"hospital_Little Hills Healthcare, LLC" last_updated_ 2023-12-31 version_1 "hospital_Weldon, Missouri" hospital_address 4801 Weldon Spring Parkway license_ 475-20 | MO "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|COMMERCIAL] standard_charge|[payer_AARP|COMMERCIAL] |percent standard_charge|[payer_AARP|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AARP|COMMERCIAL] standard_charge|[payer_ADULT MEDICAID|SELF PAY CHARITY] standard_charge|[payer_ADULT MEDICAID|SELF PAY CHARITY] |percent standard_charge|[payer_ADULT MEDICAID|SELF PAY CHARITY] |contracting_method additional_payer_notes |[payer_ADULT MEDICAID|SELF PAY CHARITY] 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 ILL|MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH ILL|MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH ILL|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH ILL|MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH MCR|MANAGED MEDICARE] standard_charge|[payer_AETNA MCR ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_AETNA MCR ADVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MCR ADVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MCR ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_ALLEGIANCE CIGNA|HMO/PPO] standard_charge|[payer_ALLEGIANCE CIGNA|HMO/PPO] |percent standard_charge|[payer_ALLEGIANCE CIGNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_ALLEGIANCE CIGNA|HMO/PPO] standard_charge|[payer_ALLWELL|MANAGED MEDICARE] standard_charge|[payer_ALLWELL|MANAGED MEDICARE] |percent standard_charge|[payer_ALLWELL|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ALLWELL|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_AUXIANT|COMMERCIAL] standard_charge|[payer_AUXIANT|COMMERCIAL] |percent standard_charge|[payer_AUXIANT|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AUXIANT|COMMERCIAL] standard_charge|[payer_BCBS COMMUNITY PLAN ILL|MANAGED MEDICAID] standard_charge|[payer_BCBS COMMUNITY PLAN ILL|MANAGED MEDICAID] |percent standard_charge|[payer_BCBS COMMUNITY PLAN ILL|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BCBS COMMUNITY PLAN ILL|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 MCR ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_BCBS MCR ADVANTAGE|MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MCR ADVANTAGE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MCR ADVANTAGE|MANAGED MEDICARE] standard_charge|[payer_BCBS MERCY EPO|BLUE CROSS] standard_charge|[payer_BCBS MERCY EPO|BLUE CROSS] |percent standard_charge|[payer_BCBS MERCY EPO|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS MERCY EPO|BLUE CROSS] standard_charge|[payer_BCBS MO|BLUE CROSS] standard_charge|[payer_BCBS MO|BLUE CROSS] |percent standard_charge|[payer_BCBS MO|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS MO|BLUE CROSS] standard_charge|[payer_BCBS OF ILL|BLUE CROSS] standard_charge|[payer_BCBS OF ILL|BLUE CROSS] |percent standard_charge|[payer_BCBS OF ILL|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF ILL|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_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] |percent standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] |contracting_method additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS|HMO/PPO] standard_charge|[payer_CARELON BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_CARELON BEHAVIORAL HEALTH|HMO/PPO] |percent standard_charge|[payer_CARELON BEHAVIORAL HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_CARELON BEHAVIORAL HEALTH|HMO/PPO] standard_charge|[payer_CARPENTERS MERITAIN|HMO/PPO] standard_charge|[payer_CARPENTERS MERITAIN|HMO/PPO] |percent standard_charge|[payer_CARPENTERS MERITAIN|HMO/PPO] |contracting_method additional_payer_notes |[payer_CARPENTERS MERITAIN|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 MEDICARE|MANAGED MEDICARE] standard_charge|[payer_CIGNA MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA MEDICARE|MANAGED MEDICARE] standard_charge|[payer_COMPSYCH|HMO/PPO] standard_charge|[payer_COMPSYCH|HMO/PPO] |percent standard_charge|[payer_COMPSYCH|HMO/PPO] |contracting_method additional_payer_notes |[payer_COMPSYCH|HMO/PPO] standard_charge|[payer_COX HEALTHPLANS|COMMERCIAL] standard_charge|[payer_COX HEALTHPLANS|COMMERCIAL] |percent standard_charge|[payer_COX HEALTHPLANS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_COX HEALTHPLANS|COMMERCIAL] standard_charge|[payer_DISTRICT 9 HEALTH & WELF|COMMERCIAL] standard_charge|[payer_DISTRICT 9 HEALTH & WELF|COMMERCIAL] |percent standard_charge|[payer_DISTRICT 9 HEALTH & WELF|COMMERCIAL] |contracting_method additional_payer_notes |[payer_DISTRICT 9 HEALTH & WELF|COMMERCIAL] standard_charge|[payer_GOLDEN RULE|HMO/PPO] standard_charge|[payer_GOLDEN RULE|HMO/PPO] |percent standard_charge|[payer_GOLDEN RULE|HMO/PPO] |contracting_method additional_payer_notes |[payer_GOLDEN RULE|HMO/PPO] standard_charge|[payer_HEALTH