"hospital_Signature Psychiatric Hospital, LLC" last_updated_ 2023-12-31 version_1 "hospital_Liberty, Missouri" hospital_address 2525 Glen Hendren Dr license_ 551-5| MO "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 MEDICARE|MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_AETNA 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_ALLWELL WELLCARE|MANAGED MEDICARE] standard_charge|[payer_ALLWELL WELLCARE|MANAGED MEDICARE] |percent standard_charge|[payer_ALLWELL WELLCARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_ALLWELL WELLCARE|MANAGED MEDICARE] standard_charge|[payer_AMBETTER|HMO/PPO] standard_charge|[payer_AMBETTER|HMO/PPO] |percent standard_charge|[payer_AMBETTER|HMO/PPO] |contracting_method additional_payer_notes |[payer_AMBETTER|HMO/PPO] 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 MEDICARE|MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_BCBS MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_BCBS MEDICARE|MANAGED MEDICARE] standard_charge|[payer_BCBS OF MO|BLUE CROSS] standard_charge|[payer_BCBS OF MO|BLUE CROSS] |percent standard_charge|[payer_BCBS OF MO|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OF MO|BLUE CROSS] standard_charge|[payer_BCBS OOS|BLUE CROSS] standard_charge|[payer_BCBS OOS|BLUE CROSS] |percent standard_charge|[payer_BCBS OOS|BLUE CROSS] |contracting_method additional_payer_notes |[payer_BCBS OOS|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_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_FREEDOM NETWORK|COMMERCIAL] standard_charge|[payer_FREEDOM NETWORK|COMMERCIAL] |percent standard_charge|[payer_FREEDOM NETWORK|COMMERCIAL] |contracting_method additional_payer_notes |[payer_FREEDOM NETWORK|COMMERCIAL] standard_charge|[payer_FREEDOM NETWORK|HMO/PPO] standard_charge|[payer_FREEDOM NETWORK|HMO/PPO] |percent standard_charge|[payer_FREEDOM NETWORK|HMO/PPO] |contracting_method additional_payer_notes |[payer_FREEDOM NETWORK|HMO/PPO] standard_charge|[payer_GEHA|HMO/PPO] standard_charge|[payer_GEHA|HMO/PPO] |percent standard_charge|[payer_GEHA|HMO/PPO] |contracting_method additional_payer_notes |[payer_GEHA|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_HOME STATE HEALTH|MANAGED MEDICAID] standard_charge|[payer_HOME STATE HEALTH|MANAGED MEDICAID] |percent standard_charge|[payer_HOME STATE HEALTH|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_HOME STATE HEALTH|MANAGED MEDICAID] 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 MEDICARE|MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_HUMANA MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_HUMANA MEDICARE|MANAGED MEDICARE] standard_charge|[payer_LIBERTY HOSPITAL|COMMERCIAL] standard_charge|[payer_LIBERTY HOSPITAL|COMMERCIAL] |percent standard_charge|[payer_LIBERTY HOSPITAL|COMMERCIAL] |contracting_method additional_payer_notes |[payer_LIBERTY HOSPITAL|COMMERCIAL] standard_charge|[payer_LINECO|HMO/PPO] standard_charge|[payer_LINECO|HMO/PPO] |percent standard_charge|[payer_LINECO|HMO/PPO] |contracting_method additional_payer_notes |[payer_LINECO|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|HMO/PPO] standard_charge|[payer_MERITAIN|HMO/PPO] |percent standard_charge|[payer_MERITAIN|HMO/PPO] |contracting_method additional_payer_notes |[payer_MERITAIN|HMO/PPO] standard_charge|[payer_MISSOURI MEDICAID|MEDICAID ] standard_charge|[payer_MISSOURI MEDICAID|MEDICAID ] |percent standard_charge|[payer_MISSOURI MEDICAID|MEDICAID ] |contracting_method additional_payer_notes |[payer_MISSOURI MEDICAID|MEDICAID ] standard_charge|[payer_NORTH KANSAS CITY|COMMERCIAL] standard_charge|[payer_NORTH KANSAS CITY|COMMERCIAL] |percent standard_charge|[payer_NORTH KANSAS CITY|COMMERCIAL] |contracting_method additional_payer_notes |[payer_NORTH KANSAS