hospital_name last_updated_on version hospital_location hospital_address license_number|PA "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "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" "Belmont Behavioral Hospital, LLC " 5/31/2024 2.0.0 "Philadelphia, Pennsylvania" 4200 Monument Road license_ 141610| PA TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AETNA ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_AETNA ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_AETNA ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_AETNA ]|[plan_Commercial] standard_charge|[payer_AETNA ]|[plan_Commercial] |methodology additional_payer_notes |[payer_AETNA ]|[Plan_Commercial] standard_charge|[payer_Aetna Better Health ]|[plan_Medicaid]|negotiated_dollar standard_charge|[payer_Aetna Better Health ]|[plan_Medicaid] |negotiated_percentage standard_charge|[payer_Aetna Better Health ]|[plan_Medicaid] |negotiated_algorithm estimated_amount|[payer_Aetna Better Health ]|[plan_Medicaid] standard_charge|[payer_Aetna Better Health ]|[plan_Medicaid] |methodology additional_payer_notes |[payer_Aetna Better Health ]|[Plan_Medicaid] standard_charge|[payer_AETNA ]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_AETNA ]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_AETNA ]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_AETNA ]|[plan_ Medicare] standard_charge|[payer_AETNA ]|[plan_ Medicare] |methodology additional_payer_notes |[payer_AETNA ]|[Plan_ Medicare] standard_charge|[payer_Allwell ]|[plan_Medicare]|negotiated_dollar standard_charge|[payer_Allwell ]|[plan_Medicare] |negotiated_percentage standard_charge|[payer_Allwell ]|[plan_Medicare] |negotiated_algorithm estimated_amount|[payer_Allwell ]|[plan_Medicare] standard_charge|[payer_Allwell ]|[plan_Medicare] |methodology additional_payer_notes |[payer_Allwell ]|[Plan_Medicare] standard_charge|[payer_Allied ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_Allied ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_Allied ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_Allied ]|[plan_Commercial] standard_charge|[payer_Allied ]|[plan_Commercial] |methodology additional_payer_notes |[payer_Allied ]|[Plan_Commercial] standard_charge|[payer_Ambetter ]|[plan_Medicare]|negotiated_dollar standard_charge|[payer_Ambetter ]|[plan_Medicare] |negotiated_percentage standard_charge|[payer_Ambetter ]|[plan_Medicare] |negotiated_algorithm estimated_amount|[payer_Ambetter ]|[plan_Medicare] standard_charge|[payer_Ambetter ]|[plan_Medicare] |methodology additional_payer_notes |[payer_Ambetter ]|[Plan_Medicare] standard_charge|[payer_CBH ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CBH ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CBH ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CBH ]|[plan_Managed Medicaid] standard_charge|[payer_CBH ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CBH ]|[Plan_Managed Medicaid] standard_charge|[payer_CBHNP ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CBHNP ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CBHNP ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CBHNP ]|[plan_Managed Medicaid] standard_charge|[payer_CBHNP ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CBHNP ]|[Plan_Managed Medicaid] standard_charge|[payer_CCBH ALLEGHENY ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH ALLEGHENY ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH ALLEGHENY ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH ALLEGHENY ]|[plan_Managed Medicaid] standard_charge|[payer_CCBH ALLEGHENY ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH