"hospital_Riverview Behavioral Health, LLC" last_updated_ 2023-12-31 version_1 "hospital_Texarkana, Arkansas" hospital_address 701 Arkansas Boulevard license_ AR5046 | AR "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_ADVANTRA COVENTRY| MANAGED MEDICARE] standard_charge|[payer_ADVANTRA COVENTRY| MANAGED MEDICARE] |percent standard_charge|[payer_ADVANTRA COVENTRY|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ADVANTRA COVENTRY|MANAGED MEDICARE] standard_charge|[payer_AETNA HMO PPO|HMO/PPO] standard_charge|[payer_AETNA HMO PPO|HMO/PPO] |percent standard_charge|[payer_AETNA HMO PPO|HMO/PPO] |contracting_method additional_payer_notes |[payer_AETNA HMO PPO|HMO/PPO] standard_charge|[payer_AETNA HMO PPO|HMO/PPO PHYSICIAN] standard_charge|[payer_AETNA HMO PPO|HMO/PPO PHYSICIAN] |percent standard_charge|[payer_AETNA HMO PPO|HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_AETNA HMO PPO|HMO/PPO PHYSICIAN] standard_charge|[payer_AETNA MEDICARE|MGD MEDICARE PHYS] standard_charge|[payer_AETNA MEDICARE|MGD MEDICARE PHYS] |percent standard_charge|[payer_AETNA MEDICARE|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE|MGD MEDICARE PHYS] standard_charge|[payer_AMBETTER|MANAGED MEDICAID] standard_charge|[payer_AMBETTER|MANAGED MEDICAID] |percent standard_charge|[payer_AMBETTER|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMBETTER|MANAGED MEDICAID] standard_charge|[payer_AMBETTER|MGD MEDICAID PHYS] standard_charge|[payer_AMBETTER|MGD MEDICAID PHYS] |percent standard_charge|[payer_AMBETTER|MGD MEDICAID PHYS] |contracting_method additional_payer_notes |[payer_AMBETTER|MGD MEDICAID PHYS] standard_charge|[payer_AMBETTER PREMIUM|HMO/PPO] standard_charge|[payer_AMBETTER PREMIUM|HMO/PPO] |percent standard_charge|[payer_AMBETTER PREMIUM|HMO/PPO] |contracting_method additional_payer_notes |[payer_AMBETTER PREMIUM|HMO/PPO] standard_charge|[payer_AMBETTER PREMIUM|MGD MEDICAID PHYS] standard_charge|[payer_AMBETTER PREMIUM|MGD MEDICAID PHYS] |percent standard_charge|[payer_AMBETTER PREMIUM|MGD MEDICAID PHYS] |contracting_method additional_payer_notes |[payer_AMBETTER PREMIUM|MGD MEDICAID PHYS] standard_charge|[payer_AMERIBEN|BLUE CROSS] standard_charge|[payer_AMERIBEN|BLUE CROSS] |percent standard_charge|[payer_AMERIBEN|BLUE CROSS] |contracting_method additional_payer_notes |[payer_AMERIBEN|BLUE CROSS] standard_charge|[payer_AMERIBEN| BLUE CROSS PHYSICIAN] standard_charge|[payer_AMERIBEN| BLUE CROSS PHYSICIAN] |percent standard_charge|[payer_AMERIBEN| BLUE CROSS PHYSICIAN] |contracting_method additional_payer_notes |[payer_AMERIBEN| BLUE CROSS PHYSICIAN] standard_charge|[payer_AMERIGROUP STAR|MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP STAR|MANAGED MEDICAID] |percent standard_charge|[payer_AMERIGROUP STAR|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIGROUP STAR|MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP TX MEDICARE|MGD MEDICARE PHYS] standard_charge|[payer_AMERIGROUP TX MEDICARE|MGD MEDICARE PHYS] |percent standard_charge|[payer_AMERIGROUP TX MEDICARE|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_AMERIGROUP TX MEDICARE|MGD MEDICARE PHYS] standard_charge|[payer_AMERIHEALTH CARITAS| MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS| MANAGED MEDICAID] |percent standard_charge|[payer_AMERIHEALTH CARITAS| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIHEALTH CARITAS| MANAGED MEDICAID] standard_charge|[payer_APC PASSE SUMMIT COMM CAR| MANAGED MEDICAID] standard_charge|[payer_APC PASSE SUMMIT COMM CAR| MANAGED MEDICAID] |percent standard_charge|[payer_APC PASSE SUMMIT COMM CAR| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_APC PASSE SUMMIT COMM CAR| MANAGED MEDICAID] standard_charge|[payer_APC PASSE-SUMMIT COMM CAR|MANAGED MEDICAID] standard_charge|[payer_APC PASSE-SUMMIT COMM CAR|MANAGED MEDICAID] |percent standard_charge|[payer_APC PASSE-SUMMIT COMM CAR|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_APC PASSE-SUMMIT COMM CAR|MANAGED MEDICAID] standard_charge|[payer_AR BCBS EXCHANGE| MANAGED MEDICAID] standard_charge|[payer_AR BCBS EXCHANGE| MANAGED MEDICAID] |percent standard_charge|[payer_AR BCBS EXCHANGE| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AR BCBS EXCHANGE| MANAGED MEDICAID] standard_charge|[payer_AR BCBS EXCHANGE|MGD MEDICAID PHYS] standard_charge|[payer_AR BCBS EXCHANGE|MGD MEDICAID PHYS] |percent standard_charge|[payer_AR BCBS EXCHANGE|MGD MEDICAID PHYS] |contracting_method additional_payer_notes |[payer_AR BCBS EXCHANGE|MGD MEDICAID PHYS] standard_charge|[payer_AR BCBS MARKETPLACE|MANAGED MEDICAID] standard_charge|[payer_AR BCBS MARKETPLACE|MANAGED MEDICAID] |percent standard_charge|[payer_AR BCBS MARKETPLACE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AR BCBS MARKETPLACE|MANAGED MEDICAID] standard_charge|[payer_AR HEALTH & WELLNESS|HMO/PPO] standard_charge|[payer_AR HEALTH & WELLNESS|HMO/PPO] |percent standard_charge|[payer_AR HEALTH & WELLNESS|HMO/PPO] |contracting_method additional_payer_notes |[payer_AR HEALTH & WELLNESS|HMO/PPO] standard_charge|[payer_AR HEALTH & WELLNESS|HMO/PPO PHYSICIAN] standard_charge|[payer_AR HEALTH & WELLNESS|HMO/PPO PHYSICIAN] |percent standard_charge|[payer_AR HEALTH & WELLNESS|HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_AR HEALTH & WELLNESS|HMO/PPO PHYSICIAN] standard_charge|[payer_AR HEALTH & WELLNESS MCR|MGD MEDICARE PHYS] standard_charge|[payer_AR HEALTH & WELLNESS MCR|MGD MEDICARE PHYS] |percent standard_charge|[payer_AR HEALTH & WELLNESS MCR|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_AR HEALTH & WELLNESS MCR|MGD MEDICARE PHYS] standard_charge|[payer_AR SUPERIOR SELECT INC|MGD MEDICARE PHYS] standard_charge|[payer_AR SUPERIOR SELECT INC|MGD MEDICARE PHYS] |percent standard_charge|[payer_AR SUPERIOR SELECT INC|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_AR SUPERIOR SELECT INC|MGD MEDICARE PHYS] standard_charge|[payer_ARCADIAN HEALTH PLAN INC|MANAGED MEDICARE] standard_charge|[payer_ARCADIAN HEALTH PLAN INC|MANAGED MEDICARE] |percent standard_charge|[payer_ARCADIAN HEALTH PLAN INC|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ARCADIAN HEALTH PLAN INC|MANAGED MEDICARE] standard_charge|[payer_ARCADIAN HEALTH PLAN INC|MGD MEDICARE PHYS] standard_charge|[payer_ARCADIAN HEALTH PLAN INC|MGD MEDICARE PHYS] |percent standard_charge|[payer_ARCADIAN HEALTH PLAN INC|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_ARCADIAN HEALTH PLAN INC|MGD MEDICARE PHYS] standard_charge|[payer_ARKANSAS ADULT MEDICAID|MEDICAID] standard_charge|[payer_ARKANSAS ADULT MEDICAID|MEDICAID] |percent standard_charge|[payer_ARKANSAS ADULT MEDICAID|MEDICAID] |contracting_method additional_payer_notes |[payer_ARKANSAS ADULT MEDICAID|MEDICAID] standard_charge|[payer_ARKANSAS MEDICAID| MEDICAID] standard_charge|[payer_ARKANSAS MEDICAID| MEDICAID] |percent standard_charge|[payer_ARKANSAS MEDICAID| MEDICAID] |contracting_method additional_payer_notes |[payer_ARKANSAS MEDICAID| MEDICAID] standard_charge|[payer_ARKANSAS TOTAL CARE| MANAGED MEDICAID] standard_charge|[payer_ARKANSAS TOTAL CARE| MANAGED MEDICAID] |percent standard_charge|[payer_ARKANSAS TOTAL CARE| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_ARKANSAS TOTAL CARE| MANAGED MEDICAID] standard_charge|[payer_BCBS ARKANSAS| BLUE CROSS] standard_charge|[payer_BCBS ARKANSAS| BLUE CROSS] |percent standard_charge|[payer_BCBS ARKANSAS| BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS ARKANSAS| BLUE CROSS] standard_charge|[payer_BCBS ARKANSAS| BLUE CROSS PHYSICIAN] standard_charge|[payer_BCBS ARKANSAS| BLUE CROSS PHYSICIAN] |percent standard_charge|[payer_BCBS ARKANSAS| BLUE CROSS PHYSICIAN] |contracting_method additional_payer_notes |[payer_BCBS ARKANSAS| BLUE CROSS PHYSICIAN] 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 FEDERAL| BLUE CROSS PHYSICIAN] standard_charge|[payer_BCBS FEDERAL| BLUE CROSS PHYSICIAN] |percent standard_charge|[payer_BCBS FEDERAL| BLUE CROSS PHYSICIAN] |contracting_method additional_payer_notes |[payer_BCBS FEDERAL| BLUE CROSS PHYSICIAN] 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_BCBS OUT OF STATE| BLUE CROSS PHYSICIAN] standard_charge|[payer_BCBS OUT OF STATE| BLUE CROSS PHYSICIAN] |percent standard_charge|[payer_BCBS OUT OF STATE| BLUE CROSS PHYSICIAN] |contracting_method additional_payer_notes |[payer_BCBS OUT OF STATE| BLUE CROSS PHYSICIAN] standard_charge|[payer_CARE IMPROVEMENT PLUS| MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT PLUS| MANAGED MEDICARE] |percent standard_charge|[payer_CARE IMPROVEMENT PLUS| MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CARE IMPROVEMENT PLUS| MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT PLUS| MGD MEDICARE PHYS] standard_charge|[payer_CARE IMPROVEMENT PLUS| MGD MEDICARE PHYS] |percent standard_charge|[payer_CARE IMPROVEMENT PLUS| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_CARE IMPROVEMENT PLUS| MGD MEDICARE PHYS] standard_charge|[payer_CARESOURCE| MANAGED