hospital_name last_updated_on version hospital_location hospital_address license_number|OH "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." Mount Carmel Behavioral Healthcare 5/31/2024 2.0.0 "Columbus, Ohio" 4646 Hilton Corporate Drive license_ 07-7524 | OH TRUE 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_ADAMH ADAMS LAWRENC SCIOT]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH ADAMS LAWRENC SCIOT]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH ADAMS LAWRENC SCIOT]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH ADAMS LAWRENC SCIOT]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH ADAMS LAWRENC SCIOT]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH ADAMS LAWRENC SCIOT]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH CHAMPAIGN CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH CHAMPAIGN CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH CHAMPAIGN CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH CHAMPAIGN CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH CHAMPAIGN CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH CHAMPAIGN CO]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH CRAWFORD MARION]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH CRAWFORD MARION]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH CRAWFORD MARION]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH CRAWFORD MARION]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH CRAWFORD MARION]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH CRAWFORD MARION]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH DELAWARE MORROW]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH DELAWARE MORROW]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH DELAWARE MORROW]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH DELAWARE MORROW]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH DELAWARE MORROW]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH DELAWARE MORROW]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH FAIRFIELD CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH FAIRFIELD CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH FAIRFIELD CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH FAIRFIELD CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH FAIRFIELD CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH FAIRFIELD CO]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH FRANKLIN CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH FRANKLIN CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH FRANKLIN CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH FRANKLIN CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH FRANKLIN CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH FRANKLIN CO]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH GUERNSEY CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH GUERNSEY CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH GUERNSEY CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH GUERNSEY CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH GUERNSEY CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH GUERNSEY CO]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH LICKING KNOX CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH LICKING KNOX CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH LICKING KNOX CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH LICKING KNOX CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH LICKING KNOX CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH LICKING KNOX CO]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH LOGAN COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH LOGAN COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH LOGAN COUNTY]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH LOGAN COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH LOGAN COUNTY]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH LOGAN COUNTY]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH MUSKINGUM AREA]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH MUSKINGUM AREA]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH MUSKINGUM AREA]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH MUSKINGUM AREA]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH MUSKINGUM AREA]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH MUSKINGUM AREA]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH NOBLE CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH NOBLE CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH NOBLE CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH NOBLE CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH NOBLE CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH NOBLE CO]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH NOT LISTED]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH NOT LISTED]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH NOT LISTED]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH NOT LISTED]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH NOT LISTED]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH NOT LISTED]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH PAINT VALLEY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH PAINT