ALLEGHENY ]|[Plan_Managed Medicaid] standard_charge|[payer_CCBH BERKS ]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH BERKS ]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH BERKS ]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH BERKS ]|[plan_ Managed Medicaid] standard_charge|[payer_CCBH BERKS ]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH BERKS ]|[Plan_ Managed Medicaid] standard_charge|[payer_CCBH CARBON/PIKE/MONROE ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH CARBON/PIKE/MONROE ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH CARBON/PIKE/MONROE ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH CARBON/PIKE/MONROE ]|[plan_Managed Medicaid] standard_charge|[payer_CCBH CARBON/PIKE/MONROE ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH CARBON/PIKE/MONROE ]|[Plan_Managed Medicaid] standard_charge|[payer_CCBH CHESTER ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH CHESTER ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH CHESTER ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH CHESTER ]|[plan_Managed Medicaid] standard_charge|[payer_CCBH CHESTER ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH CHESTER ]|[Plan_Managed Medicaid] standard_charge|[payer_CCBH DELAWARE ]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH DELAWARE ]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH DELAWARE ]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH DELAWARE ]|[plan_ Managed Medicaid] standard_charge|[payer_CCBH DELAWARE ]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH DELAWARE ]|[Plan_ Managed Medicaid] standard_charge|[payer_CCBH LYCOMING/CLINTON ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH LYCOMING/CLINTON ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH LYCOMING/CLINTON ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH LYCOMING/CLINTON ]|[plan_Managed Medicaid] standard_charge|[payer_CCBH LYCOMING/CLINTON ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH LYCOMING/CLINTON ]|[Plan_Managed Medicaid] standard_charge|[payer_CCBH NORTHCENTRAL ]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH NORTHCENTRAL ]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH NORTHCENTRAL ]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH NORTHCENTRAL ]|[plan_ Managed Medicaid] standard_charge|[payer_CCBH NORTHCENTRAL ]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH NORTHCENTRAL ]|[Plan_ Managed Medicaid] standard_charge|[payer_CCBH NORTHEAST ]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH NORTHEAST ]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH NORTHEAST ]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH NORTHEAST ]|[plan_ Managed Medicaid] standard_charge|[payer_CCBH NORTHEAST ]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH NORTHEAST ]|[Plan_ Managed Medicaid] standard_charge|[payer_CCBH SOMERSET/BEDFORD ]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH SOMERSET/BEDFORD ]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH SOMERSET/BEDFORD ]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH SOMERSET/BEDFORD ]|[plan_ Managed Medicaid] standard_charge|[payer_CCBH SOMERSET/BEDFORD ]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH SOMERSET/BEDFORD ]|[Plan_ Managed Medicaid] standard_charge|[payer_CCBH YORK/ADAMS ]|[plan_Managed Medicaid]|negotiated_dollar standard_charge|[payer_CCBH YORK/ADAMS ]|[plan_Managed Medicaid] |negotiated_percentage standard_charge|[payer_CCBH YORK/ADAMS ]|[plan_Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_CCBH YORK/ADAMS ]|[plan_Managed Medicaid] standard_charge|[payer_CCBH YORK/ADAMS ]|[plan_Managed