CITY|COMMERCIAL] standard_charge|[payer_PRIME HEALTHCARE|HMO/PPO] standard_charge|[payer_PRIME HEALTHCARE|HMO/PPO] |percent standard_charge|[payer_PRIME HEALTHCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_PRIME HEALTHCARE|HMO/PPO] standard_charge|[payer_QUIK TRIP|HMO/PPO] standard_charge|[payer_QUIK TRIP|HMO/PPO] |percent standard_charge|[payer_QUIK TRIP|HMO/PPO] |contracting_method additional_payer_notes |[payer_QUIK TRIP|HMO/PPO] 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_UHC MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UHC MEDICAID|MANAGED MEDICAID] |percent standard_charge|[payer_UHC MEDICAID|MANAGED MEDICAID] |contracting_method additional_payer_notes |[payer_UHC MEDICAID|MANAGED MEDICAID] standard_charge|[payer_UHC MEDICARE|MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE|MANAGED MEDICARE] |percent standard_charge|[payer_UHC MEDICARE|MANAGED MEDICARE] |contracting_method additional_payer_notes |[payer_UHC MEDICARE|MANAGED MEDICARE] 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] standard_charge|[payer_UNITED HEALTHCARE|HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE|HMO/PPO] |percent standard_charge|[payer_UNITED HEALTHCARE|HMO/PPO] |contracting_method additional_payer_notes |[payer_UNITED HEALTHCARE|HMO/PPO] standard_charge|[payer_VA CCN OPTUM|VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM|VETERANS ADMIN] |percent standard_charge|[payer_VA CCN OPTUM|VETERANS ADMIN] |contracting_method additional_payer_notes |[payer_VA CCN OPTUM|VETERANS ADMIN] standard_charge|[payer_WORK COMP|WORKERS COMP] standard_charge|[payer_WORK COMP|WORKERS COMP] |percent standard_charge|[payer_WORK COMP|WORKERS COMP] |contracting_method additional_payer_notes |[payer_WORK COMP|WORKERS COMP] ROOM AND BOARD PSYCH-GERI 124 RC facility inpatient 2268.00 900.00 804.00 1386.00 945.00 per diem 945.00 per diem 948.00 per diem 925.00 per diem 1074.00 per diem 1074.00 per diem 1074.00 per diem 1074.00 per diem 875.00 per diem 994.00 per diem 1074.00 per diem 948.00 per diem 820.32 per diem 841.50 per diem 1080.00 per diem 900.00 per diem 1074.00 per diem 945.00 per diem 820.32 per diem 850.00 per diem 960.00 per diem 900.00 per diem 974.70 per diem 804.00 per diem 1386.00 per diem 1386.00 per diem 882.31 per diem 948.00 per diem 948.00 per diem 1000.00 per diem ROOM AND BOARD PSYCH-NKC 124 RC facility inpatient 2268.00 900.00 804.00 1386.00 945.00 per diem 945.00 per diem 948.00 per diem 925.00 per diem 1074.00 per diem 1074.00 per diem 1074.00 per diem 1074.00 per diem 875.00 per diem 994.00 per diem 1074.00 per diem 948.00 per diem 820.32 per diem 841.50 per diem 1080.00 per diem 900.00 per diem 1074.00 per diem 945.00 per diem 820.32 per diem 850.00 per diem 960.00 per diem 900.00 per diem 974.70 per diem 804.00 per diem 1386.00 per diem 1386.00 per diem 882.31 per diem 948.00 per diem 948.00 per diem 1000.00 per diem TRANSCRANIAL MAGNETIC STIMULATION INITIAL MAPPING 900 RC facility outpatient 648.00 225.00 237.36 285.00 259.20 per diem 259.20 per diem 237.36 per diem 237.36 per diem 237.36 per diem 237.36 per diem 285.00 per diem 255.52 per diem 259.20 per diem 251.43 per diem 285.00 per diem 255.52 per diem TRANSCRANIAL MAGNETIC STIMULATION REMAPPING 900 RC facility outpatient 540.00 175.00 216.00 291.52 216.00 per diem 216.00 per diem 291.52 per diem 291.52 per diem 291.52 per diem 291.52 per diem 285.00 per diem 255.52 per diem 216.00 per diem 251.43 per diem 290.00 per diem 255.52 per diem TRANSCRANIAL MAGNETIC STIMULATION TREATMENT 900 RC facility outpatient 432.00 175.00 148.37 295.00 172.80 per diem 172.80 per diem 148.37 per diem 148.37 per diem 148.37 per diem 148.37 per diem 285.00 per diem 255.52 per diem 172.80 per diem 251.43 per diem 295.00 