"hospital_Crestwyn Health Group, LLC" last_updated_ 2023-12-31 version_1 "hospital_Memphis, Tennessee" hospital_address 9485 Crestwyn Hills Drive license_ L000000032695 |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 UHC|MANAGED MEDICAID] standard_charge|[payer_AARP UHC|MANAGED MEDICAID] |percent standard_charge|[payer_AARP UHC|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AARP UHC|MANAGED MEDICAID] standard_charge|[payer_AARP UHC MEDICARE ADV|MANAGED MEDICARE] standard_charge|[payer_AARP UHC MEDICARE ADV|MANAGED MEDICARE] |percent standard_charge|[payer_AARP UHC MEDICARE ADV|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AARP UHC MEDICARE ADV|MANAGED MEDICARE] 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 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_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 COMMERCIAL|COMMERCIAL] standard_charge|[payer_AMBETTER COMMERCIAL|COMMERCIAL] |percent standard_charge|[payer_AMBETTER COMMERCIAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AMBETTER COMMERCIAL|COMMERCIAL] standard_charge|[payer_AMBETTER MEDICAID|MEDICAID: OUT OF STATE] standard_charge|[payer_AMBETTER MEDICAID|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_AMBETTER MEDICAID|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_AMBETTER MEDICAID|MEDICAID: OUT OF STATE] standard_charge|[payer_AMERIBEN|HMO/PPO] standard_charge|[payer_AMERIBEN|HMO/PPO] |percent standard_charge|[payer_AMERIBEN|HMO/PPO] |contracting_method additional_payer_notes |[payer_AMERIBEN|HMO/PPO] standard_charge|[payer_AMERICAN BEHAVIORAL HLTH|COMMERCIAL] standard_charge|[payer_AMERICAN BEHAVIORAL HLTH|COMMERCIAL] |percent standard_charge|[payer_AMERICAN BEHAVIORAL HLTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_AMERICAN BEHAVIORAL HLTH|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_AMERIGROUP-MEDICARE ADV|MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP-MEDICARE ADV|MANAGED MEDICARE] |percent standard_charge|[payer_AMERIGROUP-MEDICARE ADV|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AMERIGROUP-MEDICARE ADV|MANAGED MEDICARE] 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_ANTHEM BCBS|BLUE CROSS] standard_charge|[payer_ANTHEM BCBS|BLUE CROSS] |percent standard_charge|[payer_ANTHEM BCBS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_ANTHEM BCBS|BLUE CROSS] standard_charge|[payer_AR MEDICAID|MEDICAID: OUT OF STATE] standard_charge|[payer_AR MEDICAID|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_AR MEDICAID|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_AR MEDICAID|MEDICAID: OUT OF STATE] standard_charge|[payer_ARKANSAS WELLCARE|MANAGED MEDICARE] standard_charge|[payer_ARKANSAS WELLCARE|MANAGED MEDICARE] |percent standard_charge|[payer_ARKANSAS WELLCARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ARKANSAS WELLCARE|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|COMMERCIAL] standard_charge|[payer_BEACON HEALTH|COMMERCIAL] |percent standard_charge|[payer_BEACON HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_BEACON HEALTH|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_BLUE CARE|MANAGED MEDICAID] standard_charge|[payer_BLUE CARE|MANAGED MEDICAID] |percent standard_charge|[payer_BLUE CARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BLUE CARE|MANAGED MEDICAID] standard_charge|[payer_BLUE CARE PLUS|MANAGED MEDICARE] standard_charge|[payer_BLUE CARE PLUS|MANAGED MEDICARE] |percent standard_charge|[payer_BLUE CARE PLUS|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BLUE CARE 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_CENPATICO MAGNOLIA HEALTH|MANAGED MEDICAID] standard_charge|[payer_CENPATICO MAGNOLIA HEALTH|MANAGED MEDICAID] |percent standard_charge|[payer_CENPATICO MAGNOLIA HEALTH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CENPATICO MAGNOLIA HEALTH|MANAGED MEDICAID] 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_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_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 HEALTHSPRING|MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING|MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA HEALTHSPRING|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA HEALTHSPRING|MANAGED MEDICARE] standard_charge|[payer_COMPSYCH|COMMERCIAL] standard_charge|[payer_COMPSYCH|COMMERCIAL] |percent standard_charge|[payer_COMPSYCH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_COMPSYCH|COMMERCIAL] standard_charge|[payer_COVER