"hospital_Wilmington-Treatment-Center,LLC" last_updated_ 2023-12-31 version_1 "hospital_Wilmington, North Carolina" hospital_address2520 Troy Drive license_ MHH-0961 | NC "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_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 MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_AETNA MANAGED MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MANAGED MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_ALL SAVERS HMO/PPO] standard_charge|[payer_ALL SAVERS HMO/PPO] |percent standard_charge|[payer_ALL SAVERS HMO/PPO] |contracting_method additional_payer_notes |[payer_ALL SAVERS HMO/PPO] standard_charge|[payer_ALLIED TRADE HMO/PPO] standard_charge|[payer_ALLIED TRADE HMO/PPO] |percent standard_charge|[payer_ALLIED TRADE HMO/PPO] |contracting_method additional_payer_notes |[payer_ALLIED TRADE HMO/PPO] standard_charge|[payer_AMERICAN BEHAVIORAL HMO/PPO] standard_charge|[payer_AMERICAN BEHAVIORAL HMO/PPO] |percent standard_charge|[payer_AMERICAN BEHAVIORAL HMO/PPO] |contracting_method additional_payer_notes |[payer_AMERICAN BEHAVIORAL HMO/PPO] 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_ANTHEM MEDIBLUE ACCESS MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDIBLUE ACCESS MANAGED MEDICARE] |percent standard_charge|[payer_ANTHEM MEDIBLUE ACCESS MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ANTHEM MEDIBLUE ACCESS MANAGED MEDICARE] standard_charge|[payer_BCBS HDP BLUE CROSS] standard_charge|[payer_BCBS HDP BLUE CROSS] |percent standard_charge|[payer_BCBS HDP BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS HDP BLUE CROSS] standard_charge|[payer_BCBS NC BLUE CROSS] standard_charge|[payer_BCBS NC BLUE CROSS] |percent standard_charge|[payer_BCBS NC BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS NC BLUE CROSS] standard_charge|[payer_BCBS NC FEDERAL | BLUE CROSS] standard_charge|[payer_BCBS NC FEDERAL | BLUE CROSS] |percent standard_charge|[payer_BCBS NC FEDERAL | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS NC FEDERAL | BLUE CROSS] standard_charge|[payer_BCBS OUT NETWORK | BLUE CROSS] standard_charge|[payer_BCBS OUT NETWORK | BLUE CROSS] |percent standard_charge|[payer_BCBS OUT NETWORK | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OUT NETWORK | BLUE CROSS] standard_charge|[payer_BCBS OUT OF NETWORK | BLUE CROSS] standard_charge|[payer_BCBS OUT OF NETWORK | BLUE CROSS] |percent standard_charge|[payer_BCBS OUT OF NETWORK | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OUT OF NETWORK | 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_BCBS SC CBA | BLUE CROSS] standard_charge|[payer_BCBS SC CBA | BLUE CROSS] |percent standard_charge|[payer_BCBS SC CBA | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS SC CBA | BLUE CROSS] standard_charge|[payer_BCNC STATE EMPLOYEES | BLUE CROSS] standard_charge|[payer_BCNC STATE EMPLOYEES | BLUE CROSS] |percent standard_charge|[payer_BCNC STATE EMPLOYEES | BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCNC STATE EMPLOYEES | BLUE CROSS] standard_charge|[payer_BEACON HEALTH SOLUTIONS | HMO/PPO] standard_charge|[payer_BEACON HEALTH SOLUTIONS | HMO/PPO] |percent standard_charge|[payer_BEACON HEALTH SOLUTIONS | HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HEALTH SOLUTIONS | HMO/PPO] standard_charge|[payer_BEHAVIORAL HLTH SYSTEMS | HMO/PPO] standard_charge|[payer_BEHAVIORAL HLTH SYSTEMS | HMO/PPO] |percent standard_charge|[payer_BEHAVIORAL HLTH SYSTEMS | HMO/PPO] |contracting_method additional_payer_notes |[payer_BEHAVIORAL HLTH SYSTEMS | HMO/PPO] standard_charge|[payer_BLUE