Price Transparency-TALL.xlsx

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R	S
1	hospital_name	last_updated_on	version	hospital_location	hospital_address	license_number\|LA	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.
2	Solutions Medical Consulting LLC	2024-10-14	2.0.0	Serenity Springs Specialty Hospital	1495 Frazier Rd, Ruston, LA 71270	194074	TRUE
3	description	code\|1	code\|1\|type	setting	drug_unit_of_measurement	drug_type_of_measurement	standard_charge\|gross	standard_charge\|discounted_cash	payer_name	plan_name	modifiers	standard_charge\|negotiated_dollar	standard_charge\|negotiated_percentage	standard_charge\|negotiated_algorithm	estimated_amount	standard_charge\|min	standard_charge\|max	standard_charge\|methodology	additional_generic_notes
4	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	AETNA	COMMERCIAL		815			815	815	815	per diem
5	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	AETNA	MEDICARE ADVANTAGE		619			619	619	619	per diem
6	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	AETNA	MEDICAID		738			738	738	738	per diem
7	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	AMERIHEALTH CARITAS	MEDICAID		738			738	738	738	per diem
8	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BCBS LOUSIANA	COMMERCIAL		757			757	757	757	per diem
9	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BCBS LOUSIANA	MEDICARE		695			695	695	695	per diem
10	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BCBS TEXAS	COMMERCIAL		757			757	757	757	per diem
11	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BCBS TEXAS BLUE ESSENTIALS/BLUE PREMIER/BLUE HIGH PERFORMANCE HMO	COMMERCIAL		757			757	757	757	per diem
12	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BEACON HEALTH OPTIONS	COMMERCIAL								per diem
13	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BEACON HEALTH STRATEGIES	COMMERCIAL								per diem
14	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	BEACON HEALTH STRATEGIES	MEDICAID								per diem
15	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	CIGNA	COMMERCIAL		720			720	720	720	per diem
16	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	CIGNA HEALTHSPRING	MEDICARE ADVANTAGE		797			797	797	797	per diem
17	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	GILSBAR 360 ALLIANCE	COMMERCIAL								per diem
18	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	HEALTHY BLUE	MEDICAID		738			738	738	738	per diem
19	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	HUMANA	COMMERCIAL		803			803	803	803	per diem
20	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	HUMANA	MEDICAID		738			738	738	738	per diem
21	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	HUMANA	MEDICARE ADVANTAGE		797			797	797	797	per diem
22	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	LOUISIANA HEALTHCARE CONNECTIONS	MEDICAID		737			737	737	737	per diem
23	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	LOUISIANA MEDICAID	MEDICAID								per diem
24	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	MAGELLAN	COMMERCIAL								per diem
25	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	MEDICARE	PART A		797			797	797	797	per diem
26	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	MEDICARE	PART B								per diem
27	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	MERITAIN HEALTH	COMMERCIAL								per diem
28	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	MH NEW	MEDICARE ADVANTAGE								per diem
29	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	MULTIPLAN	COMMERCIAL								per diem
30	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	OPTUM	MEDICAID		738			738	738	738	per diem
31	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	OPTUM	MEDICARE ADVANTAGE		925			925	925	925	per diem
32	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	OPTUM VA CCN	MEDICARE ADVANTAGE		797			797	797	797	per diem
33	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	TRICARE HUMANA	COMMERCIAL		844.35			844.35	844.35	844.35	per diem
34	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	TRICARE WEST	COMMERCIAL								per diem
35	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	TRIWEST HEALTHCARE ALLIANCE (VACCN)	MEDICARE ADVANTAGE		675			675	675	675	per diem
36	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	UMR	COMMERCIAL								per diem
37	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	UNITED HEALTHCARE	COMMERCIAL		675			675	675	675	per diem
38	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	UNITED HEALTHCARE	MEDICAID		675			675	675	675	per diem
39	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	UNITED HEALTHCARE	MEDICARE		797			797	797	797	per diem
40	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	WELLCARE	COMMERCIAL		797			797	797	797	per diem
41	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	WELLCARE	MEDICARE ADVANTAGE		797			797	797	797	per diem
42	Inpatient Psychiatric treatment	124	RC	inpatient			2400	1400	ZELLIS	COMMERCIAL								per diem
43	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	AETNA	COMMERCIAL		305.4			305.4	305.4	305.4	fee schedule
44	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	AETNA	MEDICARE ADVANTAGE		69.75			69.75	69.75	69.75	fee schedule
45	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	BCBS LOUSIANA	COMMERCIAL		264.6			264.6	264.6	264.6	fee schedule
46	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	BCBS LOUSIANA	MEDICARE		226.81			226.81	226.81	226.81	fee schedule
47	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	CIGNA	COMMERCIAL		222			222	222	222	fee schedule
48	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	HUMANA	MEDICARE ADVANTAGE		225.93			225.93	225.93	225.93	fee schedule
49	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	MEDICARE	PART A		223.18			223.18	223.18	223.18	fee schedule
50	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	OPTUM VA CCN	MEDICARE ADVANTAGE								fee schedule