KIDS/BCBS TN|MANAGED MEDICAID] standard_charge|[payer_COVER KIDS/BCBS TN|MANAGED MEDICAID] |percent standard_charge|[payer_COVER KIDS/BCBS TN|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_COVER KIDS/BCBS TN|MANAGED MEDICAID] standard_charge|[payer_CYPRESS|COMMERCIAL] standard_charge|[payer_CYPRESS|COMMERCIAL] |percent standard_charge|[payer_CYPRESS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_CYPRESS|COMMERCIAL] standard_charge|[payer_EXCELLUS BCBS|BLUE CROSS] standard_charge|[payer_EXCELLUS BCBS|BLUE CROSS] |percent standard_charge|[payer_EXCELLUS BCBS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_EXCELLUS BCBS|BLUE CROSS] 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_HEALTH COST SOLUTIONS|COMMERCIAL] standard_charge|[payer_HEALTH COST SOLUTIONS|COMMERCIAL] |percent standard_charge|[payer_HEALTH COST SOLUTIONS|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTH COST SOLUTIONS|COMMERCIAL] standard_charge|[payer_HEALTHPARTNERS|HMO/PPO] standard_charge|[payer_HEALTHPARTNERS|HMO/PPO] |percent standard_charge|[payer_HEALTHPARTNERS|HMO/PPO] |contracting_method additional_payer_notes |[payer_HEALTHPARTNERS|HMO/PPO] standard_charge|[payer_HEALTHSCOPE|COMMERCIAL] standard_charge|[payer_HEALTHSCOPE|COMMERCIAL] |percent standard_charge|[payer_HEALTHSCOPE|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTHSCOPE|COMMERCIAL] standard_charge|[payer_HEALTHSMART|COMMERCIAL] standard_charge|[payer_HEALTHSMART|COMMERCIAL] |percent standard_charge|[payer_HEALTHSMART|COMMERCIAL] |contracting_method additional_payer_notes |[payer_HEALTHSMART|COMMERCIAL] standard_charge|[payer_HUMANA|HMO/PPO] standard_charge|[payer_HUMANA|HMO/PPO] |percent standard_charge|[payer_HUMANA|HMO/PPO] |contracting_method additional_payer_notes |[payer_HUMANA|HMO/PPO] 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_KAISER PERMANENTE|MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE|MANAGED MEDICARE] |percent standard_charge|[payer_KAISER PERMANENTE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_KAISER PERMANENTE|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_MEDBEN|COMMERCIAL] standard_charge|[payer_MEDBEN|COMMERCIAL] |percent standard_charge|[payer_MEDBEN|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MEDBEN|COMMERCIAL] 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 OUTPATIENT|MEDICARE] standard_charge|[payer_MEDICARE OUTPATIENT|MEDICARE] |percent standard_charge|[payer_MEDICARE OUTPATIENT|MEDICARE] |contracting_method additional_payer_notes |[payer_MEDICARE OUTPATIENT|MEDICARE] standard_charge|[payer_MERITAIN HEALTH|COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH|COMMERCIAL] |percent standard_charge|[payer_MERITAIN HEALTH|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH|COMMERCIAL] 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 MCAID|MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCAID|MANAGED MEDICAID] |percent standard_charge|[payer_MISC MGD MCAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MISC MGD MCAID|MANAGED MEDICAID] 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 OOS MCAID|MEDICAID: OUT OF STATE] standard_charge|[payer_MISC OOS MCAID|MEDICAID: OUT OF STATE] |percent standard_charge|[payer_MISC OOS MCAID|MEDICAID: OUT OF STATE] |contracting_method additional_payer_notes |[payer_MISC OOS MCAID|MEDICAID: OUT OF STATE] standard_charge|[payer_MOLINA HEALTH|MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTH|MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA HEALTH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA HEALTH|MANAGED MEDICAID] standard_charge|[payer_MUTUAL OF OMAHA|COMMERCIAL] standard_charge|[payer_MUTUAL OF OMAHA|COMMERCIAL] |percent standard_charge|[payer_MUTUAL OF OMAHA|COMMERCIAL] |contracting_method additional_payer_notes |[payer_MUTUAL OF OMAHA|COMMERCIAL] standard_charge|[payer_OPTUM HEALTH|HMO/PPO] standard_charge|[payer_OPTUM HEALTH|HMO/PPO] |percent standard_charge|[payer_OPTUM HEALTH|HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM HEALTH|HMO/PPO] standard_charge|[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] standard_charge|[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] |percent standard_charge|[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] |contracting_method additional_payer_notes |[payer_PHILADELPHIA AMERICAN LIF|COMMERCIAL] standard_charge|[payer_TRICARE|TRICARE] standard_charge|[payer_TRICARE|TRICARE] |percent