VALLEY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH PAINT VALLEY]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH PAINT VALLEY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH PAINT VALLEY]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH PAINT VALLEY]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH UNION COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH UNION COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH UNION COUNTY]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH UNION COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH UNION COUNTY]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH UNION COUNTY]|[Plan_LOCAL GOVT] standard_charge|[payer_ADAMH WARREN CLINTON CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH WARREN CLINTON CO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH WARREN CLINTON CO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ADAMH WARREN CLINTON CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH WARREN CLINTON CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH WARREN CLINTON CO]|[Plan_LOCAL GOVT] standard_charge|[payer_AETNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA]|[plan_HMO/PPO] standard_charge|[payer_AETNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AETNA]|[Plan_HMO/PPO] standard_charge|[payer_AETNA BETTE MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTE MCD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AETNA BETTE MCD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AETNA BETTE MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTE MCD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AETNA BETTE MCD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTE MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA BETTE MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA BETTE MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA BETTE MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA BETTE MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA BETTE MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AETNA BH MCD OH RISE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BH MCD OH RISE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AETNA BH MCD OH RISE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AETNA BH MCD OH RISE]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BH MCD OH RISE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AETNA BH MCD OH RISE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AETNA MCR ADV PPO]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MCR ADV PPO]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MCR ADV PPO]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MCR ADV PPO]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MCR ADV PPO]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MCR ADV PPO]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLIED BENEFIT SYSTEMS IN]|[plan_COMMERCIAL] standard_charge|[payer_ALLIED BENEFIT SYSTEMS IN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_ALLIED BENEFIT SYSTEMS IN]|[Plan_COMMERCIAL] standard_charge|[payer_AMBETTER]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMBETTER]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMBETTER]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMBETTER]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMBETTER]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMBETTER]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AMERIHEALTH CARITAS OHIO]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIHEALTH CARITAS OHIO]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIHEALTH CARITAS OHIO]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIHEALTH CARITAS OHIO]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS OHIO]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIHEALTH CARITAS OHIO]|[Plan_MANAGED MEDICAID] standard_charge|[payer_ANTHEM OHIO MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ANTHEM OHIO MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ANTHEM OHIO MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ANTHEM OHIO MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_ANTHEM OHIO MEDICAID]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ANTHEM OHIO MEDICAID]|[Plan_MANAGED MEDICAID] standard_charge|[payer_ANTHEM SENIOR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ANTHEM SENIOR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ANTHEM SENIOR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ANTHEM SENIOR]|[plan_MANAGED MEDICARE] standard_charge|[payer_ANTHEM SENIOR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ANTHEM SENIOR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AULTCARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AULTCARE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AULTCARE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AULTCARE]|[plan_HMO/PPO] standard_charge|[payer_AULTCARE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AULTCARE]|[Plan_HMO/PPO] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE]|[Plan_BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS]|[Plan_HMO/PPO] standard_charge|[payer_BLUE CROSS BLUE SHIELD]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE CROSS BLUE