PARTNERS|COMMERCIAL] standard_charge|[payer_HEALTH PARTNERS|COMMERCIAL] |percent standard_charge|[payer_HEALTH PARTNERS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTH PARTNERS|COMMERCIAL] standard_charge|[payer_HEALTHCOMP|HMO/PPO] standard_charge|[payer_HEALTHCOMP|HMO/PPO] |percent standard_charge|[payer_HEALTHCOMP|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHCOMP|HMO/PPO] standard_charge|[payer_HEALTHLINK HMO|HMO/PPO] standard_charge|[payer_HEALTHLINK HMO|HMO/PPO] |percent standard_charge|[payer_HEALTHLINK HMO|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHLINK HMO|HMO/PPO] standard_charge|[payer_HEALTHLINK PPO|HMO/PPO] standard_charge|[payer_HEALTHLINK PPO|HMO/PPO] |percent standard_charge|[payer_HEALTHLINK PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHLINK PPO|HMO/PPO] standard_charge|[payer_HEALTHLINK PPO SOI|HMO/PPO] standard_charge|[payer_HEALTHLINK PPO SOI|HMO/PPO] |percent standard_charge|[payer_HEALTHLINK PPO SOI|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHLINK PPO SOI|HMO/PPO] 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_HOME STATE CENPATICO|MANAGED MEDICAID] standard_charge|[payer_HOME STATE CENPATICO|MANAGED MEDICAID] |percent standard_charge|[payer_HOME STATE CENPATICO|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HOME STATE CENPATICO|MANAGED MEDICAID] standard_charge|[payer_HUMANA COMMERCIAL|HMO/PPO] standard_charge|[payer_HUMANA COMMERCIAL|HMO/PPO] |percent standard_charge|[payer_HUMANA COMMERCIAL|HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA COMMERCIAL|HMO/PPO] standard_charge|[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE] standard_charge|[payer_IBEW|HMO/PPO] standard_charge|[payer_IBEW|HMO/PPO] |percent standard_charge|[payer_IBEW|HMO/PPO] |contracting_method additional_payer_notes |[payer_IBEW|HMO/PPO] standard_charge|[payer_LINECO|HMO/PPO] standard_charge|[payer_LINECO|HMO/PPO] |percent standard_charge|[payer_LINECO|HMO/PPO] |contracting_method additional_payer_notes |[payer_LINECO|HMO/PPO] standard_charge|[payer_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_MANAGED HEALTH NETWORK|MANAGED MEDICARE] standard_charge|[payer_MANAGED HEALTH NETWORK|MANAGED MEDICARE] |percent standard_charge|[payer_MANAGED HEALTH NETWORK|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MANAGED HEALTH NETWORK|MANAGED MEDICARE] standard_charge|[payer_MEDICA|HMO/PPO] standard_charge|[payer_MEDICA|HMO/PPO] |percent standard_charge|[payer_MEDICA|HMO/PPO] |contracting_method additional_payer_notes |[payer_MEDICA|HMO/PPO] standard_charge|[payer_MEDICAID COLORADO|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID COLORADO|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID COLORADO|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID COLORADO|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID ILLINOIS|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID ILLINOIS|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID ILLINOIS|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID ILLINOIS|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID MISSOURI|MEDICAID ] standard_charge|[payer_MEDICAID MISSOURI|MEDICAID ] |percent standard_charge|[payer_MEDICAID MISSOURI|MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID MISSOURI|MEDICAID ] standard_charge|[payer_MEDICAID NEBRASKA|MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID NEBRASKA|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MEDICAID NEBRASKA|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MEDICAID NEBRASKA|MEDICAID: OUT OF STATE] 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_MEDICARE|MEDICARE] standard_charge|[payer_MEDICARE|MEDICARE] |percent standard_charge|[payer_MEDICARE|MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE|MEDICARE] standard_charge|[payer_MEDICARE ESSENCE HEALTH|MANAGED MEDICARE] standard_charge|[payer_MEDICARE ESSENCE HEALTH|MANAGED MEDICARE] |percent standard_charge|[payer_MEDICARE ESSENCE HEALTH|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE ESSENCE HEALTH|MANAGED MEDICARE] standard_charge|[payer_MERCY BENEFIT ADMIN|HMO/PPO] standard_charge|[payer_MERCY BENEFIT ADMIN|HMO/PPO] |percent standard_charge|[payer_MERCY BENEFIT ADMIN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MERCY BENEFIT ADMIN|HMO/PPO] standard_charge|[payer_MERCY HEALTH PLANS|HMO/PPO] standard_charge|[payer_MERCY HEALTH PLANS|HMO/PPO] |percent standard_charge|[payer_MERCY HEALTH PLANS|HMO/PPO] |contracting_method additional_payer_notes |[payer_MERCY HEALTH PLANS|HMO/PPO] standard_charge|[payer_MERIDIAN HEALTHPLANS ILL|MANAGED MEDICAID] standard_charge|[payer_MERIDIAN HEALTHPLANS ILL|MANAGED MEDICAID] |percent standard_charge|[payer_MERIDIAN HEALTHPLANS ILL|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MERIDIAN HEALTHPLANS ILL|MANAGED MEDICAID] standard_charge|[payer_MERITAIN|HMO/PPO] standard_charge|[payer_MERITAIN|HMO/PPO] |percent