MEDICAID] standard_charge|[payer_CARESOURCE| MANAGED MEDICAID] |percent standard_charge|[payer_CARESOURCE| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CARESOURCE| MANAGED MEDICAID] "standard_charge|[payer_CHA HMO, INC| MANAGED MEDICARE]" "standard_charge|[payer_CHA HMO, INC| MANAGED MEDICARE] |percent" "standard_charge|[payer_CHA HMO, INC| MANAGED MEDICARE] |contracting_method" "additional_payer_notes |[payer_CHA HMO, INC| MANAGED MEDICARE]" "standard_charge|[payer_CHA HMO, INC| MGD MEDICARE PHYS]" "standard_charge|[payer_CHA HMO, INC| MGD MEDICARE PHYS] |percent" "standard_charge|[payer_CHA HMO, INC| MGD MEDICARE PHYS] |contracting_method" "additional_payer_notes |[payer_CHA HMO, INC| MGD MEDICARE PHYS]" standard_charge|[payer_CHARITY| SELF PAY CHARITY] standard_charge|[payer_CHARITY| SELF PAY CHARITY] |percent standard_charge|[payer_CHARITY| SELF PAY CHARITY] |contracting_method additional_payer_notes |[payer_CHARITY| SELF PAY CHARITY] standard_charge|[payer_CHOCTAW NATION| COMMERCIAL] standard_charge|[payer_CHOCTAW NATION| COMMERCIAL] |percent standard_charge|[payer_CHOCTAW NATION| COMMERCIAL] |contracting_method additional_payer_notes |[payer_CHOCTAW NATION| COMMERCIAL] standard_charge|[payer_CHRISTUS HEALTH PLAN| HMO/PPO] standard_charge|[payer_CHRISTUS HEALTH PLAN| HMO/PPO] |percent standard_charge|[payer_CHRISTUS HEALTH PLAN| HMO/PPO] |contracting_method additional_payer_notes |[payer_CHRISTUS HEALTH PLAN| HMO/PPO] standard_charge|[payer_CHRISTUS HEALTH PLAN| HMO/PPO PHYSICIAN] standard_charge|[payer_CHRISTUS HEALTH PLAN| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_CHRISTUS HEALTH PLAN| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_CHRISTUS HEALTH PLAN| HMO/PPO PHYSICIAN] standard_charge|[payer_CIGNA HLSPRING - MEDICARE| MGD MEDICARE PHYS] standard_charge|[payer_CIGNA HLSPRING - MEDICARE| MGD MEDICARE PHYS] |percent standard_charge|[payer_CIGNA HLSPRING - MEDICARE| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_CIGNA HLSPRING - MEDICARE| MGD MEDICARE PHYS] standard_charge|[payer_CIGNA HMO PPO| HMO/PPO] standard_charge|[payer_CIGNA HMO PPO| HMO/PPO] |percent standard_charge|[payer_CIGNA HMO PPO| HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA HMO PPO| HMO/PPO] 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_COVENTRY HEALTH AND LIFE| HMO/PPO] standard_charge|[payer_COVENTRY HEALTH AND LIFE| HMO/PPO] |percent standard_charge|[payer_COVENTRY HEALTH AND LIFE| HMO/PPO] |contracting_method additional_payer_notes |[payer_COVENTRY HEALTH AND LIFE| HMO/PPO] standard_charge|[payer_COVENTRY MEDICARE| MGD MEDICARE PHYS] standard_charge|[payer_COVENTRY MEDICARE| MGD MEDICARE PHYS] |percent standard_charge|[payer_COVENTRY MEDICARE| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_COVENTRY MEDICARE| MGD MEDICARE PHYS] standard_charge|[payer_DELTA COUNCELLING ASSOC| LOCAL GOVT] standard_charge|[payer_DELTA COUNCELLING ASSOC| LOCAL GOVT] |percent standard_charge|[payer_DELTA COUNCELLING ASSOC| LOCAL GOVT] |contracting_method additional_payer_notes |[payer_DELTA COUNCELLING ASSOC| LOCAL GOVT] standard_charge|[payer_DHS ARKANSAS| LOCAL GOVT] standard_charge|[payer_DHS ARKANSAS| LOCAL GOVT] |percent standard_charge|[payer_DHS ARKANSAS| LOCAL GOVT] |contracting_method additional_payer_notes |[payer_DHS ARKANSAS| LOCAL GOVT] standard_charge|[payer_EMPOWER| MANAGED MEDICAID] standard_charge|[payer_EMPOWER| MANAGED MEDICAID] |percent standard_charge|[payer_EMPOWER| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_EMPOWER| MANAGED MEDICAID] standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI| MGD MEDICAID PHYS] standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI| MGD MEDICAID PHYS] |percent standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI| MGD MEDICAID PHYS] |contracting_method additional_payer_notes |[payer_EMPOWER HEALTHCARE SOLUTI| MGD MEDICAID PHYS] standard_charge|[payer_GEHA| HMO/PPO] standard_charge|[payer_GEHA| HMO/PPO] |percent standard_charge|[payer_GEHA| HMO/PPO] |contracting_method additional_payer_notes |[payer_GEHA| HMO/PPO] standard_charge|[payer_HARMONY HEALTH PLAN INC| MGD MEDICARE PHYS] standard_charge|[payer_HARMONY HEALTH PLAN INC| MGD MEDICARE PHYS] |percent standard_charge|[payer_HARMONY HEALTH PLAN INC| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_HARMONY HEALTH PLAN INC| MGD MEDICARE PHYS] standard_charge|[payer_HCSC INS SERVICES CO| MGD MEDICARE PHYS] standard_charge|[payer_HCSC INS SERVICES