SHIELD]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE CROSS BLUE SHIELD]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE CROSS BLUE SHIELD]|[plan_BLUE CROSS] standard_charge|[payer_BLUE CROSS BLUE SHIELD]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE CROSS BLUE SHIELD]|[Plan_BLUE CROSS] standard_charge|[payer_BUCKEYE COMMUNITY HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BUCKEYE COMMUNITY HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BUCKEYE COMMUNITY HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BUCKEYE COMMUNITY HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_BUCKEYE COMMUNITY HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BUCKEYE COMMUNITY HEALTH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CARESOURCE MCR ADV]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARESOURCE MCR ADV]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CARESOURCE MCR ADV]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARESOURCE MCR ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARESOURCE MCR ADV]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CARESOURCE MCR ADV]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CARESOURCE OF OHIO]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CARESOURCE OF OHIO]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CARESOURCE OF OHIO]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CARESOURCE OF OHIO]|[plan_MANAGED MEDICAID] standard_charge|[payer_CARESOURCE OF OHIO]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CARESOURCE OF OHIO]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CIGNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA]|[plan_HMO/PPO] standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA]|[Plan_HMO/PPO] standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CORESOURCE]|[plan_HMO/PPO] standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CORESOURCE]|[Plan_HMO/PPO] standard_charge|[payer_DELAWARE MORROW BOARD]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DELAWARE MORROW BOARD]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DELAWARE MORROW BOARD]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DELAWARE MORROW BOARD]|[plan_LOCAL GOVT] standard_charge|[payer_DELAWARE MORROW BOARD]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DELAWARE MORROW BOARD]|[Plan_LOCAL GOVT] standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHSMART]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHSMART]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HUMANA MCD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HUMANA MCD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HUMANA MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_HUMANA MCD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HUMANA MCD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MED BEN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MED BEN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MED BEN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MED BEN]|[plan_HMO/PPO] standard_charge|[payer_MED BEN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MED BEN]|[Plan_HMO/PPO] standard_charge|[payer_MEDICAID]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID]|[plan_MEDICAID ] standard_charge|[payer_MEDICAID]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID]|[Plan_MEDICAID ] standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO] standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MEDICAL MUTUAL]|[Plan_HMO/PPO] standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE]|[Plan_MEDICARE] standard_charge|[payer_MEDIGOLD]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MEDIGOLD]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MEDIGOLD]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDIGOLD]|[plan_MANAGED MEDICARE] standard_charge|[payer_MEDIGOLD]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MEDIGOLD]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MERITAIN HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MISC COMMERCIAL]|[Plan_COMMERCIAL] standard_charge|[payer_MOLINA COMMERCIAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MOLINA COMMERCIAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MOLINA COMMERCIAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MOLINA COMMERCIAL]|[plan_COMMERCIAL] standard_charge|[payer_MOLINA COMMERCIAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MOLINA COMMERCIAL]|[Plan_COMMERCIAL] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA HEALTHCARE OF OHIO]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA MYCARE MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MOLINA MYCARE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MOLINA MYCARE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MOLINA MYCARE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MOLINA MYCARE MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MOLINA MYCARE MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_NGS AMERICAN INSURANCE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_NGS AMERICAN INSURANCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_NGS AMERICAN INSURANCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_NGS AMERICAN INSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_NGS