standard_charge|[payer_MERITAIN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN|HMO/PPO] standard_charge|[payer_MISC HMO/PPO|HMO/PPO] standard_charge|[payer_MISC HMO/PPO|HMO/PPO] |percent standard_charge|[payer_MISC HMO/PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_MISC HMO/PPO|HMO/PPO] standard_charge|[payer_MISC MGD MCARE|MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCARE|MANAGED MEDICARE] |percent standard_charge|[payer_MISC MGD MCARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MISC MGD MCARE|MANAGED MEDICARE] standard_charge|[payer_MO BLUE CROSS PATHWAYS|BLUE CROSS] standard_charge|[payer_MO BLUE CROSS PATHWAYS|BLUE CROSS] |percent standard_charge|[payer_MO BLUE CROSS PATHWAYS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_MO BLUE CROSS PATHWAYS|BLUE CROSS] standard_charge|[payer_MOLINA HEALTHCARE OF ILL|MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF ILL|MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA HEALTHCARE OF ILL|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA HEALTHCARE OF ILL|MANAGED MEDICAID] standard_charge|[payer_NE DHHS|MEDICAID: OUT OF STATE] standard_charge|[payer_NE DHHS|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_NE DHHS|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_NE DHHS|MEDICAID: OUT OF STATE] standard_charge|[payer_PROVIDER PARTNERS HEALTH|MANAGED MEDICARE] standard_charge|[payer_PROVIDER PARTNERS HEALTH|MANAGED MEDICARE] |percent standard_charge|[payer_PROVIDER PARTNERS HEALTH|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_PROVIDER PARTNERS HEALTH|MANAGED MEDICARE] standard_charge|[payer_RURAL CARRIER BENEFIT|HMO/PPO] standard_charge|[payer_RURAL CARRIER BENEFIT|HMO/PPO] |percent standard_charge|[payer_RURAL CARRIER BENEFIT|HMO/PPO] |contracting_method additional_payer_notes |[payer_RURAL CARRIER BENEFIT|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|TRICARE] standard_charge|[payer_TRICARE EAST|TRICARE] |percent standard_charge|[payer_TRICARE EAST|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE EAST|TRICARE] standard_charge|[payer_TRICARE FOR LIFE|COMMERCIAL] standard_charge|[payer_TRICARE FOR LIFE|COMMERCIAL] |percent standard_charge|[payer_TRICARE FOR LIFE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_TRICARE FOR LIFE|COMMERCIAL] standard_charge|[payer_TRICARE WEST|TRICARE] standard_charge|[payer_TRICARE WEST|TRICARE] |percent standard_charge|[payer_TRICARE WEST|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE WEST|TRICARE] standard_charge|[payer_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 ALL SAVERS|HMO/PPO] standard_charge|[payer_UHC ALL SAVERS|HMO/PPO] |percent standard_charge|[payer_UHC ALL SAVERS|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC ALL SAVERS|HMO/PPO] standard_charge|[payer_UHC CARE IMPROVEMENT PLUS|MANAGED MEDICARE] standard_charge|[payer_UHC CARE IMPROVEMENT PLUS|MANAGED MEDICARE] |percent standard_charge|[payer_UHC CARE IMPROVEMENT PLUS|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC CARE IMPROVEMENT PLUS|MANAGED MEDICARE] standard_charge|[payer_UHC COMM MCARE|MANAGED MEDICARE] standard_charge|[payer_UHC COMM MCARE|MANAGED MEDICARE] |percent standard_charge|[payer_UHC COMM MCARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC COMM MCARE|MANAGED MEDICARE] standard_charge|[payer_UHC COMPLETE|MANAGED MEDICARE] standard_charge|[payer_UHC COMPLETE|MANAGED MEDICARE] |percent standard_charge|[payer_UHC COMPLETE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC COMPLETE|MANAGED MEDICARE] standard_charge|[payer_UHC OF MIDWEST|MANAGED MEDICAID] standard_charge|[payer_UHC OF MIDWEST|MANAGED MEDICAID] |percent standard_charge|[payer_UHC OF MIDWEST|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC OF MIDWEST|MANAGED MEDICAID] standard_charge|[payer_UHC SHARED SERVICES|HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES|HMO/PPO] |percent standard_charge|[payer_UHC SHARED SERVICES|HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC SHARED SERVICES|HMO/PPO] standard_charge|[payer_UMR|HMO/PPO] standard_charge|[payer_UMR|HMO/PPO] |percent standard_charge|[payer_UMR|HMO/PPO] |contracting_method additional_payer_notes |[payer_UMR|HMO/PPO] standard_charge|[payer_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_WEB TPA AETNA|HMO/PPO] standard_charge|[payer_WEB TPA AETNA|HMO/PPO] |percent standard_charge|[payer_WEB TPA AETNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_WEB TPA AETNA|HMO/PPO] standard_charge|[payer_WEB TPA CIGNA|HMO/PPO] standard_charge|[payer_WEB TPA CIGNA|HMO/PPO] |percent standard_charge|[payer_WEB TPA CIGNA|HMO/PPO] |contracting_method additional_payer_notes |[payer_WEB TPA CIGNA|HMO/PPO] standard_charge|[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] standard_charge|[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE HEALTH PLANS|MANAGED MEDICARE] standard_charge|[payer_WELLFIRST|HMO/PPO] standard_charge|[payer_WELLFIRST|HMO/PPO] |percent standard_charge|[payer_WELLFIRST|HMO/PPO] |contracting_method additional_payer_notes |[payer_WELLFIRST|HMO/PPO] standard_charge|[payer_WELLFIRST MCARE|MANAGED MEDICARE] standard_charge|[payer_WELLFIRST MCARE|MANAGED MEDICARE] |percent standard_charge|[payer_WELLFIRST MCARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLFIRST MCARE|MANAGED MEDICARE] ROOM AND BOARD PSYCH ADOLESCENT 124 RC facility inpatient 2450.00 1100 462.24 1080 820.32 per diem 945 per diem 462.24 per diem 462.24 per diem 945 per diem 994 per diem DRG #VALUE! 