MEDICARE | MANAGED MEDICARE] standard_charge|[payer_BLUE MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_BLUE MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BLUE MEDICARE | MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH | HMO/PPO] standard_charge|[payer_BRIGHT HEALTH | HMO/PPO] |percent standard_charge|[payer_BRIGHT HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_BRIGHT HEALTH | HMO/PPO] standard_charge|[payer_BRIGHT HEALTH MNGD MCR | MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH MNGD MCR | MANAGED MEDICARE] |percent standard_charge|[payer_BRIGHT HEALTH MNGD MCR | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BRIGHT HEALTH MNGD MCR | MANAGED MEDICARE] standard_charge|[payer_CAROLINA BEHAVIORAL HEALT | HMO/PPO] standard_charge|[payer_CAROLINA BEHAVIORAL HEALT | HMO/PPO] |percent standard_charge|[payer_CAROLINA BEHAVIORAL HEALT | HMO/PPO] |contracting_method additional_payer_notes |[payer_CAROLINA BEHAVIORAL HEALT | HMO/PPO] standard_charge|[payer_CAROLINA COMPLETE HEALTH | MANAGED MEDICAID] standard_charge|[payer_CAROLINA COMPLETE HEALTH | MANAGED MEDICAID] |percent standard_charge|[payer_CAROLINA COMPLETE HEALTH | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CAROLINA COMPLETE 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_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 BEHAVIORAL HEALTH | HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH | HMO/PPO] |percent standard_charge|[payer_CIGNA BEHAVIORAL HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH | HMO/PPO] standard_charge|[payer_CIGNA GREAT WEST | HMO/PPO] standard_charge|[payer_CIGNA GREAT WEST | HMO/PPO] |percent standard_charge|[payer_CIGNA GREAT WEST | HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA GREAT WEST | HMO/PPO] standard_charge|[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] |percent standard_charge|[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_CIGNA HEALTH SPRING | MANAGED MEDICARE] standard_charge|[payer_COMPSYCH | HMO/PPO] standard_charge|[payer_COMPSYCH | HMO/PPO] |percent standard_charge|[payer_COMPSYCH | HMO/PPO] |contracting_method additional_payer_notes |[payer_COMPSYCH | HMO/PPO] standard_charge|[payer_CORE SOURCE | HMO/PPO] standard_charge|[payer_CORE SOURCE | HMO/PPO] |percent standard_charge|[payer_CORE SOURCE | HMO/PPO] |contracting_method additional_payer_notes |[payer_CORE SOURCE | HMO/PPO] standard_charge|[payer_FIRST CAROLINA CARE | HMO/PPO] standard_charge|[payer_FIRST CAROLINA CARE | HMO/PPO] |percent standard_charge|[payer_FIRST CAROLINA CARE | HMO/PPO] |contracting_method additional_payer_notes |[payer_FIRST CAROLINA CARE | HMO/PPO] standard_charge|[payer_GHI - NEW YORK | HMO/PPO] standard_charge|[payer_GHI - NEW YORK | HMO/PPO] |percent standard_charge|[payer_GHI - NEW YORK | HMO/PPO] |contracting_method additional_payer_notes |[payer_GHI - NEW YORK | HMO/PPO] standard_charge|[payer_GOLDEN RULE INSURANCE | HMO/PPO] standard_charge|[payer_GOLDEN RULE INSURANCE | HMO/PPO] |percent standard_charge|[payer_GOLDEN RULE INSURANCE | HMO/PPO] |contracting_method additional_payer_notes |[payer_GOLDEN RULE INSURANCE | HMO/PPO] standard_charge|[payer_HEALTHY BLUE | MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE | MANAGED MEDICAID] |percent standard_charge|[payer_HEALTHY BLUE | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HEALTHY BLUE | MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE + MEDICARE | MANAGED MEDICARE] standard_charge|[payer_HEALTHY BLUE + MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_HEALTHY BLUE + MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HEALTHY BLUE + MEDICARE | MANAGED MEDICARE] 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 GOLD MGD MCR | MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD MGD MCR | MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA GOLD MGD MCR | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA GOLD MGD MCR | MANAGED MEDICARE] standard_charge|[payer_LEAD PROGRAM | LOCAL GOVT] standard_charge|[payer_LEAD PROGRAM | LOCAL GOVT] |percent standard_charge|[payer_LEAD PROGRAM | LOCAL GOVT] |contracting_method additional_payer_notes |[payer_LEAD PROGRAM | LOCAL GOVT] standard_charge|[payer_MAGELLAN BEHAVIORAL HLTH | HMO/PPO] standard_charge|[payer_MAGELLAN BEHAVIORAL HLTH | HMO/PPO] |percent standard_charge|[payer_MAGELLAN BEHAVIORAL HLTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN BEHAVIORAL HLTH | HMO/PPO] standard_charge|[payer_MEDCOST | HMO/PPO] standard_charge|[payer_MEDCOST | HMO/PPO] |percent standard_charge|[payer_MEDCOST | HMO/PPO] |contracting_method additional_payer_notes |[payer_MEDCOST | HMO/PPO] 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_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_OXFORD HEALTH | HMO/PPO] standard_charge|[payer_OXFORD HEALTH | HMO/PPO] |percent standard_charge|[payer_OXFORD HEALTH | HMO/PPO] |contracting_method additional_payer_notes |[payer_OXFORD HEALTH | HMO/PPO] standard_charge|[payer_RAILROAD MEDICARE | MEDICARE PHYSICIAN] standard_charge|[payer_RAILROAD MEDICARE | MEDICARE PHYSICIAN] |percent standard_charge|[payer_RAILROAD MEDICARE | MEDICARE PHYSICIAN] |contracting_method additional_payer_notes |[payer_RAILROAD MEDICARE | MEDICARE PHYSICIAN] standard_charge|[payer_TRICARE EAST | TRICARE] standard_charge|[payer_TRICARE EAST | TRICARE] |percent standard_charge|[payer_TRICARE EAST | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE EAST | TRICARE] standard_charge|[payer_TRICARE FOR LIFE | TRICARE] standard_charge|[payer_TRICARE FOR LIFE | TRICARE] |percent standard_charge|[payer_TRICARE FOR LIFE | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE FOR LIFE | TRICARE] standard_charge|[payer_TRICARE OVERSEAS | TRICARE] standard_charge|[payer_TRICARE OVERSEAS | TRICARE] |percent standard_charge|[payer_TRICARE OVERSEAS | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE OVERSEAS | TRICARE] standard_charge|[payer_TRICARE WEST | TRICARE] standard_charge|[payer_TRICARE WEST | TRICARE] |percent standard_charge|[payer_TRICARE WEST | TRICARE] |contracting_method additional_payer_notes |[payer_TRICARE WEST | TRICARE] standard_charge|[payer_TRUSTMARK HEALTH BENEFITS | COMMERCIAL] standard_charge|[payer_TRUSTMARK HEALTH BENEFITS | COMMERCIAL] |percent standard_charge|[payer_TRUSTMARK HEALTH BENEFITS | COMMERCIAL] |contracting_method additional_payer_notes |[payer_TRUSTMARK HEALTH BENEFITS | COMMERCIAL] 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 AARP | HMO/PPO] standard_charge|[payer_UBH AARP | HMO/PPO] |percent standard_charge|[payer_UBH AARP | HMO/PPO] |contracting_method additional_payer_notes |[payer_UBH AARP | HMO/PPO] standard_charge|[payer_UBH MGD MCR | MANAGED MEDICARE] standard_charge|[payer_UBH MGD MCR | MANAGED MEDICARE] |percent standard_charge|[payer_UBH MGD MCR | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UBH MGD MCR | 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_UMR | COMMERCIAL] standard_charge|[payer_UMR | COMMERCIAL] |percent standard_charge|[payer_UMR | COMMERCIAL] |contracting_method additional_payer_notes |[payer_UMR | COMMERCIAL] standard_charge|[payer_WELLCARE