"hospital_Northeast Behavioral Health, LLC" last_updated_ 2023-12-31 version_1 "hospital_Dartmouth, Massachusetts" hospital_address 581 Faunce Corner Road license_ 1191 | MA "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded in this machine-readable file is true, accurate, and complete as of the date indicated in this file" description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AARP MEDICARE COMPLETE MANAGED MEDICARE] standard_charge|[payer_AARP MEDICARE COMPLETE MANAGED MEDICARE] |percent standard_charge|[payer_AARP MEDICARE COMPLETE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AARP MEDICARE COMPLETE MANAGED MEDICARE] standard_charge|[payer_AETNA 13+|HMO/PPO] standard_charge|[payer_AETNA 13+|HMO/PPO] |percent standard_charge|[payer_AETNA 13+|HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA 13+|HMO/PPO] standard_charge|[payer_AETNA 2-12|HMO/PPO] standard_charge|[payer_AETNA 2-12|HMO/PPO] |percent standard_charge|[payer_AETNA 2-12|HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA 2-12|HMO/PPO] standard_charge|[payer_AETNA MNGD MEDICARE|MANAGED MEDICARE] standard_charge|[payer_AETNA MNGD MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MNGD MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MNGD MEDICARE|MANAGED MEDICARE] standard_charge|[payer_BCBS MA MCR ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_BCBS MA MCR ADVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MA MCR ADVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MA MCR ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_BCBS MASS ADOL 13-17|BLUE CROSS] standard_charge|[payer_BCBS MASS ADOL 13-17|BLUE CROSS] |percent standard_charge|[payer_BCBS MASS ADOL 13-17|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS MASS ADOL 13-17|BLUE CROSS] standard_charge|[payer_BCBS OF MASS ADUL 18 PLUS|BLUE CROSS] standard_charge|[payer_BCBS OF MASS ADUL 18 PLUS|BLUE CROSS] |percent standard_charge|[payer_BCBS OF MASS ADUL 18 PLUS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF MASS ADUL 18 PLUS|BLUE CROSS] standard_charge|[payer_BCBS OF MASS CHILD 2-12|BLUE CROSS] standard_charge|[payer_BCBS OF MASS CHILD 2-12|BLUE CROSS] |percent standard_charge|[payer_BCBS OF MASS CHILD 2-12|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF MASS CHILD 2-12|BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS|HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS|HMO/PPO] |percent standard_charge|[payer_BEACON HEALTH OPTIONS|HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS|HMO/PPO] standard_charge|[payer_BLUE BENEFIT ADMIN ADOL|BLUE CROSS] standard_charge|[payer_BLUE BENEFIT ADMIN ADOL|BLUE CROSS] |percent standard_charge|[payer_BLUE BENEFIT ADMIN ADOL|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BLUE BENEFIT ADMIN ADOL|BLUE CROSS] standard_charge|[payer_BMCHP COMMERCIAL|HMO/PPO] standard_charge|[payer_BMCHP COMMERCIAL|HMO/PPO] |percent standard_charge|[payer_BMCHP COMMERCIAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_BMCHP COMMERCIAL|HMO/PPO] standard_charge|[payer_BMCHP COMMUNITY ALLIANCE|MANAGED MEDICAID] standard_charge|[payer_BMCHP COMMUNITY ALLIANCE|MANAGED MEDICAID] |percent standard_charge|[payer_BMCHP COMMUNITY ALLIANCE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BMCHP COMMUNITY ALLIANCE|MANAGED MEDICAID] standard_charge|[payer_BMCHP MEDICAID|MANAGED MEDICAID] standard_charge|[payer_BMCHP MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_BMCHP MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BMCHP MEDICAID|MANAGED MEDICAID] standard_charge|[payer_BMCHP QHP