925 per diem 462.24 per diem DRG #VALUE! 915 per diem 925 per diem 849 per diem 994 per diem 994 per diem 900 per diem 900 per diem 950 per diem 948 994 945 per diem 950 per diem 950 per diem 950 per diem 844.93 per diem 1066.42 per diem 1080 per diem 915 per diem 849 per diem 975 per diem 945 per diem 948 per diem 462.24 per diem 820.32 per diem 820.32 per diem 915 per diem 915 per diem 915 per diem 462.24 per diem 945 per diem 462.24 per diem 948 per diem 948 per diem 563 per diem 948 per diem 948 per diem DRG DRG DRG DRG DRG 820.32 per diem 948 per diem 948 per diem DRG DRG 945 per diem 994 per diem DRG DRG 975 per diem DRG DRG ROOM AND BOARD PSYCH GERIATRIC 124 RC facility inpatient 2450.00 1100 462.24 1080 820.32 per diem 945 per diem 462.24 per diem 462.24 per diem 945 per diem 994 per diem DRG #VALUE! 925 per diem 462.24 per diem DRG #VALUE! 915 per diem 925 per diem 849 per diem 994 per diem 994 per diem 900 per diem 900 per diem 950 per diem 948 994 945 per diem 950 per diem 950 per diem 950 per diem 844.93 per diem 1066.42 per diem 1080 per diem 915 per diem 849 per diem 975 per diem 945 per diem 948 per diem 462.24 per diem 820.32 per diem 820.32 per diem 915 per diem 915 per diem 915 per diem 462.24 per diem 945 per diem 462.24 per diem 948 per diem 948 per diem 563 per diem 948 per diem 948 per diem DRG DRG DRG DRG DRG 820.32 per diem 948 per diem 948 per diem DRG DRG 945 per diem 994 per diem DRG DRG 975 per diem DRG DRG ROOM AND BOARD DETOX ADULT 126 RC facility inpatient 2450.00 1100 462.24 1080 820.32 per diem 945 per diem 462.24 per diem 462.24 per diem 945 per diem 994 per diem DRG #VALUE! 925 per diem 462.24 per diem DRG #VALUE! 915 per diem 925 per diem 849 per diem 994 per diem 994 per diem 900 per diem 900 per diem 950 per diem 948 per diem 994 per diem 945 per diem 950 per diem 950 per diem 950 per diem 844.93 per diem 1066.42 per diem 1080 per diem 915 per diem 849 per diem 975 per diem 945 per diem 948 per diem 462.24 per diem 820.32 per diem 820.32 per diem 915 per diem 915 per diem 915 per diem 462.24 per diem 945 per diem 462.24 per diem 948 per diem 948 per diem 563 per diem 948 per diem 948 per diem DRG DRG DRG DRG DRG 820.32 per diem 948 per diem 948 per diem DRG DRG 945 per diem 994 per diem DRG DRG 975 per diem DRG DRG ROOM AND BOARD REHAB 128 RC facility inpatient 2450.00 1100 563 1080 945 per diem 945 per diem 994 per diem DRG #VALUE! 925 per diem DRG #VALUE! 915 per diem 925 per diem 849 per diem 994 per diem 994 per diem 900 per diem 900 per diem 948 per diem 994 per diem 945 per diem 844.93 per diem 1066.42 per diem 1080 per diem 915 per diem 849 per diem 975 per diem 945 per diem 948 per diem 915 per diem 915 per diem 915 per diem 945 per diem 948 per diem 948 per diem 563 per diem 948 per diem 948 per diem DRG DRG DRG DRG DRG 820.32 per diem 948 per diem 948 per diem DRG DRG 945 per diem 994 per diem DRG DRG 975 per diem DRG DRG TRANSCRANIAL MAGNETIC STIMULATION-INITIAL TREATMNT 900 RC facility inpatient/outpatient 700.00 525 192 400 260.92 per diem 360 per diem 260.92 per diem 360 per diem 273 per diem 260.92 per diem 239 per diem 260.92 per diem 309 per diem 239 per diem 239 per diem 239 per diem 400 per diem 345.12 per diem 273 per diem 260.92 per diem 273 per diem 260.92 per diem 325 per diem 360 per diem 250 per diem 285 per diem 192 per diem 240 per diem 250 per diem 250 per diem 250 per diem 300 per diem 260.92 per diem 309 per diem 345.12 per diem 395.44 per diem 360 per diem 285 per diem 260.92 per diem 309 per diem 309 per diem 309 per diem 360 per diem 225 per diem 287.01 per diem 285 per diem 285 per diem 260.92 per diem 285 per diem 285 per diem 260.92 per diem 260.92 per diem 260.92 per diem 285 per diem 285 per diem 260.92 per diem 360 per diem 273 per diem 260.92 per diem 357 per diem 260.92 per diem TRANSCRANIAL MAGNETIC STIMULATION-MOTOR THRESH/RED 900 RC facility inpatient/outpatient 467.00 350 191.77 357 260.92 per diem 240 per diem 260.92 per diem 240 per diem 192 per diem 260.92 per diem 239 per diem 260.92 per diem 283 per diem 239 per diem 239 per diem 239 per diem 225 per diem 300 per diem 192 per diem 260.92 per diem 192 per diem 260.92 per diem 325 per diem 240 per diem 250 per diem 295 per diem 192 per diem 240 per diem 250 per diem 250 per diem 250 per diem 285 per diem 260.92 per diem 283 per diem 300 per diem 191.77 per diem 240 per diem 295 per diem 260.92 per diem 283 per diem 283 per diem 283 per diem 240 per diem 225 per diem 