standard_charge|[payer_TRICARE|TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE|TRICARE] standard_charge|[payer_UBH|HMO/PPO] standard_charge|[payer_UBH|HMO/PPO] |percent standard_charge|[payer_UBH|HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH|HMO/PPO] standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] |percent standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UBH MEDICARE HMO|MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN MS CHP|MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN MS CHP|MANAGED MEDICAID] |percent standard_charge|[payer_UHC COMMUNITY PLAN MS CHP|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC COMMUNITY PLAN MS CHP|MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN TNCARE|MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN TNCARE|MANAGED MEDICAID] |percent standard_charge|[payer_UHC COMMUNITY PLAN TNCARE|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC COMMUNITY PLAN TNCARE|MANAGED MEDICAID] standard_charge|[payer_UHC OF RIVER VALLEY|MANAGED MEDICARE] standard_charge|[payer_UHC OF RIVER VALLEY|MANAGED MEDICARE] |percent standard_charge|[payer_UHC OF RIVER VALLEY|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC OF RIVER VALLEY|MANAGED MEDICARE] 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 OPTUM|VETERANS ADMIN] standard_charge|[payer_VA OPTUM|VETERANS ADMIN] |percent standard_charge|[payer_VA OPTUM|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA OPTUM|VETERANS ADMIN] standard_charge|[payer_WELLCARE|MANAGED MEDICARE] standard_charge|[payer_WELLCARE|MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE|MANAGED MEDICARE] ROOM AND BOARD ADOL PSYCH 124 RC facility inpatient 1775.00 900 565 1571.3 650 per diem 1070 per diem 1030 per diem 1000 per diem DRG DRG 846.1 per diem 650 per diem 900 per diem 675 per diem DRG DRG DRG DRG 1023 per diem 700 per diem DRG DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem DRG DRG 900 per diem 1137 per diem DRG DRG 1571.3 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1240.5 per diem DRG DRG 850 per diem 1030 per diem 1100 per diem DRG DRG 1030 per diem 900 per diem 900 per diem 565 per diem DRG DRG 565 per diem DRG DRG 900 per diem 900 per diem 900 per diem 1085.59 per diem 900 per diem 1070 per diem 900 per diem 650 per diem 1070 per diem 900 per diem DRG DRG DRG DRG ROOM AND BOARD ADULT PSYCH 124 RC facility inpatient 1775.00 900 565 1571.3 650 per diem 1070 per diem 1030 per diem 1000 per diem DRG DRG 846.1 per diem 650 per diem 900 per diem 675 per diem DRG DRG DRG DRG 1023 per diem DRG DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem DRG DRG 900 per diem 1137 per diem DRG DRG 1571.3 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1240.5 per diem DRG DRG 850 per diem 1030 per diem 1100 per diem DRG DRG 1030 per diem 900 per diem 900 per diem 565 per diem DRG DRG 565 per diem DRG DRG 900 per diem 900 per diem 900 per diem 1085.59 per diem 900 per diem 1070 per diem 900 per diem 650 per diem 1070 per diem 900 per diem DRG DRG DRG DRG ROOM AND BOARD ADOL DETOX 126 RC facility inpatient 1775.00 900 565 1571.3 650 per diem 817 per diem 1030 per diem 1000 per diem DRG DRG 846.1 per diem 650 per diem 900 per diem 675 per diem DRG DRG DRG DRG 1023 per diem 700 per diem DRG DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem DRG DRG 900 per diem 1137 per diem DRG DRG 1571.3 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1240.5 per diem DRG DRG 850 per diem 1030 per diem 1100 per diem DRG DRG 1030 per diem 900 per diem 900 per diem 565 per diem DRG DRG 565 per diem DRG DRG 900 per diem 900 per diem 900 per diem 1085.59 per diem 900 per diem 845 per diem 900 per diem 650 per diem 845 per diem 900 per diem DRG DRG DRG DRG ROOM AND BOARD ADULT DETOX 126 RC facility inpatient 1775.00 900 565 1571.3 650 per diem 817 per diem 1030 per diem 1000 per diem DRG DRG 846.1 per diem 650 per diem 900 per diem 675 per diem DRG DRG DRG DRG 1023 per diem DRG DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem DRG DRG 900 per diem 1137 per diem DRG DRG 1571.3 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1240.5 per diem DRG DRG 850 per diem 1030 per diem 1100 per diem DRG DRG 1030 per diem 900 per diem 900 per diem 565 per diem DRG DRG 565 per diem DRG DRG 900 per diem 900 per diem 900 per diem 1085.59 per diem 900 per diem 845 per diem 900 per diem 650 per diem 845 per diem 900 per diem DRG DRG DRG DRG ROOM AND BOARD ADULT DETOX -A/G 126 RC facility inpatient 1775.00 