AMERICAN INSURANCE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_NGS AMERICAN INSURANCE]|[Plan_COMMERCIAL] standard_charge|[payer_OHIO HEALTHY]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_OHIO HEALTHY]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_OHIO HEALTHY]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_OHIO HEALTHY]|[plan_COMMERCIAL] standard_charge|[payer_OHIO HEALTHY]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_OHIO HEALTHY]|[Plan_COMMERCIAL] standard_charge|[payer_OHIO PPO CONNECT]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_OHIO PPO CONNECT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_OHIO PPO CONNECT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_OHIO PPO CONNECT]|[plan_COMMERCIAL] standard_charge|[payer_OHIO PPO CONNECT]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_OHIO PPO CONNECT]|[Plan_COMMERCIAL] standard_charge|[payer_OPTUM]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM]|[plan_HMO/PPO] standard_charge|[payer_OPTUM]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM]|[Plan_HMO/PPO] standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_OSCAR HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_OSCAR HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_TRICARE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE]|[plan_TRICARE] standard_charge|[payer_TRICARE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE]|[Plan_TRICARE] standard_charge|[payer_TRICARE EAST]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST]|[Plan_TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE]|[plan_TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE FOR LIFE]|[Plan_TRICARE] standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_TRUSTMARK]|[plan_COMMERCIAL] standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_TRUSTMARK]|[Plan_COMMERCIAL] standard_charge|[payer_UHC COMMERCIAL HMO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC COMMERCIAL HMO]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC COMMERCIAL HMO]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC COMMERCIAL HMO]|[plan_HMO/PPO] standard_charge|[payer_UHC COMMERCIAL HMO]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC COMMERCIAL HMO]|[Plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES (GEHA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC SHARED SERVICES (GEHA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC SHARED SERVICES (GEHA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC SHARED SERVICES (GEHA]|[plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES (GEHA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC SHARED SERVICES (GEHA]|[Plan_HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC STUDENT RESOURCES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC STUDENT RESOURCES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC STUDENT RESOURCES]|[plan_HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC STUDENT RESOURCES]|[Plan_HMO/PPO] standard_charge|[payer_UHCCP MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHCCP MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHCCP MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHCCP MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHCCP MEDICAID]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHCCP MEDICAID]|[Plan_MANAGED MEDICAID] standard_charge|[payer_UMR]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UMR]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UMR]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_COMMERCIAL] standard_charge|[payer_UMR]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UMR]|[Plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA CCN OPTUM]|[Plan_VETERANS ADMIN] standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE BY ALLWELL]|[Plan_MANAGED MEDICARE] additional_generic_notes ROOM AND BOARD PSYCH ADULT RECO 124 RC facility Inpatient 3300 750 800 1146 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 945 per diem 728 per diem 945 per diem 800 per diem 728 per diem 1025 per diem 1020 per diem 988 per diem 1020 per diem 728 per diem 728 per diem 955 per diem 1025 per diem 800 per diem 1025 per diem 980 per diem 728 per diem 1025 per diem 1080 per diem 945 per diem 728 per diem 1025 per diem 1146 per diem 1146 per diem 888 per diem 888 per diem 888 per diem 1025 per diem 1146 per diem 1146 per diem 1146 per diem 728 per diem 1146 per diem ROOM AND BOARD PSYCH ADULT RENE 124 RC facility Inpatient 3300 750 800 1146 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 945 per diem 728 per diem 945 per diem 800 per diem 728 per diem 1025 per diem 1020 per diem 988 per diem 1020 per diem 728 per diem 728 per diem 955 per diem 1025 per diem 800 per diem 1025 per diem 980 per diem 728 per diem 1025 per diem 1080 per diem 945 per diem 728 per diem 1025 per diem 1146 per diem 1146 per diem 888 per diem 888 per diem 888 per diem 1025 per diem 1146 per diem 1146 per diem 1146 per diem 728 per diem 1146 per diem ROOM AND BOARD PSYCH ADULT REST 124 RC facility Inpatient 3300 750 800 1146 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 945 per diem 728 per diem 945 per diem 800 per diem 728 per diem 1025 per diem 1020 per diem 988 per diem 1020 per diem 728 per