"hospital_Dowell Springs Behavioral Health, LLC" last_updated_ 2023-12-31 version_1 "hospital_Knoxville, Tennessee" hospital_address 1444 Old Wisgarber Rd. license_ L000000033642 | TN "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_AETNA | COMMERCIAL] standard_charge|[payer_AETNA | COMMERCIAL] |percent standard_charge|[payer_AETNA | COMMERCIAL] |contracting_method additional_payer_notes |[payer_AETNA | COMMERCIAL] standard_charge|[payer_AETNA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MEDICARE | MANAGED MEDICARE] standard_charge|[payer_AMBETTER | COMMERCIAL] standard_charge|[payer_AMBETTER | COMMERCIAL] |percent standard_charge|[payer_AMBETTER | COMMERCIAL] |contracting_method additional_payer_notes |[payer_AMBETTER | COMMERCIAL] standard_charge|[payer_AMERIGROUP | MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP | MANAGED MEDICAID] |percent standard_charge|[payer_AMERIGROUP | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIGROUP | MANAGED MEDICAID] standard_charge|[payer_AMERIVANTAGE | MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_AMERIVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AMERIVANTAGE | MANAGED MEDICARE] 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 OF TENNESSEE | BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE | BLUE CROSS] |percent standard_charge|[payer_BCBS OF TENNESSEE | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF TENNESSEE | BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE | BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE | BLUE CROSS] |percent standard_charge|[payer_BCBS OUT OF STATE | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OUT OF STATE | BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS | COMMERCIAL] standard_charge|[payer_BEACON HEALTH OPTIONS | COMMERCIAL] |percent standard_charge|[payer_BEACON HEALTH OPTIONS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS | COMMERCIAL] standard_charge|[payer_BEACON HEALTH OPTIONS | HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS | HMO/PPO] |percent standard_charge|[payer_BEACON HEALTH OPTIONS | HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS | HMO/PPO] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS | COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS | COMMERCIAL] |percent standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS | COMMERCIAL] standard_charge|[payer_BLUE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_BLUE ADVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_BLUE ADVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BLUE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_BLUECARE | MANAGED MEDICAID] standard_charge|[payer_BLUECARE | MANAGED MEDICAID] |percent standard_charge|[payer_BLUECARE | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BLUECARE | MANAGED MEDICAID] standard_charge|[payer_BLUECARE PLUS | MANAGED MEDICARE] standard_charge|[payer_BLUECARE PLUS | MANAGED MEDICARE] |percent standard_charge|[payer_BLUECARE PLUS | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BLUECARE PLUS | MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH | COMMERCIAL] standard_charge|[payer_BRIGHT HEALTH | COMMERCIAL] |percent standard_charge|[payer_BRIGHT HEALTH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_BRIGHT HEALTH | COMMERCIAL] standard_charge|[payer_BRIGHT HLTH MDR | MANAGED MEDICARE] standard_charge|[payer_BRIGHT HLTH MDR | MANAGED MEDICARE] |percent standard_charge|[payer_BRIGHT HLTH MDR | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BRIGHT HLTH MDR | MANAGED MEDICARE] standard_charge|[payer_CHAMPVA | VETERANS ADMIN] standard_charge|[payer_CHAMPVA | VETERANS ADMIN] |percent standard_charge|[payer_CHAMPVA | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_CHAMPVA | VETERANS ADMIN] standard_charge|[payer_CIGNA | COMMERCIAL] standard_charge|[payer_CIGNA | COMMERCIAL] |percent standard_charge|[payer_CIGNA | COMMERCIAL] |contracting_method additional_payer_notes |[payer_CIGNA | COMMERCIAL] 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 HEALTHSPRINGS | MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRINGS | MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA HEALTHSPRINGS | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA HEALTHSPRINGS | MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH| COMMERCIAL] standard_charge|[payer_DEVOTED HEALTH| COMMERCIAL] |percent standard_charge|[payer_DEVOTED HEALTH| COMMERCIAL] |contracting_method additional_payer_notes |[payer_DEVOTED HEALTH| COMMERCIAL] standard_charge|[payer_GILSBAR | COMMERCIAL] standard_charge|[payer_GILSBAR | COMMERCIAL] |percent standard_charge|[payer_GILSBAR | COMMERCIAL] |contracting_method additional_payer_notes |[payer_GILSBAR | COMMERCIAL] standard_charge|[payer_GILSBAR | HMO/PPO] standard_charge|[payer_GILSBAR | HMO/PPO] |percent standard_charge|[payer_GILSBAR | HMO/PPO] |contracting_method additional_payer_notes |[payer_GILSBAR | HMO/PPO] standard_charge|[payer_HARTFORD | WORKERS COMP] standard_charge|[payer_payer_HARTFORD | WORKERS COMP] |percent standard_charge|[payer_payer_HARTFORD | WORKERS COMP] |contracting_method additional_payer_notes |[payer_payer_HARTFORD | WORKERS COMP] standard_charge|[payer_HEALTH PLANS INC.