"hospital_Greenbrier Hospital, LLC" last_updated_ 2023-12-31 version_1 "hospital_Covington, Louisiana" hospital_address 201 Greenbriar Boulevard license_ 691 | 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 | MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH | MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH | MANAGED MEDICAID] standard_charge|[payer_AETNA MEDICARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE ADVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE ADVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_AL ELMORE COUNTY DHR | COMMERCIAL] standard_charge|[payer_AL ELMORE COUNTY DHR | COMMERCIAL] |percent standard_charge|[payer_AL ELMORE COUNTY DHR | COMMERCIAL] |contracting_method additional_payer_notes |[payer_AL ELMORE COUNTY DHR | 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_ALLWELL BY LOUISIANA HEAL | MANAGED MEDICARE] standard_charge|[payer_ALLWELL BY LOUISIANA HEAL | MANAGED MEDICARE] |percent standard_charge|[payer_ALLWELL BY LOUISIANA HEAL | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ALLWELL BY LOUISIANA HEAL | MANAGED MEDICARE] standard_charge|[payer_AMBETTER | HMO/PPO] standard_charge|[payer_AMBETTER | HMO/PPO] |percent standard_charge|[payer_AMBETTER | HMO/PPO] |contracting_method additional_payer_notes |[payer_AMBETTER | HMO/PPO] standard_charge|[payer_AMERIHEALTH CARITAS | MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS | MANAGED MEDICAID] |percent standard_charge|[payer_AMERIHEALTH CARITAS | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIHEALTH CARITAS | MANAGED MEDICAID] 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 MEDICARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE ADVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MEDICARE ADVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MEDICARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_BCBS OF LOUISIANA | BLUE CROSS] standard_charge|[payer_BCBS OF LOUISIANA | BLUE CROSS] |percent standard_charge|[payer_BCBS OF LOUISIANA | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF LOUISIANA | 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_CHAMP VA | VETERANS ADMIN] standard_charge|[payer_CHAMP VA | VETERANS ADMIN] |percent standard_charge|[payer_CHAMP VA | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_CHAMP VA | 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 BEHAVIORAL | HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL | HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL | HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL | HMO/PPO] standard_charge|[payer_COMMUNITY CARE HEALTH | MANAGED MEDICARE] standard_charge|[payer_COMMUNITY CARE HEALTH | MANAGED MEDICARE] |percent standard_charge|[payer_COMMUNITY CARE HEALTH | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_COMMUNITY CARE HEALTH | MANAGED MEDICARE] standard_charge|[payer_COVENTRY MHNET | COMMERCIAL] standard_charge|[payer_COVENTRY MHNET | COMMERCIAL] |percent standard_charge|[payer_COVENTRY MHNET | COMMERCIAL] |contracting_method additional_payer_notes |[payer_COVENTRY MHNET | COMMERCIAL] standard_charge|[payer_DCFS | LOCAL GOVT] standard_charge|[payer_DCFS | LOCAL GOVT] |percent standard_charge|[payer_DCFS | LOCAL GOVT] |contracting_method additional_payer_notes |[payer_DCFS | LOCAL GOVT] standard_charge|[payer_ENTRUST | COMMERCIAL] standard_charge|[payer_ENTRUST | COMMERCIAL] |percent standard_charge|[payer_ENTRUST | COMMERCIAL] |contracting_method additional_payer_notes |[payer_ENTRUST | COMMERCIAL] standard_charge|[payer_GEHA | HMO/PPO] standard_charge|[payer_GEHA | HMO/PPO] |percent standard_charge|[payer_GEHA | HMO/PPO] |contracting_method additional_payer_notes |[payer_GEHA | HMO/PPO] 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_GULF GUARANTY | COMMERCIAL] standard_charge|[payer_GULF GUARANTY | COMMERCIAL] |percent standard_charge|[payer_GULF GUARANTY | COMMERCIAL] |contracting_method additional_payer_notes |[payer_GULF GUARANTY | COMMERCIAL] standard_charge|[payer_HEALTHY