Medicaid] |methodology additional_payer_notes |[payer_CCBH YORK/ADAMS ]|[Plan_Managed Medicaid] standard_charge|[payer_Cigna ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_Cigna ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_Cigna ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_Cigna ]|[plan_Commercial] standard_charge|[payer_Cigna ]|[plan_Commercial] |methodology additional_payer_notes |[payer_Cigna ]|[Plan_Commercial] standard_charge|[payer_Cigna HS ]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_Cigna HS ]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_Cigna HS ]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_Cigna HS ]|[plan_ Medicare] standard_charge|[payer_Cigna HS ]|[plan_ Medicare] |methodology additional_payer_notes |[payer_Cigna HS ]|[Plan_ Medicare] standard_charge|[payer_Compsych]|[plan_ Commercial]|negotiated_dollar standard_charge|[payer_Compsych]|[plan_ Commercial] |negotiated_percentage standard_charge|[payer_Compsych]|[plan_ Commercial] |negotiated_algorithm estimated_amount|[payer_Compsych]|[plan_ Commercial] standard_charge|[payer_Compsych]|[plan_ Commercial] |methodology additional_payer_notes |[payer_Compsych]|[Plan_ Commercial] standard_charge|[payer_Coresource ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_Coresource ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_Coresource ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_Coresource ]|[plan_Commercial] standard_charge|[payer_Coresource ]|[plan_Commercial] |methodology additional_payer_notes |[payer_Coresource ]|[Plan_Commercial] standard_charge|[payer_Geisinger]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_Geisinger]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_Geisinger]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_Geisinger]|[plan_ Medicare] standard_charge|[payer_Geisinger]|[plan_ Medicare] |methodology additional_payer_notes |[payer_Geisinger]|[Plan_ Medicare] standard_charge|[payer_Gateway ]|[plan_Medicare]|negotiated_dollar standard_charge|[payer_Gateway ]|[plan_Medicare] |negotiated_percentage standard_charge|[payer_Gateway ]|[plan_Medicare] |negotiated_algorithm estimated_amount|[payer_Gateway ]|[plan_Medicare] standard_charge|[payer_Gateway ]|[plan_Medicare] |methodology additional_payer_notes |[payer_Gateway ]|[Plan_Medicare] standard_charge|[payer_Health Partners ]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_Health Partners ]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_Health Partners ]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_Health Partners ]|[plan_ Medicare] standard_charge|[payer_Health Partners ]|[plan_ Medicare] |methodology additional_payer_notes |[payer_Health Partners ]|[Plan_ Medicare] standard_charge|[payer_Humana ]|[plan_Medicare]|negotiated_dollar standard_charge|[payer_Humana ]|[plan_Medicare] |negotiated_percentage standard_charge|[payer_Humana ]|[plan_Medicare] |negotiated_algorithm estimated_amount|[payer_Humana ]|[plan_Medicare] standard_charge|[payer_Humana ]|[plan_Medicare] |methodology additional_payer_notes |[payer_Humana ]|[Plan_Medicare] standard_charge|[payer_IBC]|[plan_ MEDICARE ]|negotiated_dollar standard_charge|[payer_IBC]|[plan_ MEDICARE ] |negotiated_percentage standard_charge|[payer_IBC]|[plan_ MEDICARE ] |negotiated_algorithm estimated_amount|[payer_IBC]|[plan_ MEDICARE ] standard_charge|[payer_IBC]|[plan_ MEDICARE ] |methodology additional_payer_notes |[payer_IBC]|[Plan_ MEDICARE ] standard_charge|[payer_IBC ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_IBC ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_IBC ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_IBC ]|[plan_Commercial] standard_charge|[payer_IBC ]|[plan_Commercial] |methodology additional_payer_notes |[payer_IBC ]|[Plan_Commercial] standard_charge|[payer_Keystone VIP ]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_Keystone VIP ]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_Keystone VIP ]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_Keystone VIP ]|[plan_ Medicare] standard_charge|[payer_Keystone VIP ]|[plan_ Medicare] |methodology additional_payer_notes |[payer_Keystone VIP ]|[Plan_ Medicare] standard_charge|[payer_KIDZ PARTNERS]|[plan_ Medicaid]|negotiated_dollar standard_charge|[payer_KIDZ PARTNERS]|[plan_ Medicaid] |negotiated_percentage standard_charge|[payer_KIDZ PARTNERS]|[plan_ Medicaid] |negotiated_algorithm estimated_amount|[payer_KIDZ PARTNERS]|[plan_ Medicaid] standard_charge|[payer_KIDZ PARTNERS]|[plan_ Medicaid] |methodology additional_payer_notes |[payer_KIDZ PARTNERS]|[Plan_ Medicaid] standard_charge|[payer_LEHIGH/NORTHAMPTON]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_LEHIGH/NORTHAMPTON]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_LEHIGH/NORTHAMPTON]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_LEHIGH/NORTHAMPTON]|[plan_ Managed Medicaid] standard_charge|[payer_LEHIGH/NORTHAMPTON]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_LEHIGH/NORTHAMPTON]|[Plan_ Managed Medicaid] standard_charge|[payer_Magellan Bucks]|[plan_ Managed Medicaid]|negotiated_dollar standard_charge|[payer_Magellan Bucks]|[plan_ Managed Medicaid] |negotiated_percentage standard_charge|[payer_Magellan Bucks]|[plan_ Managed Medicaid] |negotiated_algorithm estimated_amount|[payer_Magellan Bucks]|[plan_ Managed Medicaid] standard_charge|[payer_Magellan Bucks]|[plan_ Managed Medicaid] |methodology additional_payer_notes |[payer_Magellan Bucks]|[Plan_ Managed Medicaid] standard_charge|[payer_Medicaid ]|[plan_ Medicaid]|negotiated_dollar standard_charge|[payer_Medicaid ]|[plan_ Medicaid] |negotiated_percentage standard_charge|[payer_Medicaid ]|[plan_ Medicaid] |negotiated_algorithm estimated_amount|[payer_Medicaid ]|[plan_ Medicaid] standard_charge|[payer_Medicaid ]|[plan_ Medicaid] |methodology additional_payer_notes |[payer_Medicaid ]|[Plan_ Medicaid] standard_charge|[payer_Medicare ]|[plan_Medicare ]|negotiated_dollar standard_charge|[payer_Medicare ]|[plan_Medicare ] |negotiated_percentage standard_charge|[payer_Medicare ]|[plan_Medicare ] |negotiated_algorithm estimated_amount|[payer_Medicare ]|[plan_Medicare ] standard_charge|[payer_Medicare ]|[plan_Medicare ] |methodology additional_payer_notes |[payer_Medicare ]|[Plan_Medicare ] standard_charge|[payer_MERCY LIFE]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_MERCY LIFE]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_MERCY LIFE]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_MERCY LIFE]|[plan_ Medicare] standard_charge|[payer_MERCY LIFE]|[plan_ Medicare] |methodology additional_payer_notes |[payer_MERCY LIFE]|[Plan_ Medicare] standard_charge|[payer_Meritain ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_Meritain ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_Meritain ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_Meritain ]|[plan_Commercial] standard_charge|[payer_Meritain ]|[plan_Commercial] |methodology additional_payer_notes |[payer_Meritain ]|[Plan_Commercial] standard_charge|[payer_MH Consultants]|[plan_ Commercial]|negotiated_dollar standard_charge|[payer_MH Consultants]|[plan_ Commercial] |negotiated_percentage standard_charge|[payer_MH Consultants]|[plan_ Commercial] |negotiated_algorithm estimated_amount|[payer_MH