900 565 1571.3 650 per diem 817 per diem 1030 per diem 1000 per diem DRG DRG 846.1 per diem 650 per diem 900 per diem 675 per diem DRG DRG DRG DRG 1023 per diem DRG DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem DRG DRG 900 per diem 1137 per diem DRG DRG 1571.3 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1240.5 per diem DRG DRG 850 per diem 1030 per diem 1100 per diem DRG DRG 1030 per diem 900 per diem 900 per diem 565 per diem DRG DRG 565 per diem DRG DRG 900 per diem 900 per diem 900 per diem 1085.59 per diem 900 per diem 845 per diem 900 per diem 650 per diem 845 per diem 900 per diem DRG DRG DRG DRG INTENSIVE OUTPATIENT PROGRAM PSYCH - ADOL 905 RC facility outpatient 564.00 200 100 400 170 per diem 205 per diem 205 per diem 205 per diem 130 per diem 181.11 per diem 205 per diem 205 per diem 205 per diem 205 per diem 300 per diem 205 per diem 160 per diem 175 per diem 275 per diem 216.82 per diem 336 per diem 237.98 per diem 205 per diem 160 per diem 300 per diem 400 per diem 400 per diem 393.75 per diem 216.82 per diem 205 per diem 400 per diem 216.82 per diem 205 per diem 200 per diem 100 per diem 300 per diem 225 per diem 225 per diem 159 per diem 100 per diem 159 per diem 225 per diem 216.82 per diem 216.82 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH - ADULT 905 RC facility outpatient 564.00 200 100 400 170 per diem 205 per diem 205 per diem 205 per diem 130 per diem 181.11 per diem 205 per diem 205 per diem 205 per diem 205 per diem 300 per diem 205 per diem 160 per diem 175 per diem 275 per diem 216.82 per diem 336 per diem 237.98 per diem 205 per diem 160 per diem 300 per diem 400 per diem 400 per diem 393.75 per diem 216.82 per diem 205 per diem 400 per diem 216.82 per diem 205 per diem 200 per diem 100 per diem 300 per diem 225 per diem 225 per diem 159 per diem 100 per diem 159 per diem 225 per diem 216.82 per diem 216.82 per diem PARTIAL HOSPITAL PROGRAM PSYCH - ADOL 912 RC facility outpatient 795.00 250 142.75 600 350 per diem 415 per diem 430 per diem 430 per diem 260 per diem 185.39 per diem 142.75 per diem 430 per diem 430 per diem 430 per diem 430 per diem 350 per diem 430 per diem 175 per diem 175 per diem 450 per diem 237.98 per diem 476 per diem 237.98 per diem 430 per diem 175 per diem 350 per diem 560 per diem 600 per diem 551.25 per diem 237.98 per diem 415 per diem 600 per diem 237.98 per diem 415 per diem 250 per diem 150 per diem 350 per diem 400 per diem 237.98 per diem 400 per diem 265 per diem 165 per diem 265 per diem 400 per diem 237.98 per diem 237.98 per diem PARTIAL HOSPITAL PROGRAM PSYCH - ADULT 912 RC facility outpatient 795.00 250 142.75 600 350 per diem 415 per diem 430 per diem 430 per diem 260 per diem 185.39 per diem 142.75 per diem 430 per diem 430 per diem 430 per diem 430 per diem 350 per diem 430 per diem 175 per diem 175 per diem 450 per diem 237.98 per diem 476 per diem 237.98 per diem 430 per diem 175 per diem 350 per diem 560 per diem 600 per diem 551.25 per diem 237.98 per diem 415 per diem 600 per diem 237.98 per diem 415 per diem 250 per diem 150 per diem 350 per diem 400 per diem 237.98 per diem 400 per diem 265 per diem 165 per diem 265 per diem 400 per diem 237.98 per diem 237.98 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 1 915 RC facility outpatient 188.00 0 68.4 68.4 68.40 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 2 915 RC facility outpatient 188.00 0 68.4 68.4 68.40 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 3 915 RC facility outpatient 188.00 0 68.4 68.4 68.40 per diem Initial Hospital Care (30 Min) 99221 RC facility pro fees 150.00 0 49.02 78.09 77.90 fee schedule 78.09 fee schedule 56.22 fee schedule 75.87 fee schedule 65.17 fee schedule 66.38 fee schedule 49.02 fee schedule 78.09 fee schedule 78.09 fee schedule Subseq Care (15 Min) 99231 RC facility pro fees 90.00 0 20.38 72.1 72.10 fee schedule 30.32 fee schedule 39.82 fee schedule 33.73 fee schedule 31.54 fee schedule 32.63 fee schedule 46.85 fee schedule 39.82 fee schedule 20.38 fee schedule 46.85 fee schedule 27.09 fee schedule 46.85 fee schedule 39.82 fee schedule Subseq Care (25 Min) 99232 RC facility pro fees 100.00 0 34.43 75.07 56.34 fee schedule 58.55 fee schedule 34.43 fee schedule 60.00 fee schedule 75.07 fee schedule 36.52 fee schedule 75.07 fee schedule 75.07 fee schedule 75.07 fee schedule Discharge Day Mgmt <30 Min 99238 RC facility pro fees 150.00 0 37.03 76.39 37.03 fee schedule 76.39 fee schedule