MANAGED MCD | MANAGED MEDICAID] standard_charge|[payer_WELLCARE MANAGED MCD | MANAGED MEDICAID] |percent standard_charge|[payer_WELLCARE MANAGED MCD | MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_WELLCARE MANAGED MCD | MANAGED MEDICAID] standard_charge|[payer_WELLCARE MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_WELLCARE MANAGED MEDICARE | MANAGED MEDICARE] |percent standard_charge|[payer_WELLCARE MANAGED MEDICARE | MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_WELLCARE MANAGED MEDICARE | MANAGED MEDICARE] standard_charge|[payer_WORKFORCE ASSISTANCE PROG| HMO/PPO] standard_charge|[payer_WORKFORCE ASSISTANCE PROG| HMO/PPO] |percent standard_charge|[payer_WORKFORCE ASSISTANCE PROG| HMO/PPO] |contracting_method additional_payer_notes |[payer_WORKFORCE ASSISTANCE PROG| HMO/PPO] standard_charge|[payer_WORTH PROJECT | LOCAL GOVT] standard_charge|[payer_WORTH PROJECT | LOCAL GOVT] |percent standard_charge|[payer_WORTH PROJECT | LOCAL GOVT] |contracting_method additional_payer_notes |[payer_WORTH PROJECT | LOCAL GOVT] ROOM AND BOARD DETOX 126 RC facility Inpatient 1500 1100 350 1450 1016 per diem 1016 per diem 773 per diem 350 per diem 700 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 718 per diem 773 per diem 1128 per diem 855 per diem 821 per diem 588 per diem 800 per diem 800 per diem 800 per diem 662 per diem 948 per diem 780 per diem 633 per diem 773 per diem 525 per diem 850 per diem 1450 per diem 978 per diem 640 per diem 1015 per diem 773 per diem 948 per diem 773 per diem 773 per diem 620 per diem 773 per diem 515 per diem 700 per diem 600 per diem 900 per diem ROOM AND BOARD REHAB 128 RC facility Inpatient 1400 1000 325 1128 862 per diem 862 per diem 677 per diem 325 per diem 700 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 589 per diem 677 per diem 1128 per diem 855 per diem 727 per diem 727 per diem 727 per diem 605 per diem 813 per diem 670 per diem 519 per diem 677 per diem 525 per diem 525 per diem 700 per diem 855 per diem 633 per diem 677 per diem 813 per diem 677 per diem 677 per diem 677 per diem 515 per diem 700 per diem 900 per diem INTENSIVE OUTPATIENT PROGRAM WILMINGTON 906 RC facility Outpatient 350 125 123 404 206 per diem 186 per diem 186 per diem 186 per diem 186 per diem 186 per diem 186 per diem 177 per diem 192 per diem 359 per diem 326 per diem 212 per diem 404 per diem 404 per diem 198 per diem 151 per diem 192 per diem 221 per diem 123 per diem 192 per diem 222 per diem 156 per diem 192 per diem 192 per diem PARTIAL HOSPITAL PROGRAM DAY TX 912 RC facility Outpatient 1200 735 233 1150 577 per diem 458 per diem 300 per diem 375 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 353 per diem 458 per diem 248 per diem 469 per diem 469 per diem 474 per diem 421 per diem 498 per diem 498 per diem 498 per diem 252 per diem 456 per diem 541 per diem 416 per diem 233 per diem 903 per diem 248 per diem 500 per diem 252 per diem 1150 per diem 579 per diem 436 per diem 252 per diem 576 per diem 458 per diem 452 per diem 452 per diem 452 per diem 452 per diem 541 per diem 458 per diem 458 per diem 458 per diem 458 per diem 325 per diem 900 per diem PARTIAL HOSPITAL PROGRAM W/LODGING 912 RC facility Outpatient 1150 735 233 1150 577 per diem 458 per diem 300 per diem 375 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 540 per diem 353 per diem 458 per diem 248 per diem 469 per diem 469 per diem 474 per diem 421 per diem 498 per diem 498 per diem 498 per diem 252 per diem 456 per diem 541 per diem 416 per diem 233 per diem 903 per diem 248 per diem 500 per