"hospital_Mt. Airy Development, LLC" last_updated_ 2023-12-31 version_1 "hospital_Cincinnati, Ohio" hospital_address 2446 Kipling Avenue license_ 07-8013 | OH "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 BETTER HEALTH O MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH O MANAGED MEDICAID] |percent standard_charge|[payer_AETNA BETTER HEALTH O MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AETNA BETTER HEALTH O MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS OHIO MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS OHIO MANAGED MEDICAID] |percent standard_charge|[payer_AMERIHEALTH CARITAS OHIO MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_AMERIHEALTH CARITAS OHIO MANAGED MEDICAID] standard_charge|[payer_ANTHEM BCBS OH BLUE CROSS] standard_charge|[payer_ANTHEM BCBS OH BLUE CROSS] |percent standard_charge|[payer_ANTHEM BCBS OH BLUE CROSS] |contracting_method additional_payer_notes |[payer_ANTHEM BCBS OH BLUE CROSS] standard_charge|[payer_ANTHEM MEDICAID MANAGED MEDICAID] standard_charge|[payer_ANTHEM MEDICAID MANAGED MEDICAID] |percent standard_charge|[payer_ANTHEM MEDICAID MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_ANTHEM MEDICAID MANAGED MEDICAID] standard_charge|[payer_ANTHEM MEDICARE MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDICARE MANAGED MEDICARE] |percent standard_charge|[payer_ANTHEM MEDICARE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ANTHEM MEDICARE MANAGED MEDICARE] standard_charge|[payer_BCBS FEDERAL BLUE CROSS] standard_charge|[payer_BCBS FEDERAL BLUE CROSS] |percent standard_charge|[payer_BCBS FEDERAL BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS FEDERAL 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_BEACON HEALTH OPTIONS HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS HMO/PPO] |percent standard_charge|[payer_BEACON HEALTH OPTIONS HMO/PPO] |contracting_method additional_payer_notes |[payer_BEACON HEALTH OPTIONS HMO/PPO] standard_charge|[payer_BUCKEYE COMMUNITY HEALTH MANAGED MEDICAID] standard_charge|[payer_BUCKEYE COMMUNITY HEALTH MANAGED MEDICAID] |percent standard_charge|[payer_BUCKEYE COMMUNITY HEALTH MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_BUCKEYE COMMUNITY HEALTH MANAGED MEDICAID] standard_charge|[payer_BUCKEYE MEDICARE MANAGED MEDICARE] standard_charge|[payer_BUCKEYE MEDICARE MANAGED MEDICARE] |percent standard_charge|[payer_BUCKEYE MEDICARE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BUCKEYE MEDICARE MANAGED MEDICARE] standard_charge|[payer_CARESOURCE HMO/PPO] standard_charge|[payer_CARESOURCE HMO/PPO] |percent standard_charge|[payer_CARESOURCE HMO/PPO] |contracting_method additional_payer_notes |[payer_CARESOURCE HMO/PPO] standard_charge|[payer_CARESOURCE MCD MANAGED MEDICAID] standard_charge|[payer_CARESOURCE MCD MANAGED MEDICAID] |percent standard_charge|[payer_CARESOURCE MCD MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_CARESOURCE MCD MANAGED MEDICAID] 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/EVERNORTH HMO/PPO] standard_charge|[payer_CIGNA/EVERNORTH HMO/PPO] |percent standard_charge|[payer_CIGNA/EVERNORTH HMO/PPO] |contracting_method additional_payer_notes |[payer_CIGNA/EVERNORTH HMO/PPO] 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 MCR MANAGED MEDICARE] standard_charge|[payer_HUMANA MCR MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MCR MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MCR MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICAID MANAGED MEDICAID] standard_charge|[payer_HUMANA