facility | tax_id | update_date | version | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| allegiance-behavioral-health-center-of-plainview | 201871394 | 4/1/2023 | 1.0.0 | ||||||||||||||||||||||
| SERVICE DESCRIPTION | CATEGORY | BILLING MSDRG | CPT | HCPCS | ITEM/SERVICE DESCRIPTION | BILLING REVENUE CODE | GROSS CHARGES | BCBS of Texas (Commercial) | REIMBURSEMENT METHOD | Beacon Health Options | REIMBURSEMENT METHOD | Cigna Behavioral Health (Commercial) | REIMBURSEMENT METHOD | Medicare (Traditional) | REIMBURSEMENT METHOD | Optum (United Healthcare/United Behavioral Health) | REIMBURSEMENT METHOD | TriWest (VCP) | 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 | 700 | Per Diem | 600 | Per Diem | 750 | Per Diem | 865.63 | Per Diem | 750 | Per Diem | 865.63 | Per Diem | 900 | Per Diem | 865.63 | Per Diem | 750 | $575.00 | $900.00 | 900 | |
| Outpatient | Intensive Outpatient Services | 90853 | Group Psychotherapy | 915 | N/A | 200 | Per Diem | 130 | Per Diem | 170 | Per Diem | 195 | Per Diem | 150 | Per Diem | 195 | Per Diem | 250 | Per Diem | 0 | Per Diem | 250 | $110.00 | $300.00 | 175 |