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT - MPN 905 RC facility outpatient 567.00 175.00 150.00 285.00 235.00 per diem 235.00 per diem 252.00 per diem 225.00 per diem 260.00 per diem 260.00 per diem 260.00 per diem 260.00 per diem 268.00 per diem 273.00 per diem 260.00 per diem 252.00 per diem 200.00 per diem 180.00 per diem 285.00 per diem 172.51 per diem 260.00 per diem 235.00 per diem 252.00 per diem 235.00 per diem 216.73 per diem 214.32 per diem 216.73 per diem 214.32 per diem 150.00 per diem 225.00 per diem 252.00 per diem 252.00 per diem 214.32 per diem 275.00 per diem INTENSIVE OUTPATIENT PROGRAM AM NKC 905 RC facility outpatient 567.00 175.00 150.00 285.00 235.00 per diem 235.00 per diem 252.00 per diem 225.00 per diem 260.00 per diem 260.00 per diem 260.00 per diem 260.00 per diem 268.00 per diem 273.00 per diem 260.00 per diem 252.00 per diem 200.00 per diem 180.00 per diem 285.00 per diem 172.51 per diem 260.00 per diem 235.00 per diem 252.00 per diem 235.00 per diem 216.73 per diem 214.32 per diem 216.73 per diem 214.32 per diem 150.00 per diem 225.00 per diem 252.00 per diem 252.00 per diem 214.32 per diem 275.00 per diem INTENSIVE OUTPATIENT PROGRAM CD - MPN 906 RC facility outpatient 567.00 175.00 150.00 285.00 235.00 per diem 235.00 per diem 252.00 per diem 225.00 per diem 260.00 per diem 260.00 per diem 260.00 per diem 260.00 per diem 268.00 per diem 273.00 per diem 260.00 per diem 252.00 per diem 200.00 per diem 180.00 per diem 285.00 per diem 172.51 per diem 260.00 per diem 235.00 per diem 252.00 per diem 235.00 per diem 216.73 per diem 214.32 per diem 216.73 per diem 214.32 per diem 150.00 per diem 225.00 per diem 252.00 per diem 252.00 per diem 214.32 per diem 275.00 per diem PARTIAL HOSPITAL PROGRAM ADULT - LIBERTY 912 RC facility outpatient 756.00 225.00 200.14 470.00 398.00 per diem 398.00 per diem 402.00 per diem 380.00 per diem 368.00 per diem 368.00 per diem 368.00 per diem 368.00 per diem 410.00 per diem 426.00 per diem 368.00 per diem 402.00 per diem 300.00 per diem 300.00 per diem 470.00 per diem 200.14 per diem 368.00 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 252.63 per diem 251.43 per diem 252.63 per diem 274.00 per diem 350.00 per diem 402.00 per diem 402.00 per diem 252.63 per diem 375.00 per diem PARTIAL HOSPITAL PROGRAM BTC ADLT- NKC 912 RC facility outpatient 756.00 225.00 200.14 470.00 398.00 per diem 398.00 per diem 402.00 per diem 380.00 per diem 368.00 per diem 368.00 per diem 368.00 per diem 368.00 per diem 410.00 per diem 426.00 per diem 368.00 per diem 402.00 per diem 300.00 per diem 300.00 per diem 470.00 per diem 200.14 per diem 368.00 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 252.63 per diem 251.43 per diem 252.63 per diem 274.00 per diem 350.00 per diem 402.00 per diem 402.00 per diem 252.63 per diem 375.00 per diem VALOR PARTIAL HOSPITAL PROGRAM - NKC 912 RC facility outpatient 756.00 225.00 200.14 470.00 398.00 per diem 398.00 per diem 402.00 per diem 380.00 per diem 368.00 per diem 368.00 per diem 368.00 per diem 368.00 per diem 410.00 per diem 426.00 per diem 368.00 per diem 402.00 per diem 300.00 per diem 300.00 per diem 470.00 per diem 200.14 per diem 368.00 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 252.63 per diem 251.43 per diem 252.63 per diem 274.00 per diem 350.00 per diem 402.00 per diem 402.00 per diem 252.63 per diem 375.00 per diem PARTIAL HOSPITAL PROGRAM CD ADULT - NKC 913 RC facility outpatient 756.00 225.00 200.14 470.00 398.00 per diem 398.00 per diem 380.00 per diem 410.00 per diem 426.00 per diem 402.00 per diem 300.00 per diem 300.00 per diem 470.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 252.63 per diem 251.43 per diem 252.63 per diem 274.00 per diem 350.00 per diem 402.00 per diem 252.63 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT GRP1 915 RC facility outpatient 189.00 225.00 200.14 426.00 398.00 per diem 398.00 per diem 426.