CO| MGD MEDICARE PHYS] |percent standard_charge|[payer_HCSC INS SERVICES CO| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_HCSC INS SERVICES CO| MGD MEDICARE PHYS] standard_charge|[payer_HEALTHFIRST| HMO/PPO] standard_charge|[payer_HEALTHFIRST| HMO/PPO] |percent standard_charge|[payer_HEALTHFIRST| HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHFIRST| HMO/PPO] standard_charge|[payer_HEALTHFIRST| HMO/PPO PHYSICIAN] standard_charge|[payer_HEALTHFIRST| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_HEALTHFIRST| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_HEALTHFIRST| HMO/PPO PHYSICIAN] standard_charge|[payer_HUMANA HMO PPO| HMO/PPO] standard_charge|[payer_HUMANA HMO PPO| HMO/PPO] |percent standard_charge|[payer_HUMANA HMO PPO| HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA HMO PPO| HMO/PPO] standard_charge|[payer_HUMANA HMO PPO| HMO/PPO PHYSICIAN] standard_charge|[payer_HUMANA HMO PPO| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_HUMANA HMO PPO| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_HUMANA HMO PPO| HMO/PPO PHYSICIAN] standard_charge|[payer_HUMANA MEDICARE HMO PPO| MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE HMO PPO| MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE HMO PPO| MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE HMO PPO| MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE HMO PPO| MGD MEDICARE PHYS] standard_charge|[payer_HUMANA MEDICARE HMO PPO| MGD MEDICARE PHYS] |percent standard_charge|[payer_HUMANA MEDICARE HMO PPO| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE HMO PPO| MGD MEDICARE PHYS] standard_charge|[payer_MAGELLAN HMO| HMO/PPO] standard_charge|[payer_MAGELLAN HMO| HMO/PPO] |percent standard_charge|[payer_MAGELLAN HMO| HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN HMO| HMO/PPO] standard_charge|[payer_MAGELLAN HMO| HMO/PPO PHYSICIAN] standard_charge|[payer_MAGELLAN HMO| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_MAGELLAN HMO| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_MAGELLAN HMO| HMO/PPO PHYSICIAN] standard_charge|[payer_MAILHANDLERS| HMO/PPO] standard_charge|[payer_MAILHANDLERS| HMO/PPO] |percent standard_charge|[payer_MAILHANDLERS| HMO/PPO] |contracting_method additional_payer_notes |[payer_MAILHANDLERS| HMO/PPO] standard_charge|[payer_MAILHANDLERS| HMO/PPO PHYSICIAN] standard_charge|[payer_MAILHANDLERS| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_MAILHANDLERS| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_MAILHANDLERS| HMO/PPO PHYSICIAN] 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| MEDICARE PHYSICIAN] standard_charge|[payer_MEDICARE| MEDICARE PHYSICIAN] |percent standard_charge|[payer_MEDICARE| MEDICARE PHYSICIAN] |contracting_method additional_payer_notes |[payer_MEDICARE| MEDICARE PHYSICIAN] standard_charge|[payer_MERITAIN HEALTH| HMO/PPO] standard_charge|[payer_MERITAIN HEALTH| HMO/PPO] |percent standard_charge|[payer_MERITAIN HEALTH| HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH| HMO/PPO] standard_charge|[payer_MN BLUE PLUS| MEDICAID: CBS OOS] standard_charge|[payer_MN BLUE PLUS| MEDICAID: CBS OOS] |percent standard_charge|[payer_MN BLUE PLUS| MEDICAID: CBS OOS] |contracting_method additional_payer_notes |[payer_MN BLUE PLUS| MEDICAID: CBS OOS] standard_charge|[payer_MOLINA| MANAGED MEDICAID] standard_charge|[payer_MOLINA| MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA| MANAGED MEDICAID] standard_charge|[payer_MUNICIPAL HEALTH BENEFIT| HMO/PPO] standard_charge|[payer_MUNICIPAL HEALTH BENEFIT| HMO/PPO] |percent standard_charge|[payer_MUNICIPAL HEALTH BENEFIT| HMO/PPO] |contracting_method additional_payer_notes |[payer_MUNICIPAL HEALTH BENEFIT| HMO/PPO] standard_charge|[payer_NEWHAVEN| LOCAL GOVT] standard_charge|[payer_NEWHAVEN| LOCAL GOVT] |percent standard_charge|[payer_NEWHAVEN| LOCAL GOVT] |contracting_method additional_payer_notes |[payer_NEWHAVEN| LOCAL GOVT] standard_charge|[payer_OKLAHOMA MEDICAID| MEDICAID: OUT OF STATE] standard_charge|[payer_OKLAHOMA MEDICAID| MEDICAID: OUT OF STATE] |percent standard_charge|[payer_OKLAHOMA MEDICAID| MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_OKLAHOMA MEDICAID| MEDICAID: OUT OF STATE] standard_charge|[payer_OUACHITA BEHAVIORAL HEALT| LOCAL GOVT] standard_charge|[payer_OUACHITA BEHAVIORAL HEALT| LOCAL GOVT] |percent standard_charge|[payer_OUACHITA BEHAVIORAL HEALT| LOCAL GOVT] |contracting_method additional_payer_notes |[payer_OUACHITA