MEDICAID MANAGED MEDICAID] |percent standard_charge|[payer_HUMANA MEDICAID MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HUMANA MEDICAID MANAGED MEDICAID] standard_charge|[payer_MAGELLAN HMO/PPO] standard_charge|[payer_MAGELLAN HMO/PPO] |percent standard_charge|[payer_MAGELLAN HMO/PPO] |contracting_method additional_payer_notes |[payer_MAGELLAN HMO/PPO] standard_charge|[payer_MEDICAID MEDICAID ] standard_charge|[payer_MEDICAID MEDICAID ] |percent standard_charge|[payer_MEDICAID MEDICAID ] |contracting_method additional_payer_notes |[payer_MEDICAID MEDICAID ] standard_charge|[payer_MEDICAL MUTUAL HMO/PPO] standard_charge|[payer_MEDICAL MUTUAL HMO/PPO] |percent standard_charge|[payer_MEDICAL MUTUAL HMO/PPO] |contracting_method additional_payer_notes |[payer_MEDICAL MUTUAL 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 COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH COMMERCIAL] |percent standard_charge|[payer_MERITAIN HEALTH COMMERCIAL] |contracting_method additional_payer_notes |[payer_MERITAIN HEALTH COMMERCIAL] standard_charge|[payer_MISC COMMERICAL COMMERCIAL] standard_charge|[payer_MISC COMMERICAL COMMERCIAL] |percent standard_charge|[payer_MISC COMMERICAL COMMERCIAL] |contracting_method additional_payer_notes |[payer_MISC COMMERICAL COMMERCIAL] standard_charge|[payer_MOLINA MCD MANAGED MEDICAID] standard_charge|[payer_MOLINA MCD MANAGED MEDICAID] |percent standard_charge|[payer_MOLINA MCD MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_MOLINA MCD MANAGED MEDICAID] standard_charge|[payer_MOLINA MYCARE MEDICARE MANAGED MEDICARE] standard_charge|[payer_MOLINA MYCARE MEDICARE MANAGED MEDICARE] |percent standard_charge|[payer_MOLINA MYCARE MEDICARE MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_MOLINA MYCARE MEDICARE MANAGED MEDICARE] standard_charge|[payer_NGS AMERICAN INSURANCE COMMERCIAL] standard_charge|[payer_NGS AMERICAN INSURANCE COMMERCIAL] |percent standard_charge|[payer_NGS AMERICAN INSURANCE COMMERCIAL] |contracting_method additional_payer_notes |[payer_NGS AMERICAN INSURANCE COMMERCIAL] standard_charge|[payer_OHIO HEALTHY COMMERCIAL] standard_charge|[payer_OHIO HEALTHY COMMERCIAL] |percent standard_charge|[payer_OHIO HEALTHY COMMERCIAL] |contracting_method additional_payer_notes |[payer_OHIO HEALTHY COMMERCIAL] standard_charge|[payer_OHIO PPO CONNECT COMMERCIAL] standard_charge|[payer_OHIO PPO CONNECT COMMERCIAL] |percent standard_charge|[payer_OHIO PPO CONNECT COMMERCIAL] |contracting_method additional_payer_notes |[payer_OHIO PPO CONNECT COMMERCIAL] standard_charge|[payer_OHIO RISE AETNA MANAGED MEDICAID] standard_charge|[payer_OHIO RISE AETNA MANAGED MEDICAID] |percent standard_charge|[payer_OHIO RISE AETNA MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_OHIO RISE AETNA MANAGED MEDICAID] standard_charge|[payer_OPTUM HMO/PPO] standard_charge|[payer_OPTUM HMO/PPO] |percent standard_charge|[payer_OPTUM HMO/PPO] |contracting_method additional_payer_notes |[payer_OPTUM HMO/PPO] standard_charge|[payer_PARAMOUNT MCD MANAGED MEDICAID] standard_charge|[payer_PARAMOUNT MCD MANAGED MEDICAID] |percent standard_charge|[payer_PARAMOUNT MCD MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_PARAMOUNT MCD MANAGED MEDICAID] standard_charge|[payer_UHC COMMERICAL HMO/PPO] standard_charge|[payer_UHC COMMERICAL HMO/PPO] |percent standard_charge|[payer_UHC COMMERICAL HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC COMMERICAL HMO/PPO] standard_charge|[payer_UHC COMMERICAL NON HMO HMO/PPO] standard_charge|[payer_UHC