| COMMERCIAL] standard_charge|[payer_HEALTH PLANS INC.| COMMERCIAL] |percent standard_charge|[payer_payer_HEALTH PLANS INC.| COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTH PLANS INC.| COMMERCIAL] standard_charge|[payer_HEALTHSCOPE BENEFITS | COMMERCIAL] standard_charge|[payer_HEALTHSCOPE BENEFITS | COMMERCIAL] |percent standard_charge|[payer_HEALTHSCOPE BENEFITS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTHSCOPE BENEFITS | COMMERCIAL] standard_charge|[payer_HUMANA | COMMERCIAL] standard_charge|[payer_HUMANA | COMMERCIAL] |percent standard_charge|[payer_HUMANA | COMMERCIAL] |contracting_method additional_payer_notes |[payer_HUMANA | COMMERCIAL] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE ADVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_LUCENT HEALTH | COMMERCIAL] standard_charge|[payer_LUCENT HEALTH | COMMERCIAL] |percent standard_charge|[payer_LUCENT HEALTH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_LUCENT HEALTH | COMMERCIAL] standard_charge|[payer_MAGELLAN | COMMERCIAL] standard_charge|[payer_MAGELLAN | COMMERCIAL] |percent standard_charge|[payer_MAGELLAN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_MAGELLAN | COMMERCIAL] standard_charge|[payer_MEDICAID TN | MEDICAID ] standard_charge|[payer_MEDICAID TN | MEDICAID ] |percent standard_charge|[payer_MEDICAID TN | MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID TN | 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_MISC COMMERCIAL | COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL | COMMERCIAL] |percent standard_charge|[payer_MISC COMMERCIAL | COMMERCIAL] |contracting_method additional_payer_notes |[payer_MISC COMMERCIAL | COMMERCIAL] standard_charge|[payer_MISC 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_MISC MGD MCD | MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCD | MANAGED MEDICAID] |percent standard_charge|[payer_MISC MGD MCD | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MISC MGD MCD | MANAGED MEDICAID] standard_charge|[payer_MISC OOS MEDICAID | MEDICAID: OUT OF STATE] standard_charge|[payer_MISC OOS MEDICAID | MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MISC OOS MEDICAID | MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MISC OOS MEDICAID | MEDICAID: OUT OF STATE] standard_charge|[payer_NEW ERA LIFE INS | COMMERCIAL] standard_charge|[payer_NEW ERA LIFE INS | COMMERCIAL] |percent standard_charge|[payer_NEW ERA LIFE INS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_NEW ERA LIFE INS | COMMERCIAL] standard_charge|[payer_SUREST UHSS | COMMERCIAL] standard_charge|[payer_SUREST UHSS | COMMERCIAL] |percent standard_charge|[payer_SUREST UHSS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_SUREST UHSS | COMMERCIAL] 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_UBH OPTUM | COMMERCIAL] standard_charge|[payer_UBH OPTUM | COMMERCIAL] |percent standard_charge|[payer_UBH OPTUM | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UBH OPTUM | COMMERCIAL standard_charge|[payer_UHC | COMMERCIAL] standard_charge|[payer_UHC | COMMERCIAL] |percent standard_charge|[payer_UHC | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UHC | COMMERCIAL] 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 AARP ADVAN | MANAGED MEDICARE] standard_charge|[payer_UHC AARP ADVAN | MANAGED MEDICARE] |percent standard_charge|[payer_UHC AARP ADVAN | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC AARP ADVAN | MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE | MANAGED MEDICARE] |percent standard_charge|[payer_UHC ADVANTAGE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC ADVANTAGE | MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN | MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN | MANAGED MEDICAID] |percent standard_charge|[payer_UHC COMMUNITY PLAN | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC COMMUNITY PLAN | MANAGED MEDICAID] standard_charge|[payer_UHC SNP DUAL