diem 252 per diem 1150 per diem 579 per diem 436 per diem 252 per diem 576 per diem 458 per diem 452 per diem 452 per diem 452 per diem 452 per diem 541 per diem 458 per diem 458 per diem 458 per diem 458 per diem 325 per diem 900 per diem GROUP THERAPY 915 RC facility Outpatient 150 0 0 577 577 per diem 0 350 per diem ROOM AND BOARD RTC 1002 RC facility Outpatient 1300 1000 316 900 631 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 691 per diem 461 per diem 622 per diem 833 per diem 728 per diem 764 per diem 727 per diem 727 per diem 727 per diem 665 per diem 316 per diem 700 per diem 721 per diem 633 per diem 584 per diem 622 per diem 325 per diem 900 per diem 90833 ADD ON 30 MIN 5204 RC facility Outpatient 104 62 57 69 per diem 62 per diem 69 per diem 57 per diem 62 per diem 57 per diem 57 per diem 57 per diem 57 per diem 57 per diem 69 per diem 57 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 62 per diem 69 per diem 69 per diem 62 per diem 62 per diem 62 per diem 62 per diem 62 per diem 99221 INITIAL PARTIAL HOSPITAL PROGRAM 5212 RC facility Outpatient 166 97 97 111 97 per diem 97 per diem 111 per diem 111 per diem 111 per diem 111 per diem 111 per diem 111 per diem 111 per diem 97 per diem 111 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 97 per diem 99222 INTL PARTIAL HOSPITAL PROGRAM MOD 5213 RC facility Outpatient 224 131 131 153 131 per diem 132 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 153 per diem 132 per diem 153 per diem 132 per diem 132 per diem 132 per diem 132 per diem 132 per diem 131 per diem 132 per diem 132 per diem 131 per diem 131 per diem 131 per diem 131 per diem 131 per diem 99223 INTL PARTIAL HOSPITAL PROGRAM HIGH 5214 RC facility Outpatient 332 192 192 225 192 per diem 194 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 225 per diem 194 per diem 225 per diem 194 per diem 194 per diem 194 per diem 194 per diem 194 per diem 192 per diem 194 per diem 194 per diem 192 per diem 192 per diem 192 per diem 192 per diem 194 per diem 99231 SUBSEQUENT PARTIAL HOSPITAL PROGRAM 5215 RC facility Outpatient 64 37 37 46 37 per diem 37 per diem 46 per diem 46 per diem 46 per diem 46 per diem 46 per diem 46 per diem 46 per diem 37 per diem 46 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 37 per diem 99232 SUB HOS MODERA 5216 RC facility Outpatient 119 69 69 83 69 per diem 69 per diem 83 per diem 83 per diem 83 per diem 83 per diem 83 per diem 83 per diem 83 per diem 69 per diem 83 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 99233 SUB PARTIAL HOSPITAL PROGRAM HIGH 5217 RC facility Outpatient 171 99 99 119 99 per diem 100 per diem 119 per diem 119 per diem 119 per diem 119 per diem 119 per diem 119 per diem 119 per diem 100 per diem 119 per diem 100 per diem 100 per diem 100 per diem 100 per diem 100 per diem 99 per diem 100 per diem 100 per diem 99 per diem 99 per diem 99 per diem 99 per diem 99 per diem 99238 D/C HOS LOW 5218 RC facility Outpatient 120 69 68 84 69 per diem 69 per diem 84 per diem 84 per diem 84 per diem 84 per diem 84 per diem 84 per diem 84 per diem 69 per diem 84 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 69 per diem 68 per diem 99239 D/C PARTIAL HOSPITAL PROGRAM >30 MI 5219 RC facility Outpatient 177 101 101 121 101 per diem 103 per diem 121 per diem 121 per diem 121 per diem 121 per diem 121 per diem 121 per diem 121 per diem 103 per diem 121 per diem 103 per diem 103 per diem 103 per diem 103 per diem 103 per diem 101 per diem 103 per diem 103 per diem 101 per diem 101 per diem 101 per diem 101 per diem 101 per diem per diem