51	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	TRICARE HUMANA	COMMERCIAL								fee schedule
52	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	TRICARE WEST	COMMERCIAL								fee schedule
53	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	TRIWEST HEALTHCARE ALLIANCE (VACCN)	MEDICARE ADVANTAGE								fee schedule
54	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	UNITED HEALTHCARE	COMMERCIAL		300			300	300	300	fee schedule
55	INTENSIVE OUTPATIENT SERVICES (IOP)	124	RC	OUTPATIENT			378	210	UNITED HEALTHCARE	MEDICARE		100			100	100	100	fee schedule
56	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	AETNA	COMMERCIAL		123.64			123.64	123.64	123.64	fee schedule
57	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	AETNA	MEDICARE ADVANTAGE		131.35			131.35	131.35	131.35	fee schedule
58	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	BCBS LOUSIANA	COMMERCIAL		148.61			148.61	148.61	148.61	fee schedule
59	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	BCBS LOUSIANA	MEDICARE		105.09			105.09	105.09	105.09	fee schedule
60	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	BCBS TEXAS	COMMERCIAL		148.61			148.61	148.61	148.61	fee schedule
61	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	BCBS TX BLUE ESSENTIALS/BLUE PREMIER/BLUE HIGH PERFORMANCE	COMMERCIAL		148.61			148.61	148.61	148.61	fee schedule
62	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	CIGNA HEALTH SPRING	MEDICARE ADVANTAGE		126.77			126.77	126.77	126.77	fee schedule
63	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	HUMANA	COMMERCIAL								fee schedule
64	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	HUMANA	MEDICARE ADVANTAGE		126.77			126.77	126.77	126.77	fee schedule
65	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	MAGELLAN	COMMERCIAL								fee schedule
66	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	MEDICARE	PART A								fee schedule
67	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	MEDICARE	PART B		126.77			126.77	126.77	126.77	fee schedule
68	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	MERITAIN HEALTH	COMMERCIAL								fee schedule
69	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	MH NET	MEDICARE ADVANTAGE								fee schedule
70	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	MULTIPLAN	COMMERCIAL								fee schedule
71	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	OPTUM	MEDICARE ADVANTAGE								fee schedule
72	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	OPTUM VACCN	MEDICARE ADVANTAGE		126.77			126.77	126.77	126.77	fee schedule
73	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	TRICARE HUMANA	COMMERCIAL								fee schedule
74	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	TRICARE WEST	COMMERCIAL								fee schedule
75	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	TRIWEST HEALTHCARE ALLIANCE (VACCN)	MEDICARE ADVANTAGE								fee schedule
76	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	UMR	COMMERCIAL		148.63			148.63	148.63	148.63	fee schedule
77	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	UNITED HEALTHCARE	COMMERCIAL		148.63			148.63	148.63	148.63	fee schedule
78	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	UNITED HEALTHCARE	MEDICARE		126.77			126.77	126.77	126.77	fee schedule
79	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	WELLCARE	COMMERCIAL								fee schedule
80	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	WELLCARE	MEDICARE ADVANTAGE		126.77			126.77	126.77	126.77	fee schedule
81	PSYCHATRIC DIAGNOSTIC EVALUATION	90791	CPT	OUTPATIENT			250	200	ZELLUS	COMMERCIAL								fee schedule
82	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	AETNA	COMMERCIAL		123.64			123.64	123.64	123.64	fee schedule
83	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	AETNA	MEDICARE ADVANTAGE		131.35			131.35	131.35	131.35	fee schedule
84	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	BCBS LOUSIANA	COMMERCIAL		148.61			148.61	148.61	148.61	fee schedule
85	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	BCBS LOUSIANA	MEDICARE		119.96			119.96	119.96	119.96	fee schedule
86	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	BCBS TEXAS	COMMERCIAL		148.61			148.61	148.61	148.61	fee schedule
87	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	BCBS TX BLUE ESSENTIALS/BLUE PREMIER/BLUE HIGH PERFORMANCE	COMMERCIAL		148.61			148.61	148.61	148.61	fee schedule
88	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	CIGNA HEALTH SPRING	MEDICARE ADVANTAGE		141.13			141.13	141.13	141.13	fee schedule
89	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	HUMANA	COMMERCIAL								fee schedule
90	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	HUMANA	MEDICARE ADVANTAGE		141.13			141.13	141.13	141.13	fee schedule
91	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	MAGELLAN	COMMERCIAL								fee schedule
92	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	MEDICARE	PART A								fee schedule
93	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	MEDICARE	PART B		141.13			141.13	141.13	141.13	fee schedule
94	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	MERITAIN HEALTH	COMMERCIAL								fee schedule
95	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	MH NET	MEDICARE ADVANTAGE								fee schedule
96	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	MULTIPLAN	COMMERCIAL								fee schedule
97	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	OPTUM	MEDICARE ADVANTAGE								fee schedule
98	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	OPTUM VACCN	MEDICARE ADVANTAGE		126.77			126.77	126.77	126.77	fee schedule
99	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	TRICARE HUMANA	COMMERCIAL								fee schedule
100	PSYCHATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES	90792	CPT	OUTPATIENT			250	200	TRICARE WEST	COMMERCIAL								fee schedule