287.01 per diem 295 per diem 295 per diem 260.92 per diem 295 per diem 295 per diem 260.92 per diem 260.92 per diem 260.92 per diem 295 per diem 295 per diem 260.92 per diem 240 per diem 192 per diem 260.92 per diem 357 per diem 260.92 per diem TRANSCRANIAL MAGNETIC STIMULATION-SUBSEQUENT TRTMN 900 RC facility inpatient/outpatient 467.00 350 192 421.99 260.92 per diem 240 per diem 260.92 per diem 240 per diem 192 per diem 260.92 per diem 239 per diem 260.92 per diem 283 per diem 239 per diem 239 per diem 239 per diem 250 per diem 421.99 per diem 240 per diem 260.92 per diem 240 per diem 260.92 per diem 325 per diem 240 per diem 250 per diem 290 per diem 192 per diem 240 per diem 250 per diem 250 per diem 250 per diem 300 per diem 260.92 per diem 309 per diem 421.99 per diem 395.44 per diem 240 per diem 290 per diem 260.92 per diem 309 per diem 309 per diem 309 per diem 240 per diem 225 per diem 287.01 per diem 290 per diem 290 per diem 260.92 per diem 290 per diem 290 per diem 260.92 per diem 260.92 per diem 260.92 per diem 290 per diem 290 per diem 260.92 per diem 240 per diem 240 per diem 260.92 per diem 357 per diem 260.92 per diem ELECTOCONVULSIVE THERAPY INPATIENT 901 RC facility inpatient 1927.00 750.00 300 1336 464.26 per diem 660 per diem 660 per diem 688 per diem 464.26 per diem 550 per diem 493 per diem 464.26 per diem 497 per diem 493 per diem 493 per diem 493 per diem 900 per diem 519 per diem 688 per diem 464.26 per diem 688 per diem 464.26 per diem 1330 per diem 510 per diem 948 per diem 1336 per diem 1320 per diem 510 per diem 510 per diem 510 per diem 300 per diem 300 per diem 698 per diem 464.26 per diem 497 per diem 519 per diem 652 per diem 660 per diem 618 per diem 464.26 per diem 497 per diem 497 per diem 497 per diem 660 per diem 465 per diem 510.69 per diem 618 per diem 618 per diem 464.26 per diem 464.26 per diem 618 per diem 618 per diem 464.26 per diem 464.26 per diem 464.26 per diem 618 per diem 618 per diem 464.26 per diem 660 per diem 688 per diem 464.26 per diem 561 per diem 464.26 per diem ELECTOCONVULSIVE THERAPY OUTPATIENT 901 RC facility outpatient 1927.00 750.00 300 1336 464.26 per diem 660 per diem 660 per diem 688 per diem 464.26 per diem 550 per diem 493 per diem 464.26 per diem 497 per diem 493 per diem 493 per diem 493 per diem 900 per diem 519 per diem 688 per diem 464.26 per diem 688 per diem 464.26 per diem 1330 per diem 510 per diem 948 per diem 1336 per diem 1320 per diem 510 per diem 510 per diem 510 per diem 300 per diem 300 per diem 698 per diem 464.26 per diem 497 per diem 519 per diem 652 per diem 660 per diem 618 per diem 464.26 per diem 497 per diem 497 per diem 497 per diem 660 per diem 465 per diem 510.69 per diem 618 per diem 618 per diem 462.26 per diem 464.26 per diem 618 per diem 618 per diem 464.26 per diem 464.26 per diem 464.26 per diem 618 per diem 618 per diem 464.26 per diem 660 per diem 688 per diem 464.26 per diem 561 per diem 464.26 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT - MRVL VIRT 905 RC facility outpatient 612.00 225 150 285 239 per diem 235 per diem 235 per diem 265 per diem 225 per diem 175 per diem 285 per diem 170 per diem 175 per diem 175 per diem 255 per diem 260 per diem 273 per diem 273 per diem 225 per diem 235 per diem 255 per diem 254 per diem 273 per diem 235 per diem 255 per diem 255 per diem 255 per diem 200 per diem 180 per diem 285 per diem 285 per diem 260 per diem 265 per diem 235 per diem 254 per diem 285 per diem 285 per diem 285 per diem 235 per diem 165 per diem 254 per diem 254 per diem 254 per diem 254 per diem 239 per diem 239 per diem 239 per diem 150 per diem 254 per diem 254 per diem 235 per diem 273 per diem 254 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADULT-CPH 905 RC facility outpatient 612.00 225 150 285 239 per diem 235 per diem 235 per diem 265 per diem 225 per diem 175 per diem 285 per diem 170 per diem 175 per diem 175 per diem 255 per diem 260 per diem 273 per diem 273 per diem 225 per diem 235 per diem 255 per diem 254 per diem 273 per diem 235 per diem 255 per diem 255 per diem 255 per diem 200 per diem 180 per diem 285 per diem 285 per diem 260 per diem 265 per diem 235 per diem 254 per diem 285 per diem 285 per diem 285 per diem 235 per diem 165 per diem 254 per diem 254 per diem 254 per diem 254 per diem 239 per diem 239 per diem 239 per diem 150 per diem 254 per diem 254 per diem 235 per diem 273 per diem 254 per diem INTENSIVE OUTPATIENT PROGRAM CD ADU - SC EV V 906 RC facility outpatient 612.00 225 150 285 239 per diem 235 per diem 235 per diem 265 per diem 225 per diem 175 per diem 285 per diem 170 per diem 175 per diem 175 per diem 255 per diem 260 per diem 273 per diem 273 per diem 225 per diem 235 per diem 255 per diem 254 per diem 273 per diem 235 per diem 255 per diem 255 per diem 255 per diem 200 per diem 180 per diem 285 per diem 285 per diem 260 per diem 265 per diem 235 per diem 254 per diem 285 per diem 285 per