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 251.43 per diem 252.63 per diem 252.63 per diem INTENSIVE OUTPATIENT PROGRAM BCI PROCESS GRP1 915 RC facility outpatient 189.00 225.00 200.14 426.00 398.00 per diem 398.00 per diem 426.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 251.43 per diem 252.63 per diem 252.63 per diem INTENSIVE OUTPATIENT PROGRAM DUAL EVE GRP1 915 RC facility outpatient 189.00 225.00 200.14 426.00 398.00 per diem 398.00 per diem 426.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 251.43 per diem 252.63 per diem 252.63 per diem INTENSIVE OUTPATIENT PROGRAM DUAL EVE TH GRP1 915 RC facility outpatient 189.00 225.00 200.14 426.00 398.00 per diem 398.00 per diem 426.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 251.43 per diem 252.63 per diem 252.63 per diem INTENSIVE OUTPATIENT PROGRAM VALOR TH GRP3 915 RC facility outpatient 189.00 225.00 200.14 426.00 398.00 per diem 398.00 per diem 426.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 251.43 per diem 252.63 per diem 252.63 per diem PARTIAL HOSPITAL PROGRAM BTC GRP1 TH 915 RC facility outpatient 189.00 225.00 200.14 426.00 398.00 per diem 398.00 per diem 426.00 per diem 200.14 per diem 398.00 per diem 410.00 per diem 375.00 per diem 251.43 per diem 251.43 per diem 252.63 per diem 252.63 per diem ROOM AND BOARD CD RESIDENTIAL 1002 RC facility inpatient 1080.00 650.00 525.00 675.00 661.00 per diem 670.00 per diem 525.00 per diem 593.00 per diem 593.00 per diem 593.00 per diem 600.00 per diem 651.00 per diem 593.00 per diem 670.00 per diem 650.00 per diem 593.00 per diem 675.00 per diem 670.00 per diem 670.00 per diem "Initial hospital inpatient or observation care, per day, moderate medical decision making" 99222 RC facility Inpatient / Outpatient 200.00 0.00 87.53 200.00 120.40 fee schedule 120.40 fee schedule 114.94 fee schedule 120.24 fee schedule 200.00 fee schedule 137.88 fee schedule 110.86 fee schedule 110.86 fee schedule 99.74 fee schedule 94.09 fee schedule 87.53 fee schedule 163.20 fee schedule 109.10 fee schedule 115.52 fee schedule 110.54 fee schedule 96.21 fee schedule 133.94 fee schedule 122.14 fee schedule 111.85 fee schedule "Initial hospital inpatient or observation care, per day, high-level medical decision making" 99223 RC facility Inpatient / Outpatient 204.00 0.00 64.75 189.75 177.12 fee schedule 177.12 fee schedule 115.28 fee schedule 189.75 fee schedule 158.29 fee schedule 162.57 fee schedule 162.57 fee schedule 139.64 fee schedule 157.89 fee schedule 134.64 fee schedule 64.75 fee schedule 73.16 fee schedule 142.80 fee schedule 162.57 fee schedule 129.71 fee schedule 159.12 fee schedule 163.86 fee schedule 171.09 fee schedule "Subsequent hospital inpatient or observation care, per day, moderate medical decision making 35 Mins" 99232 RC facility Inpatient / Outpatient 105.00 0.00 53.21 80.45 80.45 fee schedule 80.45 fee schedule 69.34 fee schedule 70.49 fee schedule 65.28 fee schedule 72.38 fee schedule 58.46 fee schedule 58.46 fee schedule 60.64 fee schedule 67.06 fee schedule 53.21 fee schedule 68.90 fee schedule 58.55 fee schedule 59.02 fee schedule 65.80 fee schedule 62.33 fee schedule 68.75 fee schedule Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter 99238 RC facility Inpatient / Outpatient 135.00 0.00 26.17 89.13 81.31 fee schedule 81.31 fee schedule 67.47 fee schedule 70.13 fee schedule 88.96 fee schedule 58.97 fee schedule 58.97 fee schedule 68.69 fee schedule 26.17 fee schedule 71.55 fee schedule 70.56 fee schedule 58.97 fee schedule 89.13 fee schedule 69.04 fee schedule 64.53 fee schedule 79.50 fee schedule