BLUE | MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE | MANAGED MEDICAID] |percent standard_charge|[payer_HEALTHY BLUE | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HEALTHY BLUE | MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA | MANAGED MEDICARE] standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA | MANAGED MEDICARE] |percent standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HEALTHY BLUE DUAL ADVANTA | MANAGED MEDICARE] 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 GOLD | MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD | MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA GOLD | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA GOLD | MANAGED MEDICARE] standard_charge|[payer_HUMANA HEALTHY HORIZONS | MANAGED MEDICAID] standard_charge|[payer_HUMANA HEALTHY HORIZONS | MANAGED MEDICAID] |percent standard_charge|[payer_HUMANA HEALTHY HORIZONS | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HUMANA HEALTHY HORIZONS | MANAGED MEDICAID] standard_charge|[payer_INLAND EMPIRE HEALTH PLAN MANAGED MEDICARE] standard_charge|[payer_INLAND EMPIRE HEALTH PLAN MANAGED MEDICARE] |percent standard_charge|[payer_INLAND EMPIRE HEALTH PLAN MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_INLAND EMPIRE HEALTH PLAN MANAGED MEDICARE] standard_charge|[payer_LOUISIANA HEALTHCARE CONN | MANAGED MEDICAID] standard_charge|[payer_LOUISIANA HEALTHCARE CONN | MANAGED MEDICAID] |percent standard_charge|[payer_LOUISIANA HEALTHCARE CONN | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_LOUISIANA HEALTHCARE CONN | MANAGED MEDICAID] standard_charge|[payer_LOUISIANA STATE MEDICAID | MEDICAID ] standard_charge|[payer_LOUISIANA STATE MEDICAID | MEDICAID ] |percent standard_charge|[payer_LOUISIANA STATE MEDICAID | MEDICAID ] |contracting_method additional_payer_notes |[payer_LOUISIANA STATE MEDICAID | MEDICAID ] 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_MAGELLAN CSOC | MANAGED MEDICAID] standard_charge|[payer_MAGELLAN CSOC | MANAGED MEDICAID] |percent standard_charge|[payer_MAGELLAN CSOC | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MAGELLAN CSOC | MANAGED MEDICAID] standard_charge|[payer_MEDICAID PENDING | PENDING MEDICAID] standard_charge|[payer_MEDICAID PENDING | PENDING MEDICAID] |percent standard_charge|[payer_MEDICAID PENDING | PENDING MEDICAID] |contracting_method additional_payer_notes |[payer_MEDICAID PENDING | PENDING MEDICAID] standard_charge|[payer_MEDICAID SECONDARY | MEDICAID ] standard_charge|[payer_MEDICAID SECONDARY | MEDICAID ] |percent standard_charge|[payer_MEDICAID SECONDARY | MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID SECONDARY | MEDICAID ] standard_charge|[payer_MEDICAID UNISYS | MEDICAID ] standard_charge|[payer_MEDICAID UNISYS | MEDICAID ] |percent standard_charge|[payer_MEDICAID UNISYS | MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID UNISYS | 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_MENTAL HEALTH NETWORK | HMO/PPO] standard_charge|[payer_MENTAL HEALTH NETWORK | HMO/PPO] |percent standard_charge|[payer_MENTAL HEALTH NETWORK | HMO/PPO] |contracting_method additional_payer_notes |[payer_MENTAL HEALTH NETWORK | HMO/PPO] 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_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_MISC MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_MISC MANAGED MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_MISC MANAGED MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MISC MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_MISSISSIPPI MEDICAID | MEDICAID: OUT OF STATE] standard_charge|[payer_MISSISSIPPI MEDICAID | MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MISSISSIPPI MEDICAID | MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MISSISSIPPI MEDICAID | MEDICAID: OUT OF STATE] standard_charge|[payer_MS MEDICAID MOLINA | MEDICAID: OUT OF STATE] standard_charge|[payer_MS MEDICAID MOLINA | MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MS MEDICAID MOLINA | MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MS MEDICAID MOLINA | MEDICAID: OUT OF STATE] standard_charge|[payer_OCHSNER MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_OCHSNER MANAGED MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_OCHSNER MANAGED MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_OCHSNER MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH | HMO/PPO] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH | HMO/PPO] |percent standard_charge|[payer_OPTUM BEHAVIORAL HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH | HMO/PPO] standard_charge|[payer_OPTUM BH MEDICARE | MANAGED MEDICARE] standard_charge|[payer_OPTUM BH MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_OPTUM BH MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_OPTUM BH MEDICARE | MANAGED MEDICARE] standard_charge|[payer_OPTUM BH MEDICARE 1500 | MANAGED MEDICARE] standard_charge|[payer_OPTUM BH MEDICARE 1500 | MANAGED MEDICARE] |percent standard_charge|[payer_OPTUM BH MEDICARE 1500 | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_OPTUM BH MEDICARE 1500 | MANAGED MEDICARE] standard_charge|[payer_OPTUM UHC COMMUNITY | MANAGED MEDICAID] standard_charge|[payer_OPTUM UHC COMMUNITY | MANAGED MEDICAID] |percent standard_charge|[payer_OPTUM UHC COMMUNITY | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_OPTUM UHC COMMUNITY | MANAGED MEDICAID] standard_charge|[payer_PEOPLES HEALTH MANAGED | MEDICARE] standard_charge|[payer_PEOPLES HEALTH MANAGED | MEDICARE] |percent standard_charge|[payer_PEOPLES HEALTH MANAGED | MEDICARE] |contracting_method additional_payer_notes |[payer_PEOPLES HEALTH MANAGED | MEDICARE] standard_charge|[payer_PRIORITY HEALTH | HMO/PPO] standard_charge|[payer_PRIORITY HEALTH | HMO/PPO] |percent standard_charge|[payer_PRIORITY HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_PRIORITY HEALTH | HMO/PPO] standard_charge|[payer_SUREST | HMO/PPO] standard_charge|[payer_SUREST | HMO/PPO] |percent standard_charge|[payer_SUREST | HMO/PPO] |contracting_method additional_payer_notes |[payer_SUREST | HMO/PPO] standard_charge|[payer_TRICARE EAST REGION CLAIM | TRICARE] standard_charge|[payer_TRICARE EAST REGION CLAIM | TRICARE] |percent standard_charge|[payer_TRICARE EAST REGION CLAIM | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE EAST REGION CLAIM | 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 PRIME | TRICARE] standard_charge|[payer_TRICARE PRIME | TRICARE] |percent standard_charge|[payer_TRICARE PRIME | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE PRIME | TRICARE] standard_charge|[payer_TRICAREWEST VAPC3 | VETERANS ADMIN] standard_charge|[payer_TRICAREWEST VAPC3 | VETERANS ADMIN] |percent standard_charge|[payer_TRICAREWEST VAPC3 | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_TRICAREWEST VAPC3 | VETERANS ADMIN] standard_charge|[payer_TRIWEST WEST REGION CLAIM | TRICARE] standard_charge|[payer_TRIWEST WEST REGION CLAIM | TRICARE] |percent standard_charge|[payer_TRIWEST WEST REGION CLAIM | TRICARE] |contracting_method additional_payer_notes |[payer_TRIWEST WEST REGION CLAIM | TRICARE] 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_UBH | HMO/PPO] standard_charge|[payer_UBH | HMO/PPO] |percent standard_charge|[payer_UBH | HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH | HMO/PPO] standard_charge|[payer_UHC| HMO/PPO] standard_charge|[payer_UHC| HMO/PPO] |percent standard_charge|[payer_UHC| HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC| 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_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 HEALTH CARE STUDEN | HMO/PPO] standard_charge|[payer_UNITED HEALTH CARE STUDEN | HMO/PPO] |percent standard_charge|[payer_UNITED HEALTH CARE STUDEN | HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTH CARE STUDEN | HMO/PPO] standard_charge|[payer_UNITED HEALTH INTGRTD SER | HMO/PPO] standard_charge|[payer_UNITED HEALTH INTGRTD SER | HMO/PPO] |percent standard_charge|[payer_UNITED HEALTH INTGRTD SER | HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTH INTGRTD SER | HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV | HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV | HMO/PPO] |percent standard_charge|[payer_UNITED HEALTH SHARED SERV | HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTH SHARED SERV | HMO/PPO] standard_charge|[payer_UNITED HEALTH WEST | MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTH WEST | MANAGED MEDICARE] |percent standard_charge|[payer_UNITED HEALTH WEST | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UNITED HEALTH WEST | MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE HMO SNP | MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE HMO SNP | MANAGED MEDICARE] |percent standard_charge|[payer_UNITED HEALTHCARE HMO SNP | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE HMO SNP | 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_VA FLORIDA | VETERANS ADMIN] standard_charge|[payer_VA FLORIDA | VETERANS ADMIN] |percent standard_charge|[payer_VA FLORIDA | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA FLORIDA | VETERANS ADMIN] standard_charge|[payer_VA TEXAS | VETERANS ADMIN] standard_charge|[payer_VA TEXAS | VETERANS ADMIN] |percent standard_charge|[payer_VA TEXAS | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA TEXAS | VETERANS ADMIN] standard_charge|[payer_VANTAGE HEALTH | HMO/PPO] standard_charge|[payer_VANTAGE HEALTH | HMO/PPO] |percent standard_charge|[payer_VANTAGE HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_VANTAGE HEALTH | HMO/PPO] standard_charge|[payer_VANTAGE HEALTH PLAN | MANAGED MEDICARE] standard_charge|[payer_VANTAGE HEALTH PLAN | MANAGED MEDICARE] |percent standard_charge|[payer_VANTAGE HEALTH PLAN | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_VANTAGE HEALTH PLAN | MANAGED MEDICARE] 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_VHA COMMUNITY CARE | VETERANS ADMIN] standard_charge|[payer_VHA COMMUNITY CARE | VETERANS ADMIN] |percent standard_charge|[payer_VHA COMMUNITY CARE | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VHA COMMUNITY CARE | VETERANS ADMIN] standard_charge|[payer_WEB TPA | HMO/PPO] standard_charge|[payer_WEB TPA | HMO/PPO] |percent standard_charge|[payer_WEB TPA | HMO/PPO] |contracting_method additional_payer_notes |[payer_WEB TPA | HMO/PPO] standard_charge|[payer_WELLCARE MEDICARE ADVANT | MANAGED MEDICARE] standard_charge|[payer_WELLCARE MEDICARE ADVANT | MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE MEDICARE ADVANT | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE MEDICARE ADVANT | MANAGED MEDICARE] ROOM AND BOARD ADOLESCENT PSYCH 124 RC facility inpatient 2376.00 702 700 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem drg psych drg 774.51 per diem 892.06 per diem psych drg 892.06 per diem 892.06 per diem 876 per diem psych drg 998 per diem 998 per diem psych drg 825 per diem 737.63 per diem drg 824 per diem 700 per diem 800 per diem 792.95 per diem psych drg 900 per diem psych drg 781.89 per diem psych drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem psyh drg 825 per diem 1112 per diem 2376 per diem psych drg psych drg 737.63 per diem psych drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem psych drg 1048.9 per diem psych drg psych drg 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem psych drg psych drg psych drg 975 per diem psych drg psych drg psych drg 825 per diem psych drg ROOM AND BOARD PSYCH 124 RC facility inpatient 2376.00 702 700 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem drg psych drg 774.51 per diem 892.06 per diem psych drg 892.06 per diem 892.06 per diem 876 per diem psych drg 998 per diem 998 per diem psych drg 825 per diem 737.63 per diem drg 824 per diem 700 per diem 800 per diem 792.95 per diem psych drg 900 per diem psych drg 781.89 per diem psych drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem psyh drg 825 per diem 1112 per diem 2376 per diem psych drg psych drg 737.63 per diem psych drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem psych drg 1048.9 per diem psych drg psych drg 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem psych drg psych drg psych drg 975 per diem psych drg psych drg psych drg 825 per diem psych drg ROOM AND BOARD ADOLESCENT DETOX 126 RC facility inpatient 2376.00 702 675 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem drg psych drg 774.51 per diem 892.06 per diem psych drg 892.06 per diem 892.06 per diem 876 per diem psych drg 998 per diem 998 per diem psych drg 825 per diem 737.63 per diem drg 824 per diem 675 per diem 800 per diem 792.95 per diem psych drg 900 per diem psych drg 781.89 per diem psych drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem psyh drg 825 per diem 1112 per diem 2376 per diem psych drg psych drg 737.63 per diem psych drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem psych drg 1048.9 per diem psych drg psych drg 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem psych drg psych drg psych drg 975 per diem psych drg psych drg psych drg 825 per diem psych drg ROOM AND BOARD ADULT DETOX 126 RC facility inpatient 2376.00 702 675 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem drg psych drg 774.51 per diem 892.06 per diem psych drg 892.06 per diem 892.06 per diem 876 per diem psych drg 998 per diem 998 per diem psych drg 825 per diem 737.63 per diem drg 824 per diem 675 per diem 800 per diem 792.95 per diem psych drg 900 per diem psych drg 781.89 per diem psych drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem psyh drg 825 per diem 1112 per diem 2376 per diem psych drg psych drg 737.63 per diem psych drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem psych drg 1048.9 per diem psych drg psych drg 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem psych drg psych drg psych drg 975 per diem psych drg psych drg psych drg 825 per diem psych drg ROOM AND BOARD REHAB 128 RC facility inpatient 2376.00 702 650 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem drg psych drg 774.51 per diem 892.06 per diem psych drg 892.06 per diem 892.06 per diem 876 per diem psych drg 998 per diem 998 per diem psych drg 825 per diem 737.63 per diem drg 824 per diem 650 per diem 800 per diem 792.95 per diem psych drg psych drg 781.89 per diem psych drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem psyh drg 825 per diem 1112 per diem 2376 per diem psych drg psych drg 737.63 per diem psych drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem psych drg 1048.9 per diem psych drg psych drg 1112 per diem INTENSIVE OUTPATIENT PROGRAM 22 JDC 905 RC facility outpatient 648.00 216 144 250 144 per diem 168 per diem 180.2 per diem 170 per diem 175 per diem 180 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 250 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM ADULT TELEMED 905 RC facility outpatient 648.00 216 144 254 254 per diem 175 per diem 254 per diem 175 per diem 240.4 per diem 240.4 per diem 240.4 per diem 180 per diem 238 per diem 238 per diem 225 per diem 225 per diem 144 per diem 168 per diem 180.2 per diem 170 per diem 175 per diem 180 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 250 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADOLESCENT 905 RC facility outpatient 648.00 216 144 254 254 per diem 175 per diem 254 per diem 175 per diem 240.4 per diem 240.4 per diem 240.4 per diem 180 per diem 238 per diem 238 per diem 225 per diem 225 per diem 144 per diem 168 per diem 180.2 per diem 170 per diem 175 per diem 180 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 250 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CD GROUP ADOLESCENT 906 RC facility outpatient 54.00 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CD GRP 1 MCD 906 RC facility outpatient 54.00 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CHEM DEP 906 RC facility outpatient 648.00 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CHEM DEP ADOLESCENT 906 RC facility outpatient 648.00 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 3 HOUR GROUP 