HBE|HMO/PPO] standard_charge|[payer_BMCHP QHP HBE|HMO/PPO] |percent standard_charge|[payer_BMCHP QHP HBE|HMO/PPO] |contracting_method additional_payer_notes |[payer_BMCHP QHP HBE|HMO/PPO] standard_charge|[payer_BMCHP SOUTHCOAST ALLIANCE|MANAGED MEDICAID] standard_charge|[payer_BMCHP SOUTHCOAST ALLIANCE|MANAGED MEDICAID] |percent standard_charge|[payer_BMCHP SOUTHCOAST ALLIANCE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BMCHP SOUTHCOAST ALLIANCE|MANAGED MEDICAID] standard_charge|[payer_BMCHP SR CARE OPTIONS MC|MANAGED MEDICARE] standard_charge|[payer_BMCHP SR CARE OPTIONS MC|MANAGED MEDICARE] |percent standard_charge|[payer_BMCHP SR CARE OPTIONS MC|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BMCHP SR CARE OPTIONS MC|MANAGED MEDICARE] 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_CIGNA CHILD 2-12|HMO/PPO] standard_charge|[payer_CIGNA CHILD 2-12|HMO/PPO] |percent standard_charge|[payer_CIGNA CHILD 2-12|HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA CHILD 2-12|HMO/PPO] standard_charge|[payer_COMMONWEALTH CARE ALLIANC|MANAGED MEDICARE] standard_charge|[payer_COMMONWEALTH CARE ALLIANC|MANAGED MEDICARE] |percent standard_charge|[payer_COMMONWEALTH CARE ALLIANC|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_COMMONWEALTH CARE ALLIANC|MANAGED MEDICARE] standard_charge|[payer_COMPSYCH CORP CHILD|HMO/PPO] standard_charge|[payer_COMPSYCH CORP CHILD|HMO/PPO] |percent standard_charge|[payer_COMPSYCH CORP CHILD|HMO/PPO] |contracting_method additional_payer_notes |[payer_COMPSYCH CORP CHILD|HMO/PPO] standard_charge|[payer_COMPSYCH CORPORATION|HMO/PPO] standard_charge|[payer_COMPSYCH CORPORATION|HMO/PPO] |percent standard_charge|[payer_COMPSYCH CORPORATION|HMO/PPO] |contracting_method additional_payer_notes |[payer_COMPSYCH CORPORATION|HMO/PPO] standard_charge|[payer_FALLON 365 CARE|MANAGED MEDICAID] standard_charge|[payer_FALLON 365 CARE|MANAGED MEDICAID] |percent standard_charge|[payer_FALLON 365 CARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FALLON 365 CARE|MANAGED MEDICAID] standard_charge|[payer_FALLON HEALTH|HMO/PPO] standard_charge|[payer_FALLON HEALTH|HMO/PPO] |percent standard_charge|[payer_FALLON HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_FALLON HEALTH|HMO/PPO] standard_charge|[payer_FALLON MEDICAID|MANAGED MEDICAID] standard_charge|[payer_FALLON MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_FALLON MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_FALLON MEDICAID|MANAGED MEDICAID] standard_charge|[payer_FALLON MEDICARE|MANAGED MEDICARE] standard_charge|[payer_FALLON MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_FALLON MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_FALLON MEDICARE|MANAGED MEDICARE] standard_charge|[payer_FALLON PPO|HMO/PPO] standard_charge|[payer_FALLON PPO|HMO/PPO] |percent standard_charge|[payer_FALLON PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_FALLON PPO|HMO/PPO] standard_charge|[payer_FALLON QHP|HMO/PPO] standard_charge|[payer_FALLON QHP|HMO/PPO] |percent standard_charge|[payer_FALLON QHP|HMO/PPO] |contracting_method additional_payer_notes |[payer_FALLON QHP|HMO/PPO] standard_charge|[payer_GROUP INS COMMISSION|HMO/PPO] standard_charge|[payer_GROUP INS COMMISSION|HMO/PPO] |percent standard_charge|[payer_GROUP INS COMMISSION|HMO/PPO] |contracting_method additional_payer_notes |[payer_GROUP INS COMMISSION|HMO/PPO] standard_charge|[payer_HARVARD PILGIRM|HMO/PPO] standard_charge|[payer_HARVARD PILGIRM|HMO/PPO] |percent standard_charge|[payer_HARVARD PILGIRM|HMO/PPO] |contracting_method additional_payer_notes |[payer_HARVARD PILGIRM|HMO/PPO] standard_charge|[payer_HARVARD PILGIRM MCARE|HMO/PPO] standard_charge|[payer_HARVARD PILGIRM MCARE|HMO/PPO] |percent standard_charge|[payer_HARVARD PILGIRM MCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_HARVARD PILGIRM MCARE|HMO/PPO] standard_charge|[payer_HEALTH PLANS INC|HMO/PPO] standard_charge|[payer_HEALTH PLANS INC|HMO/PPO] |percent standard_charge|[payer_HEALTH PLANS INC|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTH PLANS INC|HMO/PPO] standard_charge|[payer_MAGELLAN HEALTHCARE|HMO/PPO] standard_charge|[payer_MAGELLAN HEALTHCARE|HMO/PPO] |percent standard_charge|[payer_MAGELLAN HEALTHCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN HEALTHCARE|HMO/PPO] standard_charge|[payer_MASS HEALTH|MEDICAID ] standard_charge|[payer_MASS HEALTH|MEDICAID ] |percent standard_charge|[payer_MASS HEALTH|MEDICAID ] |contracting_method additional_payer_notes |[payer_MASS HEALTH|MEDICAID ] standard_charge|[payer_MBHP 13+|MANAGED MEDICAID] standard_charge|[payer_MBHP 13+|MANAGED MEDICAID] |percent standard_charge|[payer_MBHP 13+|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MBHP 13+|MANAGED MEDICAID] standard_charge|[payer_MBHP 2-12|MANAGED MEDICAID] standard_charge|[payer_MBHP 2-12|MANAGED MEDICAID] |percent standard_charge|[payer_MBHP 2-12|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MBHP 2-12|MANAGED MEDICAID] standard_charge|[payer_MEDICAID OF VERMONT|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID OF VERMONT|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID OF VERMONT|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID OF VERMONT|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID OF VERMONT ADOL|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID OF VERMONT ADOL|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID OF VERMONT ADOL|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID OF VERMONT ADOL|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID OF VERMONT CHILD|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID OF VERMONT CHILD|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID OF VERMONT CHILD|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID OF VERMONT CHILD|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICARE NGS|MEDICARE] standard_charge|[payer_MEDICARE NGS|MEDICARE] |percent standard_charge|[payer_MEDICARE NGS|MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE NGS|MEDICARE] standard_charge|[payer_MOD ASST ADOL 13-17|HMO/PPO] standard_charge|[payer_MOD ASST ADOL 13-17|HMO/PPO] |percent standard_charge|[payer_MOD ASST ADOL 13-17|HMO/PPO] |contracting_method additional_payer_notes |[payer_MOD ASST ADOL 13-17|HMO/PPO] standard_charge|[payer_MOD ASST PROG- GERI 65+|HMO/PPO] standard_charge|[payer_MOD ASST PROG- GERI 65+|HMO/PPO] |percent standard_charge|[payer_MOD ASST PROG- GERI 65+|HMO/PPO] |contracting_method additional_payer_notes |[payer_MOD ASST PROG- GERI 65+|HMO/PPO] standard_charge|[payer_MOD ASST PROG-18-64|HMO/PPO] standard_charge|[payer_MOD ASST PROG-18-64|HMO/PPO] |percent standard_charge|[payer_MOD ASST PROG-18-64|HMO/PPO] |contracting_method additional_payer_notes |[payer_MOD ASST PROG-18-64|HMO/PPO] standard_charge|[payer_MOD ASST PROG-5-12|HMO/PPO] standard_charge|[payer_MOD ASST PROG-5-12|HMO/PPO] |percent standard_charge|[payer_MOD ASST PROG-5-12|HMO/PPO] |contracting_method additional_payer_notes |[payer_MOD ASST PROG-5-12|HMO/PPO] standard_charge|[payer_NHP COMMERCIAL|HMO/PPO] standard_charge|[payer_NHP COMMERCIAL|HMO/PPO] |percent standard_charge|[payer_NHP COMMERCIAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_NHP COMMERCIAL|HMO/PPO] standard_charge|[payer_NHP PPO|HMO/PPO] standard_charge|[payer_NHP PPO|HMO/PPO] |percent standard_charge|[payer_NHP PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_NHP PPO|HMO/PPO] standard_charge|[payer_NHP QHP|HMO/PPO] standard_charge|[payer_NHP QHP|HMO/PPO] |percent standard_charge|[payer_NHP QHP|HMO/PPO] |contracting_method additional_payer_notes |[payer_NHP QHP|HMO/PPO] standard_charge|[payer_NTWK HEALTH TUFTS 21+|MANAGED MEDICAID] standard_charge|[payer_NTWK HEALTH TUFTS 21+|MANAGED MEDICAID] |percent standard_charge|[payer_NTWK HEALTH TUFTS 21+|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_NTWK HEALTH TUFTS 21+|MANAGED MEDICAID] standard_charge|[payer_NTWK HEALTH TUFTS 2-20|MANAGED MEDICAID] standard_charge|[payer_NTWK HEALTH TUFTS 2-20|MANAGED MEDICAID] |percent standard_charge|[payer_NTWK HEALTH TUFTS 2-20|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_NTWK HEALTH TUFTS 2-20|MANAGED MEDICAID] standard_charge|[payer_SR WHOLE HEALTH MC|MANAGED MEDICARE] standard_charge|[payer_SR WHOLE HEALTH MC|MANAGED MEDICARE] |percent standard_charge|[payer_SR WHOLE HEALTH MC|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_SR WHOLE HEALTH MC|MANAGED MEDICARE] standard_charge|[payer_TUFTS COMM HEALTH|HMO/PPO] standard_charge|[payer_TUFTS COMM HEALTH|HMO/PPO] |percent standard_charge|[payer_TUFTS COMM HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_TUFTS COMM HEALTH|HMO/PPO] standard_charge|[payer_TUFTS HLTH QHP DIRECT 21+|HMO/PPO] standard_charge|[payer_TUFTS HLTH QHP DIRECT 21+|HMO/PPO] |percent standard_charge|[payer_TUFTS HLTH QHP DIRECT 21+|HMO/PPO] |contracting_method additional_payer_notes |[payer_TUFTS HLTH QHP DIRECT 21+|HMO/PPO] standard_charge|[payer_TUFTS HLTH QHP DRCT 2-20|HMO/PPO] standard_charge|[payer_TUFTS HLTH QHP DRCT 2-20|HMO/PPO] |percent standard_charge|[payer_TUFTS HLTH QHP DRCT 2-20|HMO/PPO] |contracting_method additional_payer_notes |[payer_TUFTS HLTH QHP DRCT 2-20|HMO/PPO] standard_charge|[payer_TUFTS MEDICARE PREFERRED|MANAGED MEDICARE] standard_charge|[payer_TUFTS MEDICARE PREFERRED|MANAGED MEDICARE] |percent standard_charge|[payer_TUFTS MEDICARE PREFERRED|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_TUFTS MEDICARE PREFERRED|MANAGED MEDICARE] standard_charge|[payer_TUFTS ONECARE UNIFY|MANAGED MEDICARE] standard_charge|[payer_TUFTS ONECARE UNIFY|MANAGED MEDICARE] |percent standard_charge|[payer_TUFTS ONECARE UNIFY|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_TUFTS ONECARE UNIFY|MANAGED MEDICARE] standard_charge|[payer_UBH 13+|HMO/PPO] standard_charge|[payer_UBH 13+|HMO/PPO] |percent standard_charge|[payer_UBH 13+|HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH 13+|HMO/PPO] standard_charge|[payer_UBH 2-12|HMO/PPO] standard_charge|[payer_UBH 2-12|HMO/PPO] |percent standard_charge|[payer_UBH 2-12|HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH 2-12|HMO/PPO] standard_charge|[payer_UBH MCARE HMO DDU|MANAGED MEDICARE] standard_charge|[payer_UBH MCARE HMO DDU|MANAGED MEDICARE] |percent standard_charge|[payer_UBH MCARE HMO DDU|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UBH MCARE HMO DDU|MANAGED MEDICARE] standard_charge|[payer_UBH MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UBH MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_UBH MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UBH MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] |percent standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UBH MEDICARE