COMPLETE | MANAGED MEDICARE] standard_charge|[payer_UHC SNP DUAL COMPLETE | MANAGED MEDICARE] |percent standard_charge|[payer_UHC SNP DUAL COMPLETE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC SNP DUAL COMPLETE | MANAGED MEDICARE] standard_charge|[payer_UHC STUDENT RESOURCE | COMMERCIAL] standard_charge|[payer_UHC STUDENT RESOURCE | COMMERCIAL] |percent standard_charge|[payer_UHC STUDENT RESOURCE | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UHC STUDENT RESOURCE | COMMERCIAL] standard_charge|[payer_UHC STUDENT RESOURCE | HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCE | HMO/PPO] |percent standard_charge|[payer_UHC STUDENT RESOURCE | HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC STUDENT RESOURCE | HMO/PPO] standard_charge|[payer_UMR | COMMERCIAL] standard_charge|[payer_UMR | COMMERCIAL] |percent standard_charge|[payer_UMR | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UMR | COMMERCIAL] standard_charge|[payer_UNITED BEHAVIORAL HEALTH | COMMERCIAL] standard_charge|[payer_UNITED BEHAVIORAL HEALTH | COMMERCIAL] |percent standard_charge|[payer_UNITED BEHAVIORAL HEALTH | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH | COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN | COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN | COMMERCIAL] |percent standard_charge|[payer_UPMC HEALTH PLAN | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UPMC HEALTH PLAN | COMMERCIAL] standard_charge|[payer_VA CCN OPTUM | VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM | VETERANS ADMIN] |percent standard_charge|[payer_VA CCN OPTUM | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA CCN OPTUM | VETERANS ADMIN] standard_charge|[payer_VA FEE BASIS PROGRAMS | VETERANS ADMIN] standard_charge|[payer_VA FEE BASIS PROGRAMS | VETERANS ADMIN] |percent standard_charge|[payer_VA FEE BASIS PROGRAMS | VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA FEE BASIS PROGRAMS | VETERANS ADMIN] standard_charge|[payer_VIVA HEALTH MEDICARE INC | MANAGED MEDICARE] standard_charge|[payer_VIVA HEALTH MEDICARE INC | MANAGED MEDICARE] |percent standard_charge|[payer_VIVA HEALTH MEDICARE INC | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_VIVA HEALTH MEDICARE INC | MANAGED MEDICARE] 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] LOA ADULT UNIT 124 RC facility inpatient 2500.00 900 675 2500 2500 per diem 2500 per diem 675 per diem 1125 per diem 1125 per diem 1125 per diem 2500 per diem 1000 per diem 1125 per diem 700 per diem 700 per diem 2500 per diem 2500 per diem 1092 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 750 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem ROOM AND BOARD PSYCH AD1 UNIT 124 RC facility inpatient 2500.00 900 675 2500 2500 per diem 2500 per diem 675 per diem 1125 per diem 1125 per diem 1125 per diem 2500 per diem 1000 per diem 1125 per diem 700 per diem 700 per diem 2500 per diem 2500 per diem 1092 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 750 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem ELECTOCONVULSIVE THERAPY - INPATIENT 901 RC facility inpatient/outpatient 2400.00 1600 750 4800 4800 per diem 2400 per diem 4800 per diem 750 per diem 2400 per diem 1576 per diem 1576 per diem 1576 per diem 2400 per diem 2400 per diem 1400 per diem 1576 per diem 950 per diem 950 per diem 4800 per diem 2400 per diem 4800 per diem 792 per diem 792 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 940 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem ELECTOCONVULSIVE THERAPY - OUTPATIENT 901 RC facility inpatient/outpatient 2400.00 1600 750 4800 4800 per diem 2400 per diem 4800 per diem 750 per diem 2400 per diem 1576 per diem 1576 per diem 1576 per diem 2400 per diem 2400 per diem 1400 per diem 1576 per diem 950 per diem 950 per diem 4800 per diem 2400 per diem 4800 per diem 792 per diem 792 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 940 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem INTENSIVE OUTPATIENT PROGRAM OP PROGRAM-PSYCH 905 RC facility outpatient 600.00 250 131.3 600 600 per diem 600 per diem 600 per diem 131.3 per diem 600 per diem 282 per diem 282 per diem 282 per diem 600 per diem 250 per diem 282 per diem 160 per diem 160 per diem 600 per diem 600 per diem 290 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 150 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT 906 RC facility outpatient 600.00 250 600 600 per diem 600 per diem 600 per diem 600 per diem 250 per diem 282 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 910 RC facility outpatient 200.00 600 600 600 per diem 