Monroe Shoppable – Freedom Behavioral

facility	tax_id	update_date	version
freedom-behavioral-hospital-of-monroe	383731163	4/1/2023	1.0.0

SERVICE DESCRIPTION	CATEGORY	BILLING MSDRG \| CPT \| HCPCS	ITEM/SERVICE DESCRIPTION	BILLING REVENUE CODE	GROSS CHARGES	Aetna (Commercial)	REIMBURSEMENT METHOD	Aetna (Medicare Advantage)	REIMBURSEMENT METHOD	Aetna Better Health (Medicaid)	REIMBURSEMENT METHOD	Amerigroup LA Healthy Blue (Medicaid)	REIMBURSEMENT METHOD	Amerigroup (Medicare Advantage)	REIMBURSEMENT METHOD	AmeriHealth Caritas (Medicaid)	REIMBURSEMENT METHOD	Arkansas Superior Select (Access Health Services)	REIMBURSEMENT METHOD	BCBS of Louisiana (Commercial)	REIMBURSEMENT METHOD	BCBS of Louisiana (Medicare Advantage)	REIMBURSEMENT METHOD	Beacon Health Options	REIMBURSEMENT METHOD	Cigna Behavioral Health (Commercial)	REIMBURSEMENT METHOD	Humana (Commercial)	REIMBURSEMENT METHOD	Humana (Medicare Advantage)	REIMBURSEMENT METHOD	LA Healthcare Connection (Medicaid)	REIMBURSEMENT METHOD	Medicare (Traditional)	REIMBURSEMENT METHOD	Optum (United Healthcare/United Behavioral Health)	REIMBURSEMENT METHOD	TriWest (VCP)	REIMBURSEMENT METHOD	United Healthcare Community Plan (Medicaid)	REIMBURSEMENT METHOD	VA Community Care Network - Optum (UBH)	REIMBURSEMENT METHOD	Vantage Health Plan	REIMBURSEMENT METHOD	Wellcare (Harmony Health Plan)	REIMBURSEMENT METHOD	Zellis PPO	De-Identified Minimum Negotiated Rate	De-Identified Maximum Negotiated Rate	DISCOUNTED CASH PRICE
Inpatient	Inpatient Psychiatric Services		Inpatient Psychiatric Service	N/A	Base Rate	950	Per Diem	950	Per Diem	737.63	Per Diem	737.63	Per Diem	700	Per Diem	737.63	Per Diem	865.63	Per Diem	700	Per Diem	865.63	Per Diem	725	Per Diem	750	Per Diem	800	Per Diem	800	Per Diem	737.63	Per Diem	865.63	Per Diem	575	Per Diem	865.63	Per Diem	737.63	Per Diem	865.63	Per Diem	900	Per Diem	865.63	Per Diem	750	$575.00	$950.00	900
Outpatient	Intensive Outpatient Services	90853	Group Psychotherapy	915	N/A	220	Per Diem	0	Per Diem	0	Per Diem	0	Per Diem	195	Per Diem	0	Per Diem	195	Per Diem	150	Per Diem	195	Per Diem	200	Per Diem	170	Per Diem	175	Per Diem	175	Per Diem	0	Per Diem	195	Per Diem	110	Per Diem	195	Per Diem	0	Per Diem	195	Per Diem	250	Per Diem	0	Per Diem	250	$110.00	$250.00	175