diem 285 per diem 235 per diem 165 per diem 254 per diem 254 per diem 254 per diem 254 per diem 239 per diem 239 per diem 239 per diem 150 per diem 254 per diem 254 per diem 235 per diem 273 per diem 254 per diem ADOLESCENT PARTIAL HOSPITAL PROGRAM W/BOARDING 912 RC facility outpatient 816.00 265 225 756 375 per diem 398 per diem 398 per diem 398 per diem 414 per diem 257.58 per diem 380 per diem 756 per diem 281 per diem 257.58 per diem 397 per diem 281 per diem 281 per diem 281 per diem 410 per diem 398 per diem 426 per diem 257.58 per diem 426 per diem 257.58 per diem 370 per diem 375 per diem 355 per diem 412 per diem 426 per diem 398 per diem 355 per diem 355 per diem 355 per diem 300 per diem 300 per diem 470 per diem 257.58 per diem 397 per diem 398 per diem 430 per diem 398 per diem 412 per diem 257.58 per diem 397 per diem 397 per diem 397 per diem 398 per diem 265 per diem 283.34 per diem 412 per diem 412 per diem 257.58 per diem 412 per diem 412 per diem 375 per diem 375 per diem 375 per diem 274 per diem 412 per diem 412 per diem 257.58 per diem 398 per diem 426 per diem 257.58 per diem 409 per diem 257.58 per diem ADOLESCENT CD PARTIAL HOSPITAL PROGRAM W/BOARD 913 RC facility outpatient 816.00 265 225 756 375 per diem 398 per diem 398 per diem 398 per diem 414 per diem 257.58 per diem 380 per diem 756 per diem 281 per diem 257.58 per diem 397 per diem 281 per diem 281 per diem 281 per diem 410 per diem 398 per diem 426 per diem 257.58 per diem 426 per diem 257.58 per diem 370 per diem 375 per diem 355 per diem 412 per diem 426 per diem 398 per diem 355 per diem 355 per diem 355 per diem 300 per diem 300 per diem 470 per diem 257.58 per diem 397 per diem 398 per diem 430 per diem 398 per diem 412 per diem 257.58 per diem 397 per diem 397 per diem 397 per diem 398 per diem 265 per diem 283.34 per diem 412 per diem 412 per diem 257.58 per diem 412 per diem 412 per diem 375 per diem 375 per diem 375 per diem 274 per diem 412 per diem 412 per diem 257.58 per diem 398 per diem 426 per diem 257.58 per diem 409 per diem 257.58 per diem ADULT CD PARTIAL HOSPITAL PROGRAM W/BOARD 913 RC facility outpatient 816.00 265 225 756 375 per diem 398 per diem 398 per diem 398 per diem 414 per diem 257.58 per diem 380 per diem 756 per diem 281 per diem 257.58 per diem 397 per diem 281 per diem 281 per diem 281 per diem 410 per diem 398 per diem 426 per diem 257.58 per diem 426 per diem 257.58 per diem 370 per diem 375 per diem 355 per diem 412 per diem 426 per diem 398 per diem 355 per diem 355 per diem 355 per diem 300 per diem 300 per diem 470 per diem 257.58 per diem 397 per diem 398 per diem 430 per diem 398 per diem 412 per diem 257.58 per diem 397 per diem 397 per diem 397 per diem 398 per diem 265 per diem 283.34 per diem 412 per diem 412 per diem 257.58 per diem 412 per diem 412 per diem 375 per diem 375 per diem 375 per diem 274 per diem 412 per diem 412 per diem 257.58 per diem 398 per diem 426 per diem 257.58 per diem 409 per diem 257.58 per diem PARTIAL HOSPITAL PROGRAM CD ADOLESCENT GRP1 TL1 913 RC facility outpatient 816.00 265 225 756 375 per diem 398 per diem 398 per diem 398 per diem 414 per diem 257.58 per diem 380 per diem 756 per diem 281 per diem 257.58 per diem 397 per diem 281 per diem 281 per diem 281 per diem 410 per diem 398 per diem 426 per diem 257.58 per diem 426 per diem 257.58 per diem 370 per diem 375 per diem 355 per diem 412 per diem 426 per diem 398 per diem 355 per diem 355 per diem 355 per diem 300 per diem 300 per diem 470 per diem 257.58 per diem 397 per diem 398 per diem 430 per diem 398 per diem 412 per diem 257.58 per diem 397 per diem 397 per diem 397 per diem 398 per diem 265 per diem 283.34 per diem 412 per diem 412 per diem 257.58 per diem 412 per diem 412 per diem 375 per diem 375 per diem 375 per diem 274 per diem 412 per diem 412 per diem 257.58 per diem 398 per diem 426 per diem 257.58 per diem 409 per diem 257.58 per diem PARTIAL HOSPITAL PROGRAM CD ADU GRP1 913 RC facility outpatient 816.00 265 225 756 375 per diem 398 per diem 398 per diem 398 per diem 414 per diem 257.58 per diem 380 per diem 756 per diem 281 per diem 257.58 per diem 397 per diem 281 per diem 281 per diem 281 per diem 410 per diem 398 per diem 426 per diem 257.58 per diem 426 per diem 257.58 per diem 370 per diem 375 per diem 355 per diem 412 per diem 426 per diem 398 per diem 355 per diem 355 per diem 355 per diem 300 per diem 300 per diem 470 per diem 257.58 per diem 397 per diem 398 per diem 430 per diem 398 per diem 412 per diem 257.58 per diem 397 per diem 397 per diem 397 per diem 398 per diem 265 per diem 283.34 per diem 412 per diem 412 per diem 257.58 per diem 412 per diem 412 per diem 375 per diem 375 per diem 375 per diem 274 per diem 412 per diem 412 per diem 257.58 per diem 398 per diem 426 per diem 257.58 per diem 409 per diem 257.58 per diem INTENSIVE OUTPATIENT PROGRAM ADO-G1-CPH EVE V 915 RC facility outpatient 204.00 153 218.53 240.38 