diem 728 per diem 955 per diem 1025 per diem 800 per diem 1025 per diem 980 per diem 728 per diem 1025 per diem 1080 per diem 945 per diem 728 per diem 1025 per diem 1146 per diem 1146 per diem 888 per diem 888 per diem 888 per diem 1025 per diem 1146 per diem 1146 per diem 1146 per diem 728 per diem 1146 per diem ROOM AND BOARD PSYCH ADULT REVI 124 RC facility Inpatient 3300 750 800 1146 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 945 per diem 728 per diem 945 per diem 800 per diem 728 per diem 1025 per diem 1020 per diem 988 per diem 1020 per diem 728 per diem 728 per diem 955 per diem 1025 per diem 800 per diem 1025 per diem 980 per diem 728 per diem 1025 per diem 1080 per diem 945 per diem 728 per diem 1025 per diem 1146 per diem 1146 per diem 888 per diem 888 per diem 888 per diem 1025 per diem 1146 per diem 1146 per diem 1146 per diem 728 per diem 1146 per diem ROOM AND BOARD PSYCH DUAL DIAG 124 RC facility Inpatient 3300 750 800 1146 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 945 per diem 728 per diem 945 per diem 800 per diem 728 per diem 1025 per diem 1020 per diem 988 per diem 1020 per diem 728 per diem 728 per diem 955 per diem 1025 per diem 800 per diem 1025 per diem 980 per diem 728 per diem 1025 per diem 1080 per diem 945 per diem 728 per diem 1025 per diem 1146 per diem 1146 per diem 888 per diem 888 per diem 888 per diem 1025 per diem 1146 per diem 1146 per diem 1146 per diem 728 per diem 1146 per diem INTENSIVE OUTPATIENT PROGRAM ADULT PSYCH 905 RC facility Outpatient 600 250 136 600 231 per diem 231 per diem 146 per diem 260 per diem 188 per diem 224 per diem 425 per diem 275 per diem 173 per diem 425 per diem 240 per diem 173 per diem 173 per diem 231 per diem 600 per diem 183 per diem 173 per diem 600 per diem 328 per diem 328 per diem 136 per diem 136 per diem 136 per diem 328 per diem 328 per diem 328 per diem 328 per diem 328 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM ADULT PSYCH (MGD MCD) 907 RC facility Outpatient 600 250 136 183 183 per diem 136 per diem 136 per diem 136 per diem 136 per diem 136 per diem INTENSIVE OUTPATIENT PROGRAM GROUP 1 915 RC facility Outpatient 200 83 37 275 183 per diem 146 per diem 275 per diem 37 per diem 146 per diem 183 per diem 146 per diem 136 per diem 136 per diem 136 per diem 96 per diem PSYCHIATRIC DIAG EVAL 90791 90791 RC facility both 310 73 73 73 fee schedule PSYCHIATRIC DIAG EVAL WITH MED SERVICES 90792 90792 RC facility both 310 72 213 213 fee schedule 131 fee schedule 83 fee schedule 94 fee schedule 86 fee schedule 72 fee schedule 122 fee schedule 83 fee schedule 189 fee schedule 83 fee schedule 126 fee schedule 135 fee schedule 173 fee schedule 115 fee schedule 114 fee schedule 142 fee schedule 142 fee schedule 83 fee schedule 142 fee schedule 155 fee schedule 143 fee schedule 100 fee schedule 154 fee schedule 100 fee schedule 83 fee schedule 157 fee schedule INITIAL HOSPITAL CARE (30 MIN)99221 99221 RC facility both 125 36 94 38 fee schedule 94 fee schedule 38 fee schedule 36 fee schedule 64 fee schedule 38 fee schedule 38 fee schedule 50 fee schedule 80 fee schedule 64 fee schedule 38 fee schedule 80 fee schedule 54 fee schedule 83 fee schedule 70 fee schedule 89 fee schedule 70 fee schedule 38 fee schedule 91 fee schedule INITIAL HOSPITAL CARE (50 MIN)99222 99222 RC facility both 125 47 123 56 fee schedule 56 fee schedule 47 fee schedule 56 fee schedule 56 fee schedule 89 fee schedule 123 fee schedule 56 fee schedule 107 fee schedule 101 fee schedule 101 fee schedule 56 fee schedule 88 fee schedule INITIAL HOSPITAL CARE (70 MIN)99223 99223 RC facility both 125 77 98 98 fee schedule 77 fee schedule SUBSEQ CARE (15 MIN)99231 99231 RC facility both 120 16 81 57 fee schedule 38 fee schedule 17 fee schedule 38 fee schedule 27 fee schedule 17 fee schedule 16 fee schedule 33 fee schedule 17 fee schedule 48 fee schedule 17 fee schedule 34 fee schedule 43 fee schedule 54 fee schedule 27 fee schedule 33 fee schedule 46 fee schedule 81 fee schedule 30 fee schedule 17 fee schedule 45 fee schedule 43 fee schedule 39 fee schedule 36 fee schedule 39 fee schedule 17 fee schedule 69 fee schedule 33 fee schedule SUBSEQ CARE (25 MIN)99232 99232 RC facility both 140 24 84 28 fee schedule 28 fee schedule 24 fee schedule 52 fee schedule 28 fee schedule 28 fee schedule 48 fee schedule 74 fee schedule 28 fee schedule 53 fee schedule 50 fee schedule 28 fee schedule 65 fee schedule 69 fee schedule 56 fee schedule 69 fee schedule 56 fee schedule 28 fee schedule 84 fee schedule SUBSEQ CARE (35 MIN)99233 99233 RC facility both 160 40 40 40 fee schedule DISCHARGE DAY MGMT <30 MIN99238 99238 RC facility both 160 28 106 83 fee schedule 62 fee schedule 32 fee schedule 61 fee schedule 67 fee schedule 32 fee schedule 28 fee schedule 56 fee schedule 32 fee schedule 77 fee schedule 32 fee schedule 63 fee schedule 67 fee schedule 87 fee schedule 50 fee schedule 54 fee schedule 73 fee schedule 106 fee schedule 32 fee schedule 70 fee schedule 80 fee schedule 73 fee schedule 70 fee schedule 62 fee schedule 70 fee schedule 70 fee schedule 32 fee schedule 87 fee schedule 61 fee schedule DISCHARGE DAY MANAGEMENT >30 MIN99239 99239 RC facility both 200 42 110 42 fee schedule 42 fee schedule 110 fee schedule 42 fee schedule 42 fee schedule