_charge|[payer_CARELON|HMO/PPO] |contracting_method additional_payer_notes |[payer_CARELON|HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_COMMUNITY CARE OF OK|HMO/PPO] standard_charge|[payer_COMMUNITY CARE OF OK|HMO/PPO] |percent standard_charge|[payer_COMMUNITY CARE OF OK|HMO/PPO] |contracting_method additional_payer_notes |[payer_COMMUNITY CARE OF OK|HMO/PPO] standard_charge|[payer_COUSHATTA HEALTH DEPT|COMMERCIAL] standard_charge|[payer_COUSHATTA HEALTH DEPT|COMMERCIAL] |percent standard_charge|[payer_COUSHATTA HEALTH DEPT|COMMERCIAL] |contracting_method additional_payer_notes |[payer_COUSHATTA HEALTH DEPT|COMMERCIAL] standard_charge|[payer_DCFS|MEDICAID] standard_charge|[payer_DCFS|MEDICAID] |percent standard_charge|[payer_DCFS|MEDICAID] |contracting_method additional_payer_notes |[payer_DCFS|MEDICAID] standard_charge|[payer_ENTRUST CLAIMS TEAM|COMMERCIAL] standard_charge|[payer_ENTRUST CLAIMS TEAM|COMMERCIAL] |percent standard_charge|[payer_ENTRUST CLAIMS TEAM|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ENTRUST CLAIMS TEAM|COMMERCIAL] standard_charge|[payer_GILSBAR|HMO/PPO] standard_charge|[payer_GILSBAR|HMO/PPO] |percent standard_charge|[payer_GILSBAR|HMO/PPO] |contracting_method additional_payer_notes |[payer_GILSBAR|HMO/PPO] standard_charge|[payer_GILSBAR-CIGNA|HMO/PPO] standard_charge|[payer_GILSBAR-CIGNA|HMO/PPO] |percent standard_charge|[payer_GILSBAR-CIGNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_GILSBAR-CIGNA|HMO/PPO] standard_charge|[payer_GULF SOUTH RISK SERV|COMMERCIAL] standard_charge|[payer_GULF SOUTH RISK SERV|COMMERCIAL] |percent standard_charge|[payer_GULF SOUTH RISK SERV|COMMERCIAL] |contracting_method additional_payer_notes |[payer_GULF SOUTH RISK SERV|COMMERCIAL] standard_charge|[payer_HEALTH BLUE MEDICAID] standard_charge|[payer_HEALTH BLUE MEDICAID] |percent standard_charge|[payer_HEALTH BLUE MEDICAID] |contracting_method additional_payer_notes |[payer_HEALTH BLUE MEDICAID] standard_charge|[payer_HUMANA COMMERCIAL|HMO/PPO] standard_charge|[payer_HUMANA COMMERCIAL|HMO/PPO] |percent standard_charge|[payer_HUMANA COMMERCIAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA COMMERCIAL|HMO/PPO] standard_charge|[payer_HUMANA GOLD MEDICARE|MNGD MEDICARE] standard_charge|[payer_HUMANA GOLD MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_HUMANA GOLD MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA GOLD MEDICARE|MNGD MEDICARE] standard_charge|[payer_HUMANA MEDICAID|MNGD MEDICAID] standard_charge|[payer_HUMANA MEDICAID|MNGD MEDICAID] |percent standard_charge|[payer_HUMANA MEDICAID|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_HUMANA MEDICAID|MNGD MEDICAID] standard_charge|[payer_IBH-CIGNA/ADOLESCENT|HMO/PPO] standard_charge|[payer_IBH-CIGNA/ADOLESCENT|HMO/PPO] |percent standard_charge|[payer_IBH-CIGNA/ADOLESCENT|HMO/PPO] |contracting_method additional_payer_notes |[payer_IBH-CIGNA/ADOLESCENT|HMO/PPO] standard_charge|[payer_INTERFACE EAP|HMO/PPO] standard_charge|[payer_INTERFACE EAP|HMO/PPO] |percent standard_charge|[payer_INTERFACE EAP|HMO/PPO] |contracting_method additional_payer_notes |[payer_INTERFACE EAP|HMO/PPO] standard_charge|[payer_LA HEALTHCARE CONNECTIONS|MNGD MEDICAID] standard_charge|[payer_LA HEALTHCARE CONNECTIONS|MNGD MEDICAID] |percent standard_charge|[payer_LA HEALTHCARE CONNECTIONS|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_LA HEALTHCARE CONNECTIONS|MNGD MEDICAID] standard_charge|[payer_LINECO|HMO/PPO] standard_charge|[payer_LINECO|HMO/PPO] |percent standard_charge|[payer_LINECO|HMO/PPO] |contracting_method additional_payer_notes |[payer_LINECO|HMO/PPO] 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_MEDICAID MAGELLAN