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem 240.38 per diem 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem INTENSIVE OUTPATIENT PROGRAM ADU-GRP1 CPH VIR 915 RC facility outpatient 204.00 153 218.53 240.38 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem 240.38 per diem 218.53 per diem 218.53 per diem 218.53 per diem 218.53 per diem PARTIAL HOSPITAL PROGRAM ADU GRP1 - WC VI 915 RC facility outpatient 204.00 153 218.53 756 398 per diem 257.58 per diem 398 per diem 257.58 per diem 257.58 per diem 273 per diem 273 per diem 410 per diem 218.53 per diem 218.53 per diem 375 per diem 426 per diem 257.58 per diem 398 per diem 257.58 per diem 397 per diem 756 per diem 756 per diem 283.34 per diem 257.58 per diem 375 per diem 375 per diem 412 per diem 218.53 per diem 218.53 per diem 218.53 per diem VOP ADU-1G-SC DY V V 915 RC facility outpatient 204.00 153 218.53 257.58 218.53 per diem 218.53 per diem 257.58 per diem 257.58 per diem 257.58 per diem 257.58 per diem 240.38 per diem 218.53 per diem 257.58 per diem 257.58 per diem 257.58 per diem PARTIAL HOSPITAL PROGRAM LODGING FEE 995 RC facility outpatient 25.00 25 398 398 398 per diem ROOM AND BOARD RTC PSYCH ADOLESCENT 1002 RC facility outpatient 933.00 700 479 670 640 per diem 651 per diem 525 per diem 479 per diem 583 per diem 479 per diem 479 per diem 479 per diem 625 per diem 582 per diem 651 per diem 651 per diem 595 per diem 670 per diem 550 per diem 550 per diem 550 per diem 650 per diem 582 per diem 635 per diem 670 per diem 600 per diem 604.71 per diem 485 per diem 484 per diem 583 per diem 583 per diem 640 per diem 479 per diem 484 per diem 670 per diem 670 per diem 670 per diem 670 per diem 670 per diem 670 per diem 640 per diem 651 per diem 637 per diem ROOM AND BOARD RTC PSYCH ADULT 1002 RC facility outpatient 933.00 700 479 670 640 per diem 651 per diem 525 per diem 479 per diem 583 per diem 479 per diem 479 per diem 479 per diem 625 per diem 582 per diem 651 per diem 651 per diem 595 per diem 670 per diem 550 per diem 550 per diem 550 per diem 650 per diem 582 per diem 635 per diem 670 per diem 600 per diem 604.71 per diem 485 per diem 484 per diem 583 per diem 583 per diem 640 per diem 479 per diem 484 per diem 670 per diem 670 per diem 670 per diem 670 per diem 670 per diem 670 per diem 640 per diem 651 per diem 637 per diem 90792 Psychiatric Diag Eval With Med 90792 RC facility Professional Fee 243.00 150.00 107.2 183.713 183.71 fee shcedule based on diaginosis 142.48 fee shcedule based on diaginosis 107.20 fee shcedule based on diaginosis 135.00 fee shcedule based on diaginosis 133.74 fee shcedule based on diaginosis 152.56 fee shcedule based on diaginosis 174.68 fee shcedule based on diaginosis 168.73 fee shcedule based on diaginosis 152.38 fee shcedule based on diaginosis 169.89 fee shcedule based on diaginosis 143.12 fee shcedule based on diaginosis 142.72 119.92 fee shcedule based on diaginosis 142.72 fee shcedule based on diaginosis 144.03 fee shcedule based on diaginosis 148.32 fee shcedule based on diaginosis 90833 30 Minute Add On 90833 RC facility Professional Fee 103.00 61.00 32.8 76.03 63.00 fee shcedule based on diaginosis 63.67 fee shcedule based on diaginosis 38.00 fee shcedule based on diaginosis 61.56 fee shcedule based on diaginosis 34.13 fee shcedule based on diaginosis 37.72 fee shcedule based on diaginosis 32.80 fee shcedule based on diaginosis 55.76 fee shcedule based on diaginosis 58.21 fee shcedule based on diaginosis 62.20 fee shcedule based on diaginosis 76.03 fee shcedule based on diaginosis 90870 Electroconvulsive Therapy 90870 RC facility Professional Fee 270.00 111.00 103 196.42 104.57 fee shcedule based on diaginosis 103.00 fee shcedule based on diaginosis 142.89 fee shcedule based on diaginosis 105.54 fee shcedule based on diaginosis 196.42 fee shcedule based on diaginosis 174.40 fee shcedule based on diaginosis 196.42 fee shcedule based on diaginosis 99212 Est Office Visit 99212 RC facility Professional Fee 81.00 32.00 30.14 35.11 30.14 fee shcedule based on diaginosis 35.11 fee shcedule based on diaginosis 99213 Est Patient/med Management/low 99213 RC facility Professional Fee 151.00 62.00 35 94.5647619 94.56 fee shcedule based on diaginosis 66.45 fee shcedule based on diaginosis 51.43 fee shcedule based on diaginosis 65.78 fee shcedule based on diaginosis 37.55 fee shcedule based on diaginosis 52.00 fee shcedule based on diaginosis 53.64 fee shcedule based on diaginosis 52.79 fee shcedule based on diaginosis 44.07 fee shcedule based on diaginosis 75.21 fee shcedule based on diaginosis 35.00 fee shcedule based on diaginosis 47.70 fee shcedule based on diaginosis 67.12 fee shcedule based on diaginosis 59.05 fee shcedule based on diaginosis 49.90 fee shcedule based on diaginosis 65.93 fee shcedule based on diaginosis 58.32 fee shcedule based on diaginosis 54.06 fee shcedule based on diaginosis 74.00 fee shcedule based on diaginosis 80.47 fee shcedule