Northlake Behavioral Health System 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 Last Updated: 12/01/2024 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: METRIC: Gross Charge VALUE: 1200 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: METRIC: Discount Cash Price/Self Pay VALUE: 650 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: METRIC: De-Identified Minimum Negotiated Charge VALUE: 650 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: METRIC: De-Identified Maximum Negotiated Charge VALUE: 907 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Aetna |HMO/PPO METRIC: Negotiated Charge VALUE: 907 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Aetna Better Health |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Amerihealth |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Blue Cross |HMO/PPO METRIC: Negotiated Charge VALUE: 783 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Cigna | HMO/PPO METRIC: Negotiated Charge VALUE: 700 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Healthy Blue |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Humana |HMO/PPO METRIC: Negotiated Charge VALUE: 900 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: LA Healthcare Connections |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: United Healthcare | HMO/PPO METRIC: Negotiated Charge VALUE: 650 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: UHC Community Plan Bayou Health |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: MH INPATIENT INSURANCE PROVIDER: Humana Healthy Horizons |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: METRIC: Gross Charge VALUE: 1200 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: METRIC: Discount Cash Price/Self Pay VALUE: 650 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: METRIC: De-Identified Minimum Negotiated Charge VALUE: 650 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: METRIC: De-Identified Maximum Negotiated Charge VALUE: 907 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Aetna |HMO/PPO METRIC: Negotiated Charge VALUE: 907 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Aetna Better Health |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Amerihealth |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Blue Cross |HMO/PPO METRIC: Negotiated Charge VALUE: 783 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Cigna | HMO/PPO METRIC: Negotiated Charge VALUE: 700 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Healthy Blue |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Humana |HMO/PPO METRIC: Negotiated Charge VALUE: 900 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: LA Healthcare Connections |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: United Healthcare | HMO/PPO METRIC: Negotiated Charge VALUE: 650 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: UHC Community Plan Bayou Health |Medicaid METRIC: Negotiated Charge VALUE: 737 SERVICE DESCRIPTION: Detox INPATIENT INSURANCE PROVIDER: Humana Healthy Horizons |Medicaid METRIC: Negotiated Charge VALUE: 773 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: METRIC: Gross Charge VALUE: 450 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: METRIC: Discount Cash Price/Self Pay VALUE: 120 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: METRIC: De-Identified Minimum Negotiated Charge VALUE: 175 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: METRIC: De-Identified Maximum Negotiated Charge VALUE: 240 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: Aetna |HMO/PPO METRIC: Negotiated Charge VALUE: 212 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: Aetna Better Health |Medicaid METRIC: Negotiated Charge VALUE: 212 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: Blue Cross |HMO/PPO METRIC: Negotiated Charge VALUE: 240 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: Cigna | HMO/PPO METRIC: Negotiated Charge VALUE: 185 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: Humana |HMO/PPO METRIC: Negotiated Charge VALUE: 200 SERVICE DESCRIPTION: INTENSIVE OUTPATIENT PROGRAM MH PROGRAM INSURANCE PROVIDER: United Healthcare | HMO/PPO METRIC: Negotiated Charge VALUE: 175 All shoppable services, including any of the applicable 70 CMS-specified services, provided by the Hospital have been included in this Shoppable Services Charge List.