CSOC|MEDICAID] standard_charge|[payer_MEDICAID MAGELLAN CSOC|MEDICAID] |percent standard_charge|[payer_MEDICAID MAGELLAN CSOC|MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID MAGELLAN CSOC|MEDICAID] standard_charge|[payer_MEDICAID PENDING|] standard_charge|[payer_MEDICAID PENDING|] |percent standard_charge|[payer_MEDICAID PENDING|] |contracting_method additional_payer_notes |[payer_MEDICAID PENDING|] standard_charge|[payer_MEDICARE|] standard_charge|[payer_MEDICARE|] |percent standard_charge|[payer_MEDICARE|] |contracting_method additional_payer_notes |[payer_MEDICARE|] standard_charge|[payer_MERITAIN HEALTH|HMO/PPO] standard_charge|[payer_MERITAIN HEALTH|HMO/PPO] |percent standard_charge|[payer_MERITAIN HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH|HMO/PPO] standard_charge|[payer_MGMT HEALTH NET|COMMERCIAL] standard_charge|[payer_MGMT HEALTH NET|COMMERCIAL] |percent standard_charge|[payer_MGMT HEALTH NET|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MGMT HEALTH NET|COMMERCIAL] standard_charge|[payer_MHNET PPO|HMO/PPO] standard_charge|[payer_MHNET PPO|HMO/PPO] |percent standard_charge|[payer_MHNET PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_MHNET PPO|HMO/PPO] standard_charge|[payer_MISC|COMMERCIAL] standard_charge|[payer_MISC|COMMERCIAL] |percent standard_charge|[payer_MISC|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MISC|COMMERCIAL] standard_charge|[payer_MOLINA HEALTHCARE OHIO|Medicaid] standard_charge|[payer_MOLINA HEALTHCARE OHIO|Medicaid] |percent standard_charge|[payer_MOLINA HEALTHCARE OHIO|Medicaid] |contracting_method additional_payer_notes |[payer_MOLINA HEALTHCARE OHIO|Medicaid] standard_charge|[payer_OFFICE OF JUVENILE JUSTIC|MEDICAID] standard_charge|[payer_OFFICE OF JUVENILE JUSTIC|MEDICAID] |percent standard_charge|[payer_OFFICE OF JUVENILE JUSTIC|MEDICAID] |contracting_method additional_payer_notes |[payer_OFFICE OF JUVENILE JUSTIC|MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH|MNGD MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH|MNGD MEDICAID] |percent standard_charge|[payer_OPTUM BEHAVIORAL HEALTH|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH|MNGD MEDICAID] standard_charge|[payer_OPTUM MEDICARE HMO|MNGD MEDICARE] standard_charge|[payer_OPTUM MEDICARE HMO|MNGD MEDICARE] |percent standard_charge|[payer_OPTUM MEDICARE HMO|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_OPTUM MEDICARE HMO|MNGD MEDICARE] standard_charge|[payer_OPTUM VACCN|VETERANS ADMIN] standard_charge|[payer_OPTUM VACCN|VETERANS ADMIN] |percent standard_charge|[payer_OPTUM VACCN|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_OPTUM VACCN|VETERANS ADMIN] standard_charge|[payer_PEOPLES HEALTH-MEDICARE|MNGD MEDICARE] standard_charge|[payer_PEOPLES HEALTH-MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_PEOPLES HEALTH-MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_PEOPLES HEALTH-MEDICARE|MNGD MEDICARE] standard_charge|[payer_PHCS|HMO/PPO] standard_charge|[payer_PHCS|HMO/PPO] |percent standard_charge|[payer_PHCS|HMO/PPO] |contracting_method additional_payer_notes |[payer_PHCS|HMO/PPO] standard_charge|[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] standard_charge|[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] |percent standard_charge|[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] |contracting_method additional_payer_notes |[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] standard_charge|[payer_SEMPER FI|COMMERCIAL] standard_charge|[payer_SEMPER FI|COMMERCIAL] |percent standard_charge|[payer_SEMPER FI|COMMERCIAL] |contracting_method additional_payer_notes |[payer_SEMPER FI|COMMERCIAL] standard_charge|[payer_SUPERIOR HEALTHPLAN|MNGD