BEHAVIORAL HEALT| LOCAL GOVT] standard_charge|[payer_PENDING ARKANSAS MEDICAID| PENDING MEDICAID] standard_charge|[payer_PENDING ARKANSAS MEDICAID| PENDING MEDICAID] |percent standard_charge|[payer_PENDING ARKANSAS MEDICAID| PENDING MEDICAID] |contracting_method additional_payer_notes |[payer_PENDING ARKANSAS MEDICAID| PENDING MEDICAID] standard_charge|[payer_PENDING TEXAS MEDICAID| PENDING MEDICAID] standard_charge|[payer_PENDING TEXAS MEDICAID| PENDING MEDICAID] |percent standard_charge|[payer_PENDING TEXAS MEDICAID| PENDING MEDICAID] |contracting_method additional_payer_notes |[payer_PENDING TEXAS MEDICAID| PENDING MEDICAID] standard_charge|[payer_SUPERIOR CHIP| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR CHIP| MANAGED MEDICAID] |percent standard_charge|[payer_SUPERIOR CHIP| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUPERIOR CHIP| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR CHIPS| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR CHIPS| MANAGED MEDICAID] |percent standard_charge|[payer_SUPERIOR CHIPS| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUPERIOR CHIPS| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR FOSTER CARE| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR FOSTER CARE| MANAGED MEDICAID] |percent standard_charge|[payer_SUPERIOR FOSTER CARE| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUPERIOR FOSTER CARE| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTHPLAN| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTHPLAN| MANAGED MEDICAID] |percent standard_charge|[payer_SUPERIOR HEALTHPLAN| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUPERIOR HEALTHPLAN| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR MANAGED MEDICARE| MANAGED MEDICARE] standard_charge|[payer_SUPERIOR MANAGED MEDICARE| MANAGED MEDICARE] |percent standard_charge|[payer_SUPERIOR MANAGED MEDICARE| MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_SUPERIOR MANAGED MEDICARE| MANAGED MEDICARE] standard_charge|[payer_SUPERIOR PREGNANT WOMEN| MANAGED MEDICAID] standard_charge|[payer_SUPERIOR PREGNANT WOMEN| MANAGED MEDICAID] |percent standard_charge|[payer_SUPERIOR PREGNANT WOMEN| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_SUPERIOR PREGNANT WOMEN| MANAGED MEDICAID] standard_charge|[payer_SW ARK COUNSELING MNTL HE| LOCAL GOVT] standard_charge|[payer_SW ARK COUNSELING MNTL HE| LOCAL GOVT] |percent standard_charge|[payer_SW ARK COUNSELING MNTL HE| LOCAL GOVT] |contracting_method additional_payer_notes |[payer_SW ARK COUNSELING MNTL HE| LOCAL GOVT] standard_charge|[payer_TEXAS ADULT MEDICAID| MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS ADULT MEDICAID| MEDICAID: OUT OF STATE] |percent standard_charge|[payer_TEXAS ADULT MEDICAID| MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_TEXAS ADULT MEDICAID| MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS CHILDREN'S HEALTH| MANAGED MEDICAID] standard_charge|[payer_TEXAS CHILDREN'S HEALTH| MANAGED MEDICAID] |percent standard_charge|[payer_TEXAS CHILDREN'S HEALTH| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_TEXAS CHILDREN'S HEALTH| MANAGED MEDICAID] standard_charge|[payer_TEXAS MEDICAID| MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS MEDICAID| MEDICAID: OUT OF STATE] |percent standard_charge|[payer_TEXAS MEDICAID| MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_TEXAS MEDICAID| MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS PREGNANT WOMEN| MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS PREGNANT WOMEN| MEDICAID: OUT OF STATE] |percent standard_charge|[payer_TEXAS PREGNANT WOMEN| MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_TEXAS PREGNANT WOMEN| MEDICAID: OUT OF STATE] 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_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 ALL SAVERS| HMO/PPO PHYSICIAN] standard_charge|[payer_UHC ALL SAVERS| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_UHC ALL SAVERS| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_UHC ALL SAVERS| HMO/PPO PHYSICIAN] standard_charge|[payer_UHC SHARED SERVICES| COMMERCIAL] standard_charge|[payer_UHC SHARED SERVICES| COMMERCIAL] |percent standard_charge|[payer_UHC SHARED SERVICES| COMMERCIAL] |contracting_method additional_payer_notes |[payer_UHC SHARED SERVICES| COMMERCIAL] standard_charge|[payer_UHC TX STAR KIDS| MANAGED MEDICAID] standard_charge|[payer_UHC TX STAR KIDS| MANAGED MEDICAID] |percent standard_charge|[payer_UHC TX STAR