COMMERICAL NON HMO HMO/PPO] |percent standard_charge|[payer_UHC COMMERICAL NON HMO HMO/PPO] |contracting_method additional_payer_notes |[payer_UHC COMMERICAL NON HMO HMO/PPO] standard_charge|[payer_UHCCP MEDICAID MANAGED MEDICAID] standard_charge|[payer_UHCCP MEDICAID MANAGED MEDICAID] |percent standard_charge|[payer_UHCCP MEDICAID MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHCCP MEDICAID MANAGED MEDICAID] standard_charge|[payer_UMR HMO/PPO] standard_charge|[payer_UMR HMO/PPO] |percent standard_charge|[payer_UMR HMO/PPO] |contracting_method additional_payer_notes |[payer_UMR HMO/PPO] ROOM AND BOARD PSYCH ADOL-CEN1 124 RC facility inpatient 4000.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem ROOM AND BOARD PSYCH ADOL-WES4 124 RC facility inpatient 4000.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem ROOM AND BOARD PSYCH ADULT CEN4 124 RC facility inpatient 4000.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem ROOM AND BOARD PSYCH ADULT-CEN2 124 RC facility inpatient 4000.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem ROOM AND BOARD PSYCH ADULT-WES3 124 RC facility inpatient 4000.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem ROOM AND BOARD PSYCH WES4 124 RC facility inpatient 4000.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem 1:1 SUPERVISION 124 RC facility inpatient 28.00 750 927 4000 927 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1120 per diem ROOM AND BOARD DETOX ADULT-CEN2 126 RC facility inpatient 4000.00 750 824 4000 824 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1057 per diem ROOM AND BOARD DETOX ADULT-WES3 126 RC facility inpatient 4000.00 750 824 4000 824 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1057 per diem ROOM AND BOARD DETOX CEN4 126 RC facility inpatient 4000.00 750 824 4000 824 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1057 per diem ROOM AND BOARD DETOX CEN4 126 RC facility inpatient 4000.00 750 824 4000 824 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1057 per diem R&D DETOX WES4 126 RC facility inpatient 4000.00 750 824 4000 824 per diem 974 per diem 974 per diem 974 per diem 950 per diem 950 per diem 975 per diem 1352 per diem 1000 per diem 4000 per diem 1154 per diem 1057 per diem ROOM AND BOARD REHAB WES4 128 RC facility inpatient 4000.00 0 715 1352 824 per diem 974 per diem 974 per diem 950 per diem 715 per diem 1352 per diem 950 per diem ROOM AND BOARD REHAB/CD-CEN2 128 RC facility inpatient 4000.00 0 715 1352 824 per diem 974 per diem 974 per diem 950 per diem 715 per diem 1352 per diem 950 per diem ROOM AND BOARD REHAB/CD-WES3 128 RC facility inpatient 4000.00 0 715 1352 824 per diem 974 per diem 974 per diem 950 per diem 715 per diem 1352 per diem 950 per diem REHAB ROOM AND BOARD CEN4 128 RC facility inpatient 4000.00 0 715 1352 824 per diem 974 per diem 974 per diem 950 per diem 715 per diem 1352 per diem 950 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT 905 RC facility outpatient 600.00 150 146.27 1000 450 per diem 182.66 per diem 182.66 per diem 205 per diem 200 per diem 200 per diem 205 per diem 205 per diem 250 per diem 191.71 per diem 182.66 per diem 182.66 per diem 230 per diem 230 per diem 239 per diem 225 per diem 182.66 per diem 364 per diem 600 per diem 350 per diem 146.27 per diem 1000 per diem 1000 per diem 182.66 per diem 1000 per diem 1000 per diem 1000 per diem 182.66 per diem 309 per diem 182.66 per diem 309 per diem 309 per diem 182.66 per diem 309 per diem INTENSIVE OUTPATIENT PROGRAM GROUP 1 905 