HMO|MANAGED MEDICARE] standard_charge|[payer_UBH RI MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UBH RI MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_UBH RI MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UBH RI MEDICAID|MANAGED MEDICAID] standard_charge|[payer_ULTRA BENEFITS FALLON|HMO/PPO] standard_charge|[payer_ULTRA BENEFITS FALLON|HMO/PPO] |percent standard_charge|[payer_ULTRA BENEFITS FALLON|HMO/PPO] |contracting_method additional_payer_notes |[payer_ULTRA BENEFITS FALLON|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_UPRISE HEALTH ADUL|HMO/PPO] standard_charge|[payer_UPRISE HEALTH ADUL|HMO/PPO] |percent standard_charge|[payer_UPRISE HEALTH ADUL|HMO/PPO] |contracting_method additional_payer_notes |[payer_UPRISE HEALTH ADUL|HMO/PPO] standard_charge|[payer_WELLCARE OF MA/ME/RI MANAGED MEDICARE] standard_charge|[payer_WELLCARE OF MA/ME/RI MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE OF MA/ME/RI MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE OF MA/ME/RI MANAGED MEDICARE] PRIVATE ROOM 114 RC facility inpatient 3200.00 1800.00 1909.18 2100 1909.18 per diem 1909.18 per diem 2004.64 per diem 2100.00 per diem ROOM AND BOARD ADOL PSYCH >13 124 RC facility inpatient 1600.00 900.00 954.59 1442 1096.00 per diem 1174.00 per diem 1096.00 per diem 1270.34 per diem 1362.22 per diem 1270.34 per diem 1362.22 per diem 1273.75 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1137.00 per diem 1300.00 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1362.22 per diem 1362.22 per diem 968.30 per diem 1194.00 per diem 1121.00 per diem 1233.00 per diem 954.59 per diem 1002.32 per diem 1054.59 per diem 1216.95 per diem 1362.22 per diem 1362.22 per diem 1362.22 per diem 1239.00 per diem 1194.00 per diem 1239.00 per diem 1121.00 per diem 955.00 per diem 955.00 per diem 1362.22 per diem 1121.00 per diem ROOM AND BOARD ADULT 4 124 RC facility inpatient 1600.00 900.00 954.59 1442 DRG DRG 1096.00 per diem 1174.00 per diem 1096.00 per diem 1129.20 per diem 1270.34 per diem 1129.20 per diem 1362.22 per diem 1362.22 per diem 1273.75 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1225.62 per diem 1137.00 per diem 104% DRG 104% DRG 1200.00 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1225.62 per diem 1362.22 per diem 1362.22 per diem 968.30 per diem 1194.00 per diem 1072.00 per diem 1121.00 per diem 1233.00 per diem 954.59 per diem 1002.32 per diem 954.59 per diem DRG DRG 1200.15 per diem 1095.15 per diem 1362.22 per diem 1362.22 per diem 1362.22 per diem 1169.00 per diem 1239.00 per diem 1202.00 per diem 1194.00 per diem 1169.00 per diem 1239.00 per diem 1072.00 per diem DRG DRG 1121.00 per diem 955.00 per diem DRG DRG 955.00 per diem 1362.22 per diem 1121.00 per diem 1100.00 per diem DRG DRG ROOM AND BOARD CHILD 124 RC facility inpatient 1600.00 900.00 954.59 1442 1096.00 per diem 1174.00 per diem 1096.00 per diem 1270.34 per diem 1411.50 per diem 1362.22 per diem 1270.34 per diem 1362.22 per diem 1273.75 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1137.00 per diem 1189.00 per diem 1300.00 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1362.22 per diem 1362.22 per diem 968.30 per diem 1194.00 per diem 1121.00 per diem 1233.00 per diem 954.59 per diem 1002.32 per diem 1050.00 per diem 1054.59 per diem 1254.59 per diem 1216.95 per diem 1321.95 per diem 1362.22 per diem 1362.22 per diem 1362.22 per diem 1239.00 per diem 1194.00 per diem 1239.00 per diem 1121.00 per diem 1442.00 per diem 955.00 per diem 955.00 per diem 1362.22 per diem 1121.00 per diem ROOM AND BOARD