KIDS| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC TX STAR KIDS| MANAGED MEDICAID] standard_charge|[payer_UHC TX STAR PLUS| MANAGED MEDICAID] standard_charge|[payer_UHC TX STAR PLUS| MANAGED MEDICAID] |percent standard_charge|[payer_UHC TX STAR PLUS| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC TX STAR PLUS| MANAGED MEDICAID] standard_charge|[payer_UMR UNITED MEDICAL RSRCS| HMO/PPO] standard_charge|[payer_UMR UNITED MEDICAL RSRCS| HMO/PPO] |percent standard_charge|[payer_UMR UNITED MEDICAL RSRCS| HMO/PPO] |contracting_method additional_payer_notes |[payer_UMR UNITED MEDICAL RSRCS| HMO/PPO] standard_charge|[payer_UMR UNITED MEDICAL RSRCS|HMO/PPO PHYSICIAN] standard_charge|[payer_UMR UNITED MEDICAL RSRCS|HMO/PPO PHYSICIAN] |percent standard_charge|[payer_UMR UNITED MEDICAL RSRCS|HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_UMR UNITED MEDICAL RSRCS|HMO/PPO PHYSICIAN] standard_charge|[payer_UNITED HC COMM MEDICARE|MANAGED MEDICARE] standard_charge|[payer_UNITED HC COMM MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_UNITED HC COMM MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UNITED HC COMM MEDICARE|MANAGED MEDICARE] standard_charge|[payer_UNITED HC COMMUNITY| MANAGED MEDICAID] standard_charge|[payer_UNITED HC COMMUNITY| MANAGED MEDICAID] |percent standard_charge|[payer_UNITED HC COMMUNITY| MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UNITED HC COMMUNITY| MANAGED MEDICAID] standard_charge|[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO] |percent standard_charge|[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO PHYSICIAN] standard_charge|[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO PHYSICIAN] |percent standard_charge|[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO PHYSICIAN] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE HMO PPO| HMO/PPO PHYSICIAN] standard_charge|[payer_UNITED HEALTHCARE MDCR| MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE MDCR| MANAGED MEDICARE] |percent standard_charge|[payer_UNITED HEALTHCARE MDCR| MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE MDCR| MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE MDCR| MGD MEDICARE PHYS] standard_charge|[payer_UNITED HEALTHCARE MDCR| MGD MEDICARE PHYS] |percent standard_charge|[payer_UNITED HEALTHCARE MDCR| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE MDCR| MGD MEDICARE PHYS] standard_charge|[payer_USABLE PPO INS COMPANY| MGD MEDICARE PHYS] standard_charge|[payer_USABLE PPO INS COMPANY| MGD MEDICARE PHYS] |percent standard_charge|[payer_USABLE PPO INS COMPANY| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_USABLE PPO INS COMPANY| MGD MEDICARE PHYS] standard_charge|[payer_VANTAGE HEALTH PLAN|HMO/PPO] standard_charge|[payer_VANTAGE HEALTH PLAN|HMO/PPO] |percent standard_charge|[payer_VANTAGE HEALTH PLAN|HMO/PPO] |contracting_method additional_payer_notes |[payer_VANTAGE HEALTH PLAN|HMO/PPO] standard_charge|[payer_VANTAGE HEALTH PLAN| MGD MEDICARE PHYS] standard_charge|[payer_VANTAGE HEALTH PLAN| MGD MEDICARE PHYS] |percent standard_charge|[payer_VANTAGE HEALTH PLAN| MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_VANTAGE HEALTH PLAN| MGD MEDICARE PHYS] standard_charge|[payer_WELLCARE OF TEXAS|MGD MEDICARE PHYS] standard_charge|[payer_WELLCARE OF TEXAS|MGD MEDICARE PHYS] |percent standard_charge|[payer_WELLCARE OF TEXAS|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_WELLCARE OF TEXAS|MGD MEDICARE PHYS] standard_charge|[payer_WELLMED|MGD MEDICARE PHYS] standard_charge|[payer_WELLMED|MGD MEDICARE PHYS] |percent standard_charge|[payer_WELLMED|MGD MEDICARE PHYS] |contracting_method additional_payer_notes |[payer_WELLMED|MGD MEDICARE PHYS] ROOM AND BOARD ADOLESCENT ACUTE 124 RC facility Inpatient 1860 600 448.00 "1,860.00" 785.00 per diem 830.00 per diem 840.00 per diem 680.00 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD ADULT ACUTE 124 RC facility Inpatient 1860 600 448.00 "1,860.00" 785.00 per diem 830.00 per diem 840.00 per diem 680.00 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD CHILD ACUTE 124 RC facility Inpatient 1860 600 448.00 "1,860.00" 785.00 per diem 830.00 per diem 840.00 per diem 680.00 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD GERI ACUTE 124 RC facility Inpatient 1860 600 448.00 "1,860.00" 785.00 per diem 830.00 per diem 840.00 per diem 680.00 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD ADULT DETOX 126 RC facility Inpatient 1860 600 485.00 "1,082.00" 785.00 per diem 745.00 per diem 840.00 per diem 680.00 per diem 800 per diem 798 per diem 924 per diem 800 per diem 700 per diem 800 per diem 796 per diem 1082 per diem 785 per diem 485 per diem 767 per diem 800 per diem 951 per diem 767 per diem 745 per diem 1000 per diem 485 per diem 623 per diem 796 per diem 623 per diem 485 per diem 753 per diem 790 per diem 790 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem ROOM AND BOARD GERI DETOX 126 RC facility Inpatient 1860 600 485.00 "1,082.00" 785.00 per diem 745.00 per diem 840.00 per diem 680.00 per diem 800 per diem 798 per diem 924 per diem 800 per diem 700 per diem 800 per diem 796 per diem 1082 per diem 785 per diem 485 per diem 767 per diem 800 per diem 951 per diem 767 per diem 745 per diem 1000 per diem 485 per diem 623 per diem 796 per diem 623 per diem 485 per diem 753 per diem 790 per diem 790 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem ROOM AND BOARD RTU ADOLESCENT 129 RC facility Inpatient 1100 0 500.00 935.00 620.00 per diem 800 per diem 626 per diem 800 per diem 626 per diem 626 per diem 800 per diem 500 per diem 800 per diem 626 per diem 857 per diem 935 per diem 626 per diem 626 per diem 650 per diem 524 per diem 572 per diem 620 per diem 800 per diem 530 per diem 560 per diem 589 per diem 560 per diem 589 per diem ROOM AND BOARD RTU ADULT 129 RC facility Inpatient 1100 0 500.00 935.00 620.00 per diem 800 per diem 626 per diem 800 per diem 626 per diem 626 per diem 800 per diem 500 per diem 800 per diem 626 per diem 857 per diem 935 per diem 626 per diem 626 per diem 650 per diem 524 per diem 572 per diem 620 per diem 800 per diem 530 per diem 560 per diem 589 per diem 560 per diem 589 per diem ROOM AND BOARD RTU CHILD 129 RC facility Inpatient 1100 0 500.00 935.00 620.00 per diem 800 per diem 626 per diem 800 per diem 626 per diem 626 per diem 800 per diem 500 per diem 800 per diem 626 per diem 857 per diem 935 per diem 626 per diem 626 per diem 650 per diem 524 per diem 572 per diem 620 per diem 800 per diem 530 per diem 560 per diem 589 per diem 560 per diem 589 per diem INTENSIVE OUTPATIENT PROGRAM 905 RC facility Outpatient 480 200 126.00 260.00 180.00 per diem 126.00 per diem 162 per diem 162 per diem 156 per diem 206 per diem 162 per diem 150 per diem 162 per diem 157 per diem 206 per diem 150 per diem 175 per diem 212 per diem 195 per diem 135 per diem 139 per diem 244 per diem 206 per diem 200 per diem 135 per diem 206 per diem 180 per diem 220 per diem 143 per diem 132 per diem 132 per diem 139 per diem 132 per diem 139 per diem 157 per diem 260 per diem INDIVIDUAL THERAPY 915 RC facility Outpatient 160 68 157.00 206.00 206 per diem 157 per diem 206 per diem 206 per diem 206 per diem 157 per diem PSYCH DIAG INTERVIEW FOR MED 90792 CPT facility Physician 132 0 73.92 213.00 135.00 fee schedule 132.30 fee schedule 186.92 fee schedule 186.92 fee schedule 194.80 fee schedule 132.30 fee schedule 194.33 fee schedule 135.00 fee schedule 132.30 fee schedule 132.30 fee schedule 132.30 fee schedule 194.33 fee schedule 194.80 fee schedule 180.11 fee schedule 132.30 fee schedule 139.26 fee schedule 132.30 fee schedule 132.30 fee schedule 132.30 fee schedule 73.92 fee schedule 132.30 fee schedule 132.30 fee schedule 213.00 fee schedule 145.17 fee schedule 132.30 fee schedule 132.30 fee schedule 135.00 fee schedule 160.25 fee schedule 213.00 fee schedule 213.00 fee schedule 213.00 fee schedule 139.26 fee schedule 132.30 fee schedule 132.30 fee schedule 132.30 fee schedule 132.30 fee schedule INITIAL HOSPITAL/PHP LOW 99221 CPT facility Physician 184.8 0 63.25 128.00 108.29 fee schedule 92.07 fee schedule 96.00 fee schedule 96.00 fee schedule 118.02 fee schedule 92.07 fee schedule 118.02 fee schedule 108.29 fee schedule 92.07 fee schedule 92.07 fee schedule 92.07 fee schedule 118.02 fee schedule 118.02 fee schedule 128.00 fee schedule 92.07 fee schedule 63.25 fee schedule 92.07 fee schedule 92.07 fee schedule 92.07 fee schedule 73.92 fee schedule 92.07 fee schedule 92.07 fee schedule 90.88 fee schedule 97.22 fee schedule 92.07 fee schedule 92.07 fee schedule 108.29 fee schedule 88.06 fee schedule 90.88 fee schedule 90.88 fee schedule 90.88 fee schedule 63.25 fee schedule 92.07 fee schedule 92.07 fee schedule 92.07 fee schedule 92.07 fee schedule INITIAL HOSPITAL/PHP MODERAT 99222 CPT facility Physician 283.8 0 80.96 176.37 146.76 fee schedule 124.71 fee schedule 138.60 fee schedule 138.60 fee schedule 