RC facility outpatient 600.00 150 146.27 1000 450 per diem 182.66 per diem 182.66 per diem 205 per diem 200 per diem 200 per diem 205 per diem 205 per diem 250 per diem 191.71 per diem 182.66 per diem 182.66 per diem 230 per diem 230 per diem 239 per diem 225 per diem 182.66 per diem 364 per diem 600 per diem 350 per diem 146.27 per diem 1000 per diem 1000 per diem 182.66 per diem 1000 per diem 1000 per diem 1000 per diem 182.66 per diem 309 per diem 182.66 per diem 309 per diem 309 per diem 182.66 per diem 309 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADULT 1 905 RC facility outpatient 600.00 150 146.27 1000 450 per diem 182.66 per diem 182.66 per diem 205 per diem 200 per diem 200 per diem 205 per diem 205 per diem 250 per diem 191.71 per diem 182.66 per diem 182.66 per diem 230 per diem 230 per diem 239 per diem 225 per diem 182.66 per diem 364 per diem 600 per diem 350 per diem 146.27 per diem 1000 per diem 1000 per diem 182.66 per diem 1000 per diem 1000 per diem 1000 per diem 182.66 per diem 309 per diem 182.66 per diem 309 per diem 309 per diem 182.66 per diem 309 per diem PARTIAL HOSPITAL PROGRAM PSYCH ED 1 912 RC facility outpatient 250.00 300 374 520 425 per diem 374 per diem 374 per diem 374 per diem 430 per diem 440 per diem 520 per diem 500 per diem 400 per diem 400 per diem PARTIAL HOSPITAL PROGRAM PSYCH THERAPY 1 912 RC facility outpatient 250.00 300 374 520 425 per diem 374 per diem 374 per diem 374 per diem 430 per diem 440 per diem 520 per diem 500 per diem 400 per diem 400 per diem INITIAL HOSPITAL INPATIENT CARE 99221 RC facility Pro Fee 200.00 0 37.61 71.31 37.61 fee schedule 37.61 fee schedule 71.31 fee schedule 37.61 fee schedule INITIAL HOSPITAL INPATIENT CARE 99222 RC facility Pro Fee 210.00 0 55.71 106.51 55.71 fee schedule 55.71 fee schedule 58.50 fee schedule 55.71 fee schedule 55.71 fee schedule 106.51 fee schedule 55.71 fee schedule INITIAL HOSPITAL INPATIENT CARE 99223 RC facility Pro Fee 250.00 0 76.84 218.5 76.84 fee schedule 76.84 fee schedule 141.86 fee schedule 76.84 fee schedule 218.50 fee schedule 155.29 fee schedule 148.78 fee schedule 120.17 fee schedule 76.84 fee schedule 141.86 fee schedule 140.37 fee schedule 147.76 fee schedule SUBSEQUENT HOSPITAL INPATIENT CARE 99231 RC facility Pro Fee 120.00 0 17.49 69.42 17.49 fee schedule 17.49 fee schedule 47.94 fee schedule 17.49 fee schedule 34.3 fee schedule 39.24 fee schedule 17.49 fee schedule 41.49 fee schedule 69.42 fee schedule LEVEL 2 HOSPITAL SUBSEQUENT CARE 99232 RC facility Pro Fee 140.00 0 25.36 72.94 28.18 fee schedule 28.18 fee schedule 29.10 fee schedule 67.70 fee schedule 28.18 fee schedule 25.36 fee schedule 50.8 fee schedule 51.76 fee schedule 28.18 fee schedule 64.70 fee schedule 61.3 fee schedule 28.18 fee schedule 72.94 fee schedule LEVEL 3 HOSPITAL SUBSEQUENT CARE 99233 RC facility Pro Fee 160.00 0 36.25 97.34 40.28 fee schedule 40.28 fee schedule 40.28 fee schedule 40.28 fee schedule 36.25 fee schedule 76.82 fee schedule 63.24 fee schedule 40.28 fee schedule 97.34 fee schedule 87.16 fee schedule 40.28 fee schedule HOSPITAL INPATIENT CARE DISCHARGE 99238 RC facility Pro Fee 160.00 0 31.62 68.84 52.59 fee schedule 31.62 fee schedule 68.84 fee schedule HOSPITAL INPATIENT CARE DISCHARGE 99239 RC facility Pro Fee 200.00 0 37.6 97.65 41.78 fee schedule 41.78 fee schedule 43.17 fee schedule 41.78 fee schedule 37.60 fee schedule 78.43 fee schedule 74.67 fee schedule 41.78 fee schedule 93.34 fee schedule 76.1 fee schedule 41.78 fee schedule 97.65 fee schedule