DUAL DX 124 RC facility inpatient 1600.00 900.00 954.59 1442 DRG DRG 1096.00 per diem 1174.00 per diem 1096.00 per diem 1129.20 per diem 1270.34 per diem 1129.20 per diem 1362.22 per diem 1362.22 per diem 1273.75 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1225.62 per diem 1137.00 per diem 104% DRG 104% DRG 1200.00 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1225.62 per diem 1362.22 per diem 1362.22 per diem 968.30 per diem 1194.00 per diem 1072.00 per diem 1121.00 per diem 1233.00 per diem 954.59 per diem 1002.32 per diem 954.59 per diem DRG DRG 1200.15 per diem 1095.15 per diem 1362.22 per diem 1362.22 per diem 1362.22 per diem 1169.00 per diem 1239.00 per diem 1202.00 per diem 1194.00 per diem 1169.00 per diem 1239.00 per diem 1072.00 per diem DRG DRG 1121.00 per diem 955.00 per diem DRG DRG 955.00 per diem 1362.22 per diem 1121.00 per diem 1100.00 per diem DRG DRG ROOM AND BOARD GERI PSYCH 124 RC facility inpatient 1600.00 900.00 954.59 1442 DRG DRG 1096.00 per diem 1174.00 per diem 1096.00 per diem 1129.20 per diem 1270.34 per diem 1129.20 per diem 1362.22 per diem 1362.22 per diem 1273.75 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1225.62 per diem 1137.00 per diem 104% DRG 104% DRG 1200.00 per diem 1273.75 per diem 1362.22 per diem 1273.75 per diem 1225.62 per diem 1362.22 per diem 1362.22 per diem 968.30 per diem 1194.00 per diem 1072.00 per diem 1121.00 per diem 1233.00 per diem 954.59 per diem 1002.32 per diem 954.59 per diem DRG DRG 1200.15 per diem 1095.15 per diem 1362.22 per diem 1362.22 per diem 1362.22 per diem 1169.00 per diem 1239.00 per diem 1202.00 per diem 1194.00 per diem 1169.00 per diem 1239.00 per diem 1072.00 per diem DRG DRG 1121.00 per diem 955.00 per diem DRG DRG 955.00 per diem 1362.22 per diem 1121.00 per diem 1100.00 per diem DRG DRG ROOM AND BOARD DUAL SUD DX 126 RC facility inpatient 1600.00 900.00 975.00 1075 DRG DRG DRG DRG DRG DRG 1075.00 per diem 975.00 per diem 975.00 per diem 1075.00 per diem DRG DRG ROOM AND BOARD DUAL SUD DX 138 RC facility inpatient 1600.00 900.00 952.22 1362.22 DRG DRG 952.22 per diem 952.22 per diem 1137.00 per diem 1233.00 per diem 954.59 per diem DRG DRG 1202.00 per diem DRG DRG 1362.22 per diem DRG DRG Psych Diagnostic Evaluation NP 90791 RC facility Inpatient Pro Fee 310.00 0.00 124.44 208.76 154.10 fee schedule Rates based on patient diagnose 130.99 fee schedule Rates based on patient diagnose 124.44 fee schedule Rates based on patient diagnose 208.76 fee schedule Rates based on patient diagnose 208.76 fee schedule Rates based on patient diagnose 154.10 fee schedule Rates based on patient diagnose 167.15 fee schedule Rates based on patient diagnose 154.10 fee schedule Rates based on patient diagnose Rates based on patient diagnose 208.76 fee schedule Rates based on patient diagnose Psych Diagnostic Evaluation MD 90791 RC facility Inpatient Pro Fee 310.00 0.00 146.40 208.76 154.10 fee schedule Rates based on patient diagnose 154.10 fee schedule Rates based on patient diagnose 146.40 fee schedule Rates based on patient diagnose 208.76 fee schedule Rates based on patient diagnose 208.76 fee schedule Rates based on patient diagnose 154.10 fee schedule Rates based on patient diagnose 167.15 fee schedule Rates based on patient diagnose 154.10 fee schedule Rates based on patient diagnose Rates based on patient diagnose 208.76 fee schedule Rates based on patient diagnose Psych Diagnostic Evaluation W/ Meds NP 90792 RC facility Inpatient Pro Fee 310.00 0.00 131.80 232.94 166.89 fee schedule Rates based on patient diagnose 149.32 