158.95 fee schedule 124.71 fee schedule 158.73 fee schedule 146.76 fee schedule 124.71 fee schedule 124.71 fee schedule 124.71 fee schedule 176.37 fee schedule 158.95 fee schedule 158.95 fee schedule 124.71 fee schedule 113.75 fee schedule 124.71 fee schedule 124.71 fee schedule 124.71 fee schedule 80.96 fee schedule 124.71 fee schedule 124.71 fee schedule 131.21 fee schedule 131.37 fee schedule 124.71 fee schedule 124.71 fee schedule 146.76 fee schedule 119.24 fee schedule 131.21 fee schedule 131.21 fee schedule 131.21 fee schedule 113.75 fee schedule 124.71 fee schedule 124.71 fee schedule 124.71 fee schedule 124.71 fee schedule INITIAL HOSPTIAL/PHP HIGH 99223 CPT facility Physician 60 0 175.33 275.83 217.42 fee schedule 184.14 fee schedule 212.85 fee schedule 212.85 fee schedule 235.10 fee schedule 184.14 fee schedule 235.10 fee schedule 217.42 fee schedule 184.14 fee schedule 184.14 fee schedule 184.14 fee schedule 235.10 fee schedule 235.10 fee schedule 261.22 fee schedule 184.14 fee schedule 194.88 fee schedule 184.14 fee schedule 184.14 fee schedule 184.14 fee schedule 275.83 fee schedule 184.14 fee schedule 184.14 fee schedule 201.50 fee schedule 194.93 fee schedule 184.14 fee schedule 184.14 fee schedule 217.42 fee schedule 175.33 fee schedule 201.50 fee schedule 201.50 fee schedule 201.50 fee schedule 194.88 fee schedule 184.14 fee schedule 184.14 fee schedule 184.14 fee schedule 184.14 fee schedule SUBSEQUENT HOSP/PHP LOW 99231 CPT facility Physician 94 0 27.60 50.23 41.94 fee schedule 35.82 fee schedule 49.02 fee schedule 49.02 fee schedule 45.15 fee schedule 35.82 fee schedule 45.21 fee schedule 41.94 fee schedule 35.82 fee schedule 35.82 fee schedule 35.82 fee schedule 45.15 fee schedule 45.15 fee schedule 50.23 fee schedule 35.82 fee schedule 42.75 fee schedule 35.82 fee schedule 35.82 fee schedule 35.82 fee schedule 27.60 fee schedule 35.82 fee schedule 35.82 fee schedule 42.60 fee schedule 37.70 fee schedule 35.82 fee schedule 35.82 fee schedule 41.94 fee schedule 34.13 fee schedule 42.60 fee schedule 42.60 fee schedule 42.60 fee schedule 42.75 fee schedule 35.82 fee schedule 35.82 fee schedule 35.82 fee schedule 35.82 fee schedule SUBSEQUENT HOSP/PHP MODERATE 99232 CPT facility Physician 154 0 36.80 93.61 77.72 fee schedule 66.51 fee schedule 73.30 fee schedule 73.30 fee schedule 80.00 fee schedule 66.51 fee schedule 93.61 fee schedule 77.72 fee schedule 66.51 fee schedule 66.51 fee schedule 66.51 fee schedule 93.61 fee schedule 84.54 fee schedule 93.61 fee schedule 66.51 fee schedule 55.75 fee schedule 66.51 fee schedule 66.51 fee schedule 66.51 fee schedule 36.80 fee schedule 66.51 fee schedule 66.42 fee schedule 56.80 fee schedule 69.99 fee schedule 66.51 fee schedule 66.51 fee schedule 77.72 fee schedule 63.10 fee schedule 56.80 fee schedule 56.80 fee schedule 56.80 fee schedule 55.75 fee schedule 66.51 fee schedule 66.51 fee schedule 66.51 fee schedule 66.51 fee schedule SUBSEQUENT HOSP/PHP HIGH 99233 CPT facility Physician 94 0 80.84 121.55 111.85 fee schedule 95.31 fee schedule 115.50 fee schedule 115.50 fee schedule 121.55 fee schedule 95.31 fee schedule 121.55 fee schedule 111.85 fee schedule 95.31 fee schedule 95.31 fee schedule 95.31 fee schedule 121.55 fee schedule 121.55 fee schedule 121.55 fee schedule 95.31 fee schedule 107.80 fee schedule 95.31 fee schedule 95.31 fee schedule 95.31 fee schedule 80.84 fee schedule 95.31 fee schedule 95.31 fee schedule 109.34 fee schedule 100.26 fee schedule 95.31 fee schedule 95.31 fee schedule 111.85 fee schedule 90.73 fee schedule 109.34 fee schedule 109.34 fee schedule 109.34 fee schedule 107.8 fee schedule 95.31 fee schedule 95.31 fee schedule 95.31 fee schedule 95.31 fee schedule DISCHARGE HOSP/PHP LOW 99238 CPT facility Physician 42.24 92.00 77.83 fee schedule 69.68 fee schedule 78.02 fee schedule 78.02 fee schedule 92.00 fee schedule 66.42 fee schedule 83.67 fee schedule 77.83 fee schedule 66.42 fee schedule 66.42 fee schedule 66.42 fee schedule 92.00 fee schedule 83.96 fee schedule 92.00 fee schedule 69.68 fee schedule 64.40 fee schedule 66.42 fee schedule 66.42 fee schedule 66.42 fee schedule 42.24 fee schedule 66.42 fee schedule 66.42 fee schedule 65.32 fee schedule 70.13 fee schedule 66.42 fee schedule 66.42 fee schedule 77.83 fee schedule 63.23 fee schedule 65.32 fee schedule 65.32 fee schedule 65.32 fee schedule 64.4 fee schedule 66.42 fee schedule 69.68 fee schedule 66.42 fee schedule 69.68 fee schedule