based on diaginosis 69.87 fee shcedule based on diaginosis 99214 Est Patient/med Management/ Mo 99214 RC facility Professional Fee 167.00 89.00 38.75 113.16 109.70 fee shcedule based on diaginosis 95.11 fee shcedule based on diaginosis 96.31 fee shcedule based on diaginosis 58.06 fee shcedule based on diaginosis 77.77 fee shcedule based on diaginosis 85.46 fee shcedule based on diaginosis 67.77 fee shcedule based on diaginosis 106.15 fee shcedule based on diaginosis 38.75 fee shcedule based on diaginosis 81.86 fee shcedule based on diaginosis 84.81 fee shcedule based on diaginosis 69.59 fee shcedule based on diaginosis 86.67 fee shcedule based on diaginosis 113.16 fee shcedule based on diaginosis 99215 Est Office Visit 99215 RC facility Professional Fee 211.00 126.00 98.88 133.405 133.41 fee shcedule based on diaginosis 115.06 fee shcedule based on diaginosis 120.22 fee shcedule based on diaginosis 120.22 fee shcedule based on diaginosis 98.88 fee shcedule based on diaginosis 99222 Initial Hospital Care (50 Min) 99222 RC facility Professional Fee 173.00 135.00 40 135.935 128.77 fee shcedule based on diaginosis 135.94 fee shcedule based on diaginosis 119.63 fee shcedule based on diaginosis 125.80 fee shcedule based on diaginosis 105.78 fee shcedule based on diaginosis 110.86 fee shcedule based on diaginosis 40.00 fee shcedule based on diaginosis 118.44 fee shcedule based on diaginosis 128.77 fee shcedule based on diaginosis 128.77 fee shcedule based on diaginosis 83.23 fee shcedule based on diaginosis 106.00 fee shcedule based on diaginosis 108.20 fee shcedule based on diaginosis 126.36 fee shcedule based on diaginosis 99223 Initial Hospital Care (70 Min) 99223 RC facility Professional Fee 232.00 182.00 53.75 215 183.76 fee shcedule based on diaginosis 215.00 fee shcedule based on diaginosis 183.99 fee shcedule based on diaginosis 155.23 fee shcedule based on diaginosis 181.36 fee shcedule based on diaginosis 162.57 fee shcedule based on diaginosis 53.75 fee shcedule based on diaginosis 171.65 fee shcedule based on diaginosis 171.65 fee shcedule based on diaginosis 173.59 fee shcedule based on diaginosis 160.78 fee shcedule based on diaginosis 171.65 fee shcedule based on diaginosis 99231 Subseq Care (15 Min) 99231 RC facility Professional Fee 70.00 51.00 16.25 49.16 36.19 fee shcedule based on diaginosis 31.75 fee shcedule based on diaginosis 16.25 fee shcedule based on diaginosis 48.59 fee shcedule based on diaginosis 49.16 fee shcedule based on diaginosis 32.55 fee shcedule based on diaginosis 44.67 fee shcedule based on diaginosis 99232 Subseq Care (25 Min) 99232 RC facility Professional Fee 113.00 81.00 26.7380303 105 105.00 fee shcedule based on diaginosis 78.29 fee shcedule based on diaginosis 80.24 fee shcedule based on diaginosis 63.06 fee shcedule based on diaginosis 65.82 fee shcedule based on diaginosis 52.32 fee shcedule based on diaginosis 54.25 fee shcedule based on diaginosis 58.46 fee shcedule based on diaginosis 26.74 fee shcedule based on diaginosis 75.39 fee shcedule based on diaginosis 76.20 fee shcedule based on diaginosis 50.71 fee shcedule based on diaginosis 42.00 fee shcedule based on diaginosis 76.78 fee shcedule based on diaginosis 43.54 fee shcedule based on diaginosis 87.74 fee shcedule based on diaginosis 55.12 fee shcedule based on diaginosis 61.83 fee shcedule based on diaginosis 77.72 fee shcedule based on diaginosis 76.33 fee shcedule based on diaginosis 99233 Subseq Care (35 Min) 99233 RC facility Professional Fee 130.00 121.00 30 117.78 103.84 fee shcedule based on diaginosis 117.78 fee shcedule based on diaginosis 113.76 fee shcedule based on diaginosis 98.18 fee shcedule based on diaginosis 98.05 fee shcedule based on diaginosis 95.09 fee shcedule based on diaginosis 90.50 fee shcedule based on diaginosis 90.00 fee shcedule based on diaginosis 92.99 fee shcedule based on diaginosis 84.01 fee shcedule based on diaginosis 30.00 fee shcedule based on diaginosis 106.38 fee shcedule based on diaginosis 115.35 fee shcedule based on diaginosis 116.82 fee shcedule based on diaginosis 82.95 fee shcedule based on diaginosis 116.82 fee shcedule based on diaginosis 115.02 fee shcedule based on diaginosis 99238 Discharge Day Mgmt 99238 RC facility Professional Fee 146.00 82.00 33.75 87.74 79.82 fee shcedule based on diaginosis 80.04 fee shcedule based on diaginosis 63.07 fee shcedule based on diaginosis 68.54 fee shcedule based on diaginosis 66.61 fee shcedule based on diaginosis 58.97 fee shcedule based on diaginosis 33.75 fee shcedule based on diaginosis 79.82 fee shcedule based on diaginosis 78.68 fee shcedule based on diaginosis 42.00 fee shcedule based on diaginosis 78.23 fee shcedule based on diaginosis 43.73 fee shcedule based on diaginosis 87.74 fee shcedule based on diaginosis 61.78 fee shcedule based on diaginosis 81.76 fee shcedule based on diaginosis 74.82 fee shcedule based on diaginosis 77.63 fee shcedule based on diaginosis