MEDICAID] standard_charge|[payer_SUPERIOR HEALTHPLAN|MNGD MEDICAID] |percent standard_charge|[payer_SUPERIOR HEALTHPLAN|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_SUPERIOR HEALTHPLAN|MNGD 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 FOR LIFE|] standard_charge|[payer_TRICARE FOR LIFE|] |percent standard_charge|[payer_TRICARE FOR LIFE|] |contracting_method additional_payer_notes |[payer_TRICARE FOR LIFE|] standard_charge|[payer_TRICARE SOUTH|] standard_charge|[payer_TRICARE SOUTH|] |percent standard_charge|[payer_TRICARE SOUTH|] |contracting_method additional_payer_notes |[payer_TRICARE SOUTH|] standard_charge|[payer_TRICARE WEST|] standard_charge|[payer_TRICARE WEST|] |percent standard_charge|[payer_TRICARE WEST|] |contracting_method additional_payer_notes |[payer_TRICARE WEST|] standard_charge|[payer_TRIWEST WPS VA|] standard_charge|[payer_TRIWEST WPS VA|] |percent standard_charge|[payer_TRIWEST WPS VA|] |contracting_method additional_payer_notes |[payer_TRIWEST WPS VA|] standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA|HMO/PPO] standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA|HMO/PPO] |percent standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA|HMO/PPO] |contracting_method additional_payer_notes |[payer_TUNICA-BILOXI TRIBE OF LA|HMO/PPO] standard_charge|[payer_UHC GEHA|HMO/PPO] standard_charge|[payer_UHC GEHA|HMO/PPO] |percent standard_charge|[payer_UHC GEHA|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC GEHA|HMO/PPO] standard_charge|[payer_UHC MEDICARE SOLUTIONS|MNGD MEDICARE] standard_charge|[payer_UHC MEDICARE SOLUTIONS|MNGD MEDICARE] |percent standard_charge|[payer_UHC MEDICARE SOLUTIONS|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_UHC MEDICARE SOLUTIONS|MNGD MEDICARE] standard_charge|[payer_UHC STUDENT|HMO/PPO] standard_charge|[payer_UHC STUDENT|HMO/PPO] |percent standard_charge|[payer_UHC STUDENT|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC STUDENT|HMO/PPO] standard_charge|[payer_UHC/UBH|HMO/PPO] standard_charge|[payer_UHC/UBH|HMO/PPO] |percent standard_charge|[payer_UHC/UBH|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC/UBH|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_VALUE OPTIONS|HMO/PPO] standard_charge|[payer_VALUE OPTIONS|HMO/PPO] |percent standard_charge|[payer_VALUE OPTIONS|HMO/PPO] |contracting_method additional_payer_notes |[payer_VALUE OPTIONS|HMO/PPO] standard_charge|[payer_VANTAGE HEALTH COMMERCIAL|HMO/PPO] standard_charge|[payer_VANTAGE HEALTH COMMERCIAL|HMO/PPO] |percent standard_charge|[payer_VANTAGE HEALTH COMMERCIAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_VANTAGE HEALTH COMMERCIAL|HMO/PPO] standard_charge|[payer_VANTAGE HEALTH MCARE HMO|MNGD MEDICARE] standard_charge|[payer_VANTAGE HEALTH MCARE HMO|MNGD MEDICARE] |percent standard_charge|[payer_VANTAGE HEALTH MCARE HMO|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_VANTAGE HEALTH MCARE HMO|MNGD MEDICARE] standard_charge|[payer_VERITY|HMO/PPO] standard_charge|[payer_VERITY|HMO/PPO] |percent standard_charge|[payer_VERITY|HMO/PPO] |contracting_method additional_payer_notes |[payer_VERITY|HMO/PPO] standard_charge|[payer_VERITY-PGRMA|HMO/PPO] standard_charge|[payer_VERITY-PGRMA|HMO/PPO] |percent standard_charge|[payer_VERITY-PGRMA|HMO/PPO] |contracting_method additional_payer_notes |[payer_VERITY-PGRMA|HMO/PPO] standard_charge|[payer_VETERANS AFFAIRS|VETERANS ADMIN] standard_charge|[payer_VETERANS AFFAIRS|VETERANS ADMIN] |percent standard_charge|[payer_VETERANS AFFAIRS|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VETERANS AFFAIRS|VETERANS ADMIN] standard_charge|[payer_VETERANS CHOICE VACAA|VETERANS ADMIN] standard_charge|[payer_VETERANS CHOICE VACAA|VETERANS