fee schedule Rates based on patient diagnose 141.86 fee schedule Rates based on patient diagnose 232.94 fee schedule Rates based on patient diagnose 232.94 fee schedule Rates based on patient diagnose 166.89 fee schedule Rates based on patient diagnose 131.80 fee schedule Rates based on patient diagnose 166.89 fee schedule Rates based on patient diagnose 175.67 fee schedule Rates based on patient diagnose 232.94 fee schedule Rates based on patient diagnose Psych Diagnostic Evaluation W/ Meds MD 90792 RC facility Inpatient Pro Fee 310.00 0.00 131.80 232.94 166.89 fee schedule Rates based on patient diagnose 175.67 fee schedule Rates based on patient diagnose 166.89 fee schedule Rates based on patient diagnose 232.94 fee schedule Rates based on patient diagnose 232.94 fee schedule Rates based on patient diagnose 166.89 fee schedule Rates based on patient diagnose 131.80 fee schedule Rates based on patient diagnose 166.89 fee schedule Rates based on patient diagnose 175.67 fee schedule Rates based on patient diagnose 232.94 fee schedule Rates based on patient diagnose Subsequent Hospital Follow Up Low 25 Minutes NP 99231 RC facility Inpatient Pro Fee 120.00 0.00 17.00 57.53 50.71 fee schedule Rates based on patient diagnose 43.10 fee schedule Rates based on patient diagnose 40.94 fee schedule Rates based on patient diagnose 57.53 fee schedule Rates based on patient diagnose 57.53 fee schedule Rates based on patient diagnose 50.71 fee schedule Rates based on patient diagnose 47.47 fee schedule Rates based on patient diagnose 50.71 fee schedule Rates based on patient diagnose 17.00 fee schedule Rates based on patient diagnose 57.53 fee schedule Rates based on patient diagnose Subsequent Hospital Follow Up Low 25 Minutes MD 99231 RC facility Inpatient Pro Fee 120.00 0.00 17.00 57.53 50.71 fee schedule Rates based on patient diagnose 50.71 fee schedule Rates based on patient diagnose 48.17 fee schedule Rates based on patient diagnose 57.53 fee schedule Rates based on patient diagnose 57.53 fee schedule Rates based on patient diagnose 50.71 fee schedule Rates based on patient diagnose 47.47 fee schedule Rates based on patient diagnose 50.71 fee schedule Rates based on patient diagnose 17.00 fee schedule Rates based on patient diagnose 57.53 fee schedule Rates based on patient diagnose Subsequent Hospital Follow Up Moderate 35 Minutes 99232 RC facility Inpatient Pro Fee 140.00 0.00 29.72 91.59 77.00 fee schedule Rates based on patient diagnose 68.89 fee schedule Rates based on patient diagnose 65.45 fee schedule Rates based on patient diagnose 91.59 fee schedule Rates based on patient diagnose 91.59 fee schedule Rates based on patient diagnose 77.00 fee schedule Rates based on patient diagnose 88.19 fee schedule Rates based on patient diagnose 77.00 fee schedule Rates based on patient diagnose 29.72 fee schedule Rates based on patient diagnose 91.59 fee schedule Rates based on patient diagnose Subsequent Hospital Follow Up Moderate 35 Minutes 99232 RC facility Inpatient Pro Fee 140.00 0.00 29.72 91.59 77.00 fee schedule Rates based on patient diagnose 81.05 fee schedule Rates based on patient diagnose 77.00 fee schedule Rates based on patient diagnose 91.59 fee schedule Rates based on patient diagnose 91.59 fee schedule Rates based on patient diagnose 77.00 fee schedule Rates based on patient diagnose 88.19 fee schedule Rates based on patient diagnose 77.00 fee schedule Rates based on patient diagnose 29.72 fee schedule Rates based on patient diagnose 91.59 fee schedule Rates based on patient diagnose Subsequent Hospital