Consultants]|[plan_ Commercial] standard_charge|[payer_MH Consultants]|[plan_ Commercial] |methodology additional_payer_notes |[payer_MH Consultants]|[Plan_ Commercial] standard_charge|[payer_MHNET ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_MHNET ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_MHNET ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_MHNET ]|[plan_Commercial] standard_charge|[payer_MHNET ]|[plan_Commercial] |methodology additional_payer_notes |[payer_MHNET ]|[Plan_Commercial] "standard_charge|[payer_Montgomery]|[plan_ Managed Medicaid]|negotiated_dollar" "standard_charge|[payer_Montgomery]|[plan_ Managed Medicaid] |negotiated_percentage" "standard_charge|[payer_Montgomery]|[plan_ Managed Medicaid] |negotiated_algorithm" "estimated_amount|[payer_Montgomery]|[plan_ Managed Medicaid] " "standard_charge|[payer_Montgomery]|[plan_ Managed Medicaid] |methodology" "additional_payer_notes |[payer_Montgomery]|[Plan_ Managed Medicaid]" standard_charge|[payer_New Courtland Life ]|[plan_Medicare]|negotiated_dollar standard_charge|[payer_New Courtland Life ]|[plan_Medicare] |negotiated_percentage standard_charge|[payer_New Courtland Life ]|[plan_Medicare] |negotiated_algorithm estimated_amount|[payer_New Courtland Life ]|[plan_Medicare] standard_charge|[payer_New Courtland Life ]|[plan_Medicare] |methodology additional_payer_notes |[payer_New Courtland Life ]|[Plan_Medicare] standard_charge|[payer_Quest Behavioral Health ]|[plan_ Commercial]|negotiated_dollar standard_charge|[payer_Quest Behavioral Health ]|[plan_ Commercial] |negotiated_percentage standard_charge|[payer_Quest Behavioral Health ]|[plan_ Commercial] |negotiated_algorithm estimated_amount|[payer_Quest Behavioral Health ]|[plan_ Commercial] standard_charge|[payer_Quest Behavioral Health ]|[plan_ Commercial] |methodology additional_payer_notes |[payer_Quest Behavioral Health ]|[Plan_ Commercial] standard_charge|[payer_Tricare/VA ]|[plan_Tricare]|negotiated_dollar standard_charge|[payer_Tricare/VA ]|[plan_Tricare] |negotiated_percentage standard_charge|[payer_Tricare/VA ]|[plan_Tricare] |negotiated_algorithm estimated_amount|[payer_Tricare/VA ]|[plan_Tricare] standard_charge|[payer_Tricare/VA ]|[plan_Tricare] |methodology additional_payer_notes |[payer_Tricare/VA ]|[Plan_Tricare] standard_charge|[payer_UBH/UMR ]|[plan_ Commercial]|negotiated_dollar standard_charge|[payer_UBH/UMR ]|[plan_ Commercial] |negotiated_percentage standard_charge|[payer_UBH/UMR ]|[plan_ Commercial] |negotiated_algorithm estimated_amount|[payer_UBH/UMR ]|[plan_ Commercial] standard_charge|[payer_UBH/UMR ]|[plan_ Commercial] |methodology additional_payer_notes |[payer_UBH/UMR ]|[Plan_ Commercial] standard_charge|[payer_UHC ]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_UHC ]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_UHC ]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC ]|[plan_MEDICARE] standard_charge|[payer_UHC ]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_UHC ]|[Plan_MEDICARE] standard_charge|[payer_UPMC for Life ]|[plan_ Medicare]|negotiated_dollar standard_charge|[payer_UPMC for Life ]|[plan_ Medicare] |negotiated_percentage standard_charge|[payer_UPMC for Life ]|[plan_ Medicare] |negotiated_algorithm estimated_amount|[payer_UPMC for Life ]|[plan_ Medicare] standard_charge|[payer_UPMC for Life ]|[plan_ Medicare] |methodology additional_payer_notes |[payer_UPMC for Life ]|[Plan_ Medicare] standard_charge|[payer_UPMC HP ]|[plan_ Commercial ]|negotiated_dollar standard_charge|[payer_UPMC HP ]|[plan_ Commercial ] |negotiated_percentage standard_charge|[payer_UPMC HP ]|[plan_ Commercial ] |negotiated_algorithm estimated_amount|[payer_UPMC HP ]|[plan_ Commercial ] standard_charge|[payer_UPMC HP ]|[plan_ Commercial ] |methodology additional_payer_notes |[payer_UPMC HP ]|[Plan_ Commercial ] standard_charge|[payer_UPMC ]|[plan_Medicaid]|negotiated_dollar standard_charge|[payer_UPMC ]|[plan_Medicaid] |negotiated_percentage standard_charge|[payer_UPMC ]|[plan_Medicaid] |negotiated_algorithm estimated_amount|[payer_UPMC ]|[plan_Medicaid] standard_charge|[payer_UPMC ]|[plan_Medicaid] |methodology additional_payer_notes |[payer_UPMC ]|[Plan_Medicaid] standard_charge|[payer_Value Options ]|[plan_Commercial]|negotiated_dollar standard_charge|[payer_Value Options ]|[plan_Commercial] |negotiated_percentage standard_charge|[payer_Value Options ]|[plan_Commercial] |negotiated_algorithm estimated_amount|[payer_Value Options ]|[plan_Commercial] standard_charge|[payer_Value Options ]|[plan_Commercial] |methodology additional_payer_notes |[payer_Value Options ]|[Plan_Commercial] additional_generic_notes Room and Board all Inclusive Per-Diem 124 RC facility Inpatient 2600 660 624 1400 1332 per diem 660 per diem 1293 per diem Other Medicare Rate 1000 per diem other Medicare Rate 850 per diem 659 per diem 787 per diem 729 per diem 750 per diem 880 per diem 817 per diem 737 per diem 754 per diem 1065 per diem other Medicare Rate 1400 per diem 1231 per diem other Medicare Rate 867 per diem 1151 per diem 900 per diem 1290 per diem 1290 per diem other Medicare Rate other Medicare Rate 880 per diem 880 per diem 624 per diem other Medicare Rate other Medicare Rate 1293 per diem 800 per diem 1175 per diem 880 per diem other Medicare Rate 1034 per diem other Medicare Rate 908 per diem 908 per diem 868 per diem 868 per diem Room and Board all Inclusive Per-Diem Child / Adol 114 RC facility Inpatient 2600 660 624 1400 1332 per diem 660 per diem 1050 per diem 1000 per diem 659 per diem 853 per diem 760 per diem 813 per diem 880 per diem 899 per diem 748 per diem 836 per diem 1065 per diem 1400 per diem 1231 per diem 1350 per diem 1151 per diem 880 per diem 880 per diem 624 per diem 1293 per diem 800 per diem 1175 per diem 880 per diem 1034 per diem 908 per diem 868 per diem Room and Board STAR Single Room 144 RC facility Inpatient 2600 1700 2875 1700 per diem 2875 per diem 2530 per diem 2484 per diem 2300 per diem 2300 per diem 2300 per diem 1900 per diem 1900 per diem Room and Board STAR Double Room 140 RC facility Inpatient 2600 1700 2375 1700 per diem 2375 per diem 2090 per diem 2052 per diem 1900 per diem 1900 per diem 1900 per diem 1900 per diem 1900 per diem ELECTOCONVULSIVE THERAPY 901 RC facility both 1281 42 988 986 per diem 986 per diem 850 per diem 793 per diem 300 per diem 635 per diem 635 per diem 588 per diem 450 per diem 430 per diem 661 per diem 695 per diem 526 per diem 820 per diem 894 per diem 471 per diem 650 per diem 761 per diem 499 per diem 837 per diem 837 per diem 471 per diem 133 per diem 450 per diem 425 per diem 42 per diem 499 per diem 499 per diem 939 per diem 575 per diem 831 per diem 450 per diem 471 per diem 988 per diem 507 per diem 693 per diem 666 per diem 588 per diem 588 per diem 588 per diem 131 per diem ESTAB OFF VISIT 15 99212 RC facility Outpatient 119 75 32 98 68 per diem 32 per diem 82 per diem 55 per diem 56 per diem 98 per diem 60 per diem 42 per diem 71 per diem 98 per diem 55 per diem 63 per diem 59 per diem 78 per diem 71 per diem 55 per diem 44 per diem 35 per diem 55 per diem 95 per diem 80 per diem 60 per diem 80 per diem 72 per diem 98 per diem 80 per diem 81 per diem 70 per diem 70 per diem 98 per diem 75 per diem 75 per diem 38 per diem ESTAB