{ "hospital_name": "Summit BHC West Virginia, LLC", "last_updated_on": "2026-04-29", "version": "3.0.0", "location_name": [ "Highland Hospital" ], "hospital_address": [ "300 56th Street SE, Charleston, WV 25304" ], "license_information": { "state": "WV", "license_number": "127" }, "type_2_npi": [ "1427672336" ], "attestation": { "attestation": "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 is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount.\nFor payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Patrick Burrows" }, "standard_charge_information": [ { "description": "Crisis Stabilization Per Diem", "code_information": [ { "code": "H0037", "type": "HCPCS" }, { "code": "231", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "ABH - COVENTRY", "plan_name": "ABH - COVENTRY", "standard_charge_dollar": 17.72, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - IMD", "plan_name": "ABH - IMD", "standard_charge_dollar": 26.79, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - PROMISES", "plan_name": "ABH - PROMISES", "standard_charge_dollar": 17.72, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ALLIED BENEFIT SYSTEMS", "plan_name": "ALLIED BENEFIT SYSTEMS", "standard_charge_dollar": 600.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS", "plan_name": "BCBS", "standard_charge_dollar": 756.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS FEDERAL", "plan_name": "BCBS FEDERAL", "standard_charge_dollar": 756.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS OUT OF STATE", "plan_name": "BCBS OUT OF STATE", "standard_charge_dollar": 756.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BEACON", "plan_name": "BEACON", "standard_charge_dollar": 560.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Behavioral Health Systems", "plan_name": "Behavioral Health Systems", "standard_charge_dollar": 600.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Key Benefit Administrators", "plan_name": "Key Benefit Administrators", "standard_charge_dollar": 600.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedBen", "plan_name": "MedBen", "standard_charge_dollar": 600.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN", "plan_name": "THE HEALTH PLAN", "standard_charge_dollar": 560.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 560.0, "methodology": "fee schedule", "additional_payer_notes": "" } ], "discounted_cash": 750.0, "minimum": 17.72, "maximum": 756.0 } ] }, { "description": "DC <30 minutes", "code_information": [ { "code": "99238", "type": "CPT" }, { "code": "99238", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 75.44, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 75.44, "maximum": 75.44 } ] }, { "description": "EEG READING", "code_information": [ { "code": "95819", "type": "CPT" }, { "code": "630012", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "ABH - CHIP", "plan_name": "ABH - CHIP", "standard_charge_dollar": 10.2, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - COVENTRY", "plan_name": "ABH - COVENTRY", "standard_charge_dollar": 41.93, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - IMD", "plan_name": "ABH - IMD", "standard_charge_dollar": 41.93, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - PROMISES", "plan_name": "ABH - PROMISES", "standard_charge_dollar": 41.93, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS", "plan_name": "BCBS", "standard_charge_dollar": 130.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS FEDERAL", "plan_name": "BCBS FEDERAL", "standard_charge_dollar": 130.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS MEDICARE ADVANTAGE", "plan_name": "BCBS MEDICARE ADVANTAGE", "standard_charge_dollar": 54.72, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS OUT OF STATE", "plan_name": "BCBS OUT OF STATE", "standard_charge_dollar": 130.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BEACON", "plan_name": "BEACON", "standard_charge_dollar": 43.41, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "COMP PSYCH", "plan_name": "COMP PSYCH", "standard_charge_dollar": 130.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "EVERNORTH", "plan_name": "EVERNORTH", "standard_charge_dollar": 130.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEISINGER HEALTH", "plan_name": "GEISINGER HEALTH", "standard_charge_dollar": 54.72, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "PEIA", "plan_name": "PEIA", "standard_charge_dollar": 10.2, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN", "plan_name": "THE HEALTH PLAN", "standard_charge_dollar": 44.03, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 44.03, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC MEDICARE ADVANTAGE", "plan_name": "UHC MEDICARE ADVANTAGE", "standard_charge_dollar": 54.72, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UNICARE", "plan_name": "UNICARE", "standard_charge_dollar": 41.93, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 10.2, "maximum": 130.0 } ] }, { "description": "EKG READING", "code_information": [ { "code": "93010", "type": "CPT" }, { "code": "630011", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "ABH - COVENTRY", "plan_name": "ABH - COVENTRY", "standard_charge_dollar": 6.14, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - IMD", "plan_name": "ABH - IMD", "standard_charge_dollar": 6.14, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - PROMISES", "plan_name": "ABH - PROMISES", "standard_charge_dollar": 6.14, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS", "plan_name": "BCBS", "standard_charge_dollar": 11.45, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS FEDERAL", "plan_name": "BCBS FEDERAL", "standard_charge_dollar": 11.45, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS MEDICARE ADVANTAGE", "plan_name": "BCBS MEDICARE ADVANTAGE", "standard_charge_dollar": 8.13, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS OUT OF STATE", "plan_name": "BCBS OUT OF STATE", "standard_charge_dollar": 11.45, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BEACON", "plan_name": "BEACON", "standard_charge_dollar": 6.13, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "EVERNORTH", "plan_name": "EVERNORTH", "standard_charge_dollar": 44.85, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEISINGER HEALTH", "plan_name": "GEISINGER HEALTH", "standard_charge_