600 per diem 600 per diem PARTIAL HOSPITAL PROGRAM -ADOLESCENT 912 RC facility outpatient 800.00 500 242 800 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 550 per diem 800 per diem 425 per diem 550 per diem 242 per diem 800 per diem 800 per diem 800 per diem 422 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 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem PARTIAL HOSPITAL PROGRAM OP PROGRAM 912 RC facility outpatient 800.00 500 242 800 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 550 per diem 800 per diem 425 per diem 550 per diem 242 per diem 800 per diem 800 per diem 800 per diem 422 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 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem PARTIAL HOSPITAL PROGRAM PROCESS GROUP 915 RC facility outpatient 180.00 242 800 242 per diem 242 per diem 800 per diem 800 per diem 800 per diem INTIAL HOSPITAL CARE (30 MIN) 99221 RC facility outpatient 240 14.84 240 105 fee schedule average rate 240 fee schedule average rate 77.9 fee schedule average rate 102.57 fee schedule average rate 76.53 fee schedule average rate 14.84 fee schedule average rate 64.01 fee schedule average rate 50 fee schedule average rate 49.02 fee schedule average rate 78.09 fee schedule average rate 76.53 fee schedule average rate INTIAL HOSPITAL CARE (50 MIN) 99222 RC facility outpatient 260 43.75 165.12 43.75 fee schedule average rate 165.12 fee schedule average rate 105.59 fee schedule average rate 96.57 fee schedule average rate 110.5 fee schedule average rate 80.74 fee schedule average rate 124.97 fee schedule average rate 90 fee schedule average rate 67.37 fee schedule average rate 123.17 fee schedule average rate INTIAL HOSPITAL CARE (70 MIN) 99223 RC facility outpatient 280 56 229.75 56 fee schedule average rate 168.84 fee schedule average rate 229.75 fee schedule average rate 156.82 fee schedule average rate 71.22 fee schedule average rate 170.24 fee schedule average rate 77.33 fee schedule average rate 113.36 fee schedule average rate 161.38 fee schedule average rate 115.61 fee schedule average rate 150.98 fee schedule average rate 92.93 fee schedule average rate 165.15 fee schedule average rate 137.27 fee schedule average rate 107.9 fee schedule average rate 98.12 fee schedule average rate 105 fee schedule average rate 161.4 fee schedule average rate SUBSEQ CARE (15 MIN) 99231 RC facility outpatient 140 20.46 74.96 62.5 fee schedule average rate 35.55 fee schedule average rate 30.32 fee schedule average rate 33.83 fee schedule average rate 53.82 fee schedule average rate 42.72 fee schedule average rate 39.02 fee schedule average rate 74.96 fee schedule average rate 39.35 fee schedule average rate 39.88 fee schedule average rate 32.87 fee schedule average rate 40.22 fee schedule average rate 32.35 fee schedule average rate 37.73 fee schedule average rate 20.46 fee schedule average rate 37.86 fee schedule average rate 37.07 fee schedule average rate 39.82 fee schedule average rate 43.59 fee schedule average rate 39.02 fee schedule average rate SUBSEQ CARE (25 MIN) 99232 RC facility outpatient 160 36.52 95 95 fee schedule average rate 88.35 fee schedule average rate 87.84 fee schedule average rate 56.34 fee schedule average rate 58.86 fee schedule average rate 79.49 fee schedule average rate 73.57 fee schedule average rate 54.86 fee schedule average rate 64.98 fee schedule average rate 53.42 fee schedule average rate 36.52 fee schedule average rate 60.27 fee schedule average rate 75.07 fee schedule average rate 73.58 fee schedule average rate SUBSEQ CARE (35 MIN) 99233 RC facility outpatient 180 52.37 114.27 114.27 fee schedule average rate 84.15 fee schedule average rate 56.66 fee schedule average rate 52.37 fee schedule average rate DISCHARGE DAY MGMT <30 99238 RC facility outpatient 160 37.03 118.31 118.31 fee schedule average rate 64.16 fee schedule average rate 56.39 fee schedule average rate 52.92 fee schedule average rate 48 fee schedule average rate 51.76 fee schedule average rate 63.63 fee schedule average rate 103.89 fee schedule average rate 64.17 fee schedule average rate 64.55 fee schedule average rate 46.33 fee schedule average rate 51.07 fee schedule average rate 79.29 fee schedule average rate 37.03 fee schedule average rate 61.55 fee schedule average rate 95 fee schedule average rate 76.39 fee schedule average rate 63.63 fee schedule average rate DISCHARGE DAY MGMT >30 99239 RC facility outpatient 160 53.29 84.88 84.88 fee schedule average rate 80.64 fee schedule average rate 67.3 fee schedule average rate 53.29 fee schedule average rate