OFF VISIT 30 99213 RC facility Outpatient 238 43 176 100 per diem 54 per diem 117 per diem 55 per diem 176 per diem 129 per diem 103 per diem 72 per diem 102 per diem 139 per diem 59 per diem 87 per diem 83 per diem 84 per diem 102 per diem 59 per diem 54 per diem 85 per diem 117 per diem 80 per diem 78 per diem 83 per diem 117 per diem 84 per diem 88 per diem 88 per diem 139 per diem 92 per diem 92 per diem 43 per diem ESTAB OFF VISIT 45 99214 RC facility Outpatient 356 78 197 87 per diem 78 per diem 197 per diem 197 per diem 128 per diem 157 per diem 193 per diem 79 per diem 116 per diem 124 per diem 79 per diem 78 per diem 87 per diem 100 per diem 128 per diem 119 per diem 88 per diem 106 per diem 110 per diem 110 per diem 110 per diem 95 per diem INTENSIVE OUTPATIENT PROGRAM DAILY 915 RC facility Outpatient 810 275 120 750 336 per diem 10 per diem 511 per diem 350 per diem 255 per diem 249 per diem 275 per diem 305 per diem 257 per diem 249 per diem 239 per diem 334 per diem 334 per diem 257 per diem 304 per diem 235 per diem 239 per diem 305 per diem 150 per diem 248 per diem 265 per diem 239 per diem 202 per diem 202 per diem 120 per diem 750 per diem 200 per diem PARTIAL HOSPITAL PROGRAM C&A CBH Billed 912 RC facility Outpatient 270 70 190 118 per diem 114 per diem 190 per diem 70 per diem PARTIAL HOSPITAL PROGRAM CBH ACUTE 912 RC facility Outpatient 270 109 109 109 per diem PARTIAL HOSPITAL PROGRAM CBH INTERM 912 RC facility Outpatient 270 97 97 97 per diem PARTIAL HOSPITAL PROGRAM CBH SUBACUTE 912 RC facility Outpatient 270 100 53 53 53 per diem PARTIAL HOSPITAL PROGRAM DAILY 912 RC facility Outpatient 1080 375 220 1000 511 per diem 10 per diem 511 per diem 400 per diem 237 per diem 400 per diem 281 per diem 567 per diem 442 per diem 280 per diem 252 per diem 455 per diem 455 per diem 280 per diem 456 per diem 250 per diem 220 per diem 276 per diem 276 per diem 442 per diem 375 per diem 418 per diem 231 per diem 232 per diem 398 per diem 282 per diem 270 per diem 270 per diem 1000 per diem 292 per diem PSYCH EVAL CBH 90871 RC facility Outpatient 296 150 104 104 104 per diem TRANSCRANIAL MAGNETIC STIMULATION Initial 90867 RC facility both 778 150 158 622 600 fee schedule 329 fee schedule 481 fee schedule 622 fee schedule 276 fee schedule 450 per diem 313 per diem 294 fee schedule 261 fee schedule 428 fee schedule 158 fee schedule 421 fee schedule 294 fee schedule 428 fee schedule 600 fee schedule 289 fee schedule 289 fee schedule 298 fee schedule 600 fee schedule 261 fee schedule 350 fee schedule 276 fee schedule 275 fee schedule 600 fee schedule 600 fee schedule TRANSCRANIAL MAGNETIC STIMULATION Motor Threshold 90869 RC facility both 778 360 132 622 600 fee schedule 408 fee schedule 481 fee schedule 622 fee schedule 276 fee schedule 375 per diem 343 per diem 294 fee schedule 141 fee schedule 428 fee schedule 132 fee schedule 421 fee schedule 294 fee schedule 428 fee schedule 600 fee schedule 289 fee schedule 289 fee schedule 327 fee schedule 600 fee schedule 276 fee schedule 265 fee schedule 146 fee schedule 275 fee schedule 600 fee schedule 600 fee schedule TRANSCRANIAL MAGNETIC STIMULATION Subsequent Treatment 60868 RC facility both 518 300 31 421 400 fee schedule 400 fee schedule 250 fee schedule 414 fee schedule 276 fee schedule 297 per diem 408 per diem 294 fee schedule 141 fee schedule 213 fee schedule 31 fee schedule 421 fee schedule 294 fee schedule 213 fee schedule 400 fee schedule 289 fee schedule 289 fee schedule 389 fee schedule 400 fee schedule 141 fee schedule 265 fee schedule 276 fee schedule 275 fee schedule 400 fee schedule 400 fee schedule 400 fee schedule