ADMIN] |percent standard_charge|[payer_VETERANS CHOICE VACAA|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VETERANS CHOICE VACAA|VETERANS ADMIN] standard_charge|[payer_WEBTPA|COMMERCIAL] standard_charge|[payer_WEBTPA|COMMERCIAL] |percent standard_charge|[payer_WEBTPA|COMMERCIAL] |contracting_method additional_payer_notes |[payer_WEBTPA|COMMERCIAL] standard_charge|[payer_WELL MED MEDICARE|MNGD MEDICARE] standard_charge|[payer_WELL MED MEDICARE|MNGD MEDICARE] |percent standard_charge|[payer_WELL MED MEDICARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_WELL MED MEDICARE|MNGD MEDICARE] standard_charge|[payer_WELLCARE|MNGD MEDICARE] standard_charge|[payer_WELLCARE|MNGD MEDICARE] |percent standard_charge|[payer_WELLCARE|MNGD MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE|MNGD MEDICARE] standard_charge|[payer_WELLCARE KY MEDICAID|MNGD MEDICAID] standard_charge|[payer_WELLCARE KY MEDICAID|MNGD MEDICAID] |percent standard_charge|[payer_WELLCARE KY MEDICAID|MNGD MEDICAID] |contracting_method additional_payer_notes |[payer_WELLCARE KY MEDICAID|MNGD MEDICAID] standard_charge|[payer_ZELIS|COMMERCIAL] standard_charge|[payer_ZELIS|COMMERCIAL] |percent standard_charge|[payer_ZELIS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_ZELIS|COMMERCIAL] EAST-ROOM&BOARD PSYCH ADOLESCENT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem EAST-ROOM&BOARD PSYCH ADULT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem NORTH-ROOM&BOARD PSYCH ADOLESCENT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem NORTH-ROOM&BOARD PSYCH ADULT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem SOUTH-ROOM&BOARD PSYCH ADOLESCENT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem SOUTH-ROOM&BOARD PSYCH ADULT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem WEST-ROOM&BOARD PSYCH ADOLESCENT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem WEST-ROOM&BOARD PSYCH ADULT 124 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem EAST-ROOM&BOARD DETOX ADOLESCENT 126 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 774 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem EAST-ROOM&BOARD DETOX ADULT 126 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem NORTH-ROOM&BOARD DETOX ADULT 126 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem SOUTH-ROOM&BOARD DETOX ADULT 126 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem WEST-ROOM&BOARD DETOX ADULT 126 RC facility inpatient 2400 800 600 1060.5 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem DRG DRG 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem DRG DRG 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem DRG DRG DRG DRG 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem DRG DRG 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem DRG DRG 850 per diem 850 per diem 900 per diem DRG DRG 700 per diem 737.63 per diem 775 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH PROGRAM-ADOLESCENT 905 RC facility outpatient 660 200 170 600 240 per diem 175 per diem 175 per diem 175 per diem 434.46 per diem 434.46 per diem 201 per diem 375 per diem 193 per diem 175 per diem 210 per diem 170 per diem 170 per diem 269 per diem 321.51 per diem 198.02 per diem 600 per diem 175 per diem 170 per diem 200 per diem 170 per diem 170 per diem 269 per diem 270 per diem 225 per diem 453.49 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH PROGRAM 905 RC facility outpatient 660 200 170 600 240 per diem 175 per diem 175 per diem 175 per diem 434.46 per diem 434.46 per diem 201 per diem 375 per diem 193 per diem 175 per diem 210 per diem 170 per diem 170 per diem 269 per diem 321.51 per diem 198.02 per diem 600 per diem 175 per diem 170 per diem 