915 RC facility outpatient 70.00 216 168 245 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 203.18 per diem 204.07 per diem 212.25 GROUP THERAPY 22ND 915 RC facility outpatient 25.00 216 168 245 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 203.18 per diem 204.07 per diem 212.25 per diem INTENSIVE OUTPATIENT PROGRAM MCR/T GRP 2 COVI 915 RC facility outpatient 216.00 216 144 275 144 per diem 204.12 per diem 203.18 per diem 275 per diem 250 per diem 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 245 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 203.18 per diem 204.07 per diem 212.25 per diem INTENSIVE OUTPATIENT PROGRAM MCR/TRC GRP 1 CO 915 RC facility outpatient 216.00 216 144 275 144 per diem 204.12 per diem 203.18 per diem 275 per diem 250 per diem 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 245 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 203.18 per diem 204.07 per diem 212.25 per diem INTENSIVE OUTPATIENT PROGRAM MCR/TRI GRP 3 CV 915 RC facility outpatient 216.00 216 144 275 144 per diem 204.12 per diem 203.18 per diem 275 per diem 250 per diem 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 245 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 203.18 per diem 204.07 per diem 212.25 per diem Initial Eval With Medical 90792 RC facility inpatient 310 0.00 75 144.43 75.86 fee schedule Rates based on patient diagnose 141.54 fee schedule Rates based on patient diagnose 75.00 fee schedule Rates based on patient diagnose 144.43 fee schedule Rates based on patient diagnose per diem Initial Hospital Care (50 Min) 99222 RC facility inpatient 210 0.00 87.95 136.07 136.07 fee schedule Rates based on patient diagnose 87.95 fee schedule Rates based on patient diagnose 87.95 fee schedule Rates based on patient diagnose 124.67 fee schedule Rates based on patient diagnose 99.73 fee schedule Rates based on patient diagnose 130.47 fee schedule Rates based on patient diagnose 130.47 fee schedule Rates based on patient diagnose 127.21 fee schedule Rates based on patient diagnose 124.67 fee schedule Rates based on patient diagnose Subseq Care (15 Min) 99231 RC facility inpatient 120 0.00 26.6 74.16 74.16 fee schedule Rates based on patient diagnose 26.60 fee schedule Rates based on patient diagnose 26.60 fee schedule Rates based on patient diagnose 49.81 fee schedule Rates based on patient diagnose 49.81 fee schedule Rates based on patient diagnose 49.81 fee schedule Rates based on patient diagnose Subseq Care (25 Min) 99232 RC facility inpatient 140 0.00 42.52 83.26 57.68 fee schedule Rates based on patient diagnose 42.52 fee schedule Rates based on patient diagnose 83.26 fee schedule Rates based on patient diagnose 76.34 fee schedule Rates based on patient diagnose 43.06 fee schedule Rates based on patient diagnose 71.91 fee schedule Rates based on patient diagnose 66.96 fee schedule Rates based on patient diagnose 52.60 fee schedule Rates based on patient diagnose 63.22 fee schedule Rates based on patient diagnose 77.23 fee schedule Rates based on patient diagnose 66.61 fee schedule Rates based on patient diagnose Subseq Care (35 Min) 99233 RC facility inpatient 200 0.00 54.85 196 54.85 fee schedule Rates based on patient diagnose 54.85 fee schedule Rates based on patient diagnose 77.44 fee schedule Rates based on patient diagnose 196.00 fee schedule Rates based on patient diagnose 98.78 fee schedule Rates based on patient diagnose Discharge Day Mgmt <30 Min 99238 RC facility inpatient 160 0.00 42.525 80.99 57.68 fee schedule Rates based on patient diagnose 42.53 fee schedule Rates based on patient diagnose 42.89 fee schedule Rates based on patient diagnose 65.18 fee schedule Rates based on patient diagnose 68.06 fee schedule Rates based on patient diagnose 56.75 fee schedule Rates based on patient diagnose 80.99 fee schedule Rates based on patient diagnose 80.99 fee schedule Rates based on patient diagnose 66.51 fee schedule Rates based on patient diagnose 65.18 fee schedule Rates based on patient diagnose