Follow Up High 50 Minutes NP 99233 RC facility Inpatient Pro Fee 200.00 0.00 98.44 122.55 121.91 fee schedule Rates based on patient diagnose 103.62 fee schedule Rates based on patient diagnose 98.44 fee schedule Rates based on patient diagnose 122.55 fee schedule Rates based on patient diagnose 122.55 fee schedule Rates based on patient diagnose 121.91 fee schedule Rates based on patient diagnose fee schedule Rates based on patient diagnose 121.91 fee schedule Rates based on patient diagnose Rates based on patient diagnose 122.55 fee schedule Rates based on patient diagnose Subsequent Hospital Follow Up High 50 Minutes MD 99233 RC facility Inpatient Pro Fee 200.00 0.00 115.81 122.55 121.91 fee schedule Rates based on patient diagnose 121.91 fee schedule Rates based on patient diagnose 115.81 fee schedule Rates based on patient diagnose 122.55 fee schedule Rates based on patient diagnose 122.55 fee schedule Rates based on patient diagnose 121.91 fee schedule Rates based on patient diagnose fee schedule Rates based on patient diagnose 121.91 fee schedule Rates based on patient diagnose Rates based on patient diagnose 122.55 fee schedule Rates based on patient diagnose Hospital Discharge < 30 Minutes NP 99238 RC facility Inpatient Pro Fee 160.00 0.00 56.16 85.86 61.63 fee schedule Rates based on patient diagnose 70.59 fee schedule Rates based on patient diagnose 67.07 fee schedule Rates based on patient diagnose 85.86 fee schedule Rates based on patient diagnose 85.86 fee schedule Rates based on patient diagnose 61.63 fee schedule Rates based on patient diagnose 56.16 fee schedule Rates based on patient diagnose 61.63 fee schedule Rates based on patient diagnose Rates based on patient diagnose 85.86 fee schedule Rates based on patient diagnose Hospital Discharge < 30 Minutes MD 99238 RC facility Inpatient Pro Fee 160.00 0.00 56.16 85.86 61.63 fee schedule Rates based on patient diagnose 83.05 fee schedule Rates based on patient diagnose 78.90 fee schedule Rates based on patient diagnose 85.86 fee schedule Rates based on patient diagnose 85.86 fee schedule Rates based on patient diagnose 61.63 fee schedule Rates based on patient diagnose 56.16 fee schedule Rates based on patient diagnose 61.63 fee schedule Rates based on patient diagnose Rates based on patient diagnose 85.86 fee schedule Rates based on patient diagnose Hospital Discharge > 30 Minutes NP 99239 RC facility Inpatient Pro Fee 213.00 0.00 47.47 132.69 81.05 fee schedule Rates based on patient diagnose 100.00 fee schedule Rates based on patient diagnose 95.50 fee schedule Rates based on patient diagnose 132.69 fee schedule Rates based on patient diagnose 132.69 fee schedule Rates based on patient diagnose 81.05 fee schedule Rates based on patient diagnose 91.20 fee schedule Rates based on patient diagnose 81.05 fee schedule Rates based on patient diagnose 47.47 fee schedule Rates based on patient diagnose 132.69 fee schedule Rates based on patient diagnose Hospital Discharge > 30 Minutes MD 99239 RC facility Inpatient Pro Fee 213.00 0.00 47.47 132.69 81.05 fee schedule Rates based on patient diagnose 117.65 fee schedule Rates based on patient diagnose 111.77 fee schedule Rates based on patient diagnose 132.69 fee schedule Rates based on patient diagnose 132.69 fee schedule Rates based on patient diagnose 81.05 fee schedule Rates based on patient diagnose 91.20 fee schedule Rates based on patient diagnose 81.05 fee schedule Rates based on patient diagnose 47.47 fee schedule Rates based on patient diagnose 132.69 fee schedule Rates based on patient diagnose