200 per diem 170 per diem 170 per diem 269 per diem 270 per diem 225 per diem 453.49 per diem INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY GROUP 1 MCD 906 RC facility outpatient 660 0 127 453.49 240 per diem 144 per diem 144 per diem 144 per diem 433.12 per diem 433.12 per diem 144 per diem 210 per diem 144 per diem 192 per diem 144 per diem 127 per diem 127 per diem 127 per diem 269 per diem 453.49 per diem INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY GROUP-ADOLESCENT 906 RC facility outpatient 660 0 127 453.49 240 per diem 144 per diem 144 per diem 144 per diem 144 per diem 210 per diem 144 per diem 192 per diem 144 per diem 127 per diem 127 per diem 127 per diem 269 per diem 453.49 per diem PARTIAL HOSPITAL PROGRAM PSYCH PROGRAM 912 RC facility outpatient 860 300 144 800 460 per diem 229.65 per diem 534.72 per diem 534.72 per diem 410 per diem 400 per diem 394 per diem 300 per diem 534.72 per diem 229.65 per diem 800 per diem 144 per diem 285 per diem 211.67 per diem 229.65 per diem 300 per diem 285 per diem 285 per diem 370 per diem 375 per diem 436 per diem GROUP PSYCHO THERAPY 915 RC facility outpatient 250 0 144 321.51 198.02 per diem 198.02 per diem 210 per diem 198.02 per diem 321.51 per diem 229.65 per diem 144 per diem 211.67 per diem 198.02 per diem 222.73 per diem 179.42 per diem 179.42 per diem 179.42 per diem 179.42 per diem 198.02 per diem 179.42 per diem 179.42 per diem 300 per diem PROCESS GROUP/DAY INTENSICE OUTPATIENT PROGRAM 915 RC facility outpatient 220 0 144 321.51 198.02 per diem 198.02 per diem 198.02 per diem 321.51 per diem 229.65 per diem 144 per diem 211.67 per diem 198.02 per diem 222.73 per diem 179.42 per diem 179.42 per diem 179.42 per diem 179.42 per diem 198.02 per diem 179.42 per diem 179.42 per diem 300 per diem PROCESS GROUP1/DAY INTENSICE OUTPATIENT PROGRAM 915 RC facility outpatient 150 0 144 321.51 198.02 per diem 198.02 per diem 198.02 per diem 321.51 per diem 229.65 per diem 144 per diem 211.67 per diem 198.02 per diem 222.73 per diem 179.42 per diem 179.42 per diem 179.42 per diem 179.42 per diem 198.02 per diem 179.42 per diem 179.42 per diem 300 per diem Psych Eval - With Medical 90792 RC facility outpatient 250 0 62.5 171.02 157.16 fee schedule 115.62 fee schedule 115.62 fee schedule 115.62 fee schedule 75 fee schedule 134.38 fee schedule 129.91 fee schedule 171.02 fee schedule 134.38 fee schedule 134.38 fee schedule 62.5 fee schedule Initial Hospital Care (50 Min) 99222 RC facility outpatient 210 0 77 140.83 87.95 fee schedule 102.41 fee schedule 102.41 fee schedule 140.83 fee schedule 77 fee schedule 122.05 fee schedule 107.59 fee schedule 122.05 fee schedule 122.05 fee schedule Initial Hospital Care (70 Min) 99223 RC facility outpatient 500 0 134.38 134.38 134.38 fee schedule Subseq Care (15 Min) 99231 RC facility outpatient 120 0 26.6 93.4 26.6 fee schedule 93.4 fee schedule 93.4 fee schedule 93.4 fee schedule Subseq Care (25 Min) 99232 RC facility outpatient 140 0 47.34 131.96 82.4 fee schedule 47.34 fee schedule 93.58 fee schedule 93.58 fee schedule 131.96 fee schedule 70 fee schedule 67.6 fee schedule 92.16 fee schedule 88.89 fee schedule 84.29 fee schedule 92.16 fee schedule 92.16 fee schedule 92.16 fee schedule Subseq Care (35 Min) 99233 RC facility outpatient 200 0 68.56 131.44 68.56 fee schedule 93.64 fee schedule 131.44 fee schedule 131.44 fee schedule Discharge Day Mgmt <30 Min 99238 RC facility outpatient 160 0 47.25 114.65 82.4 fee schedule 47.25 fee schedule 114.65 fee schedule 114.65 fee schedule 86.02 fee schedule 80 fee schedule 48 fee schedule 112.75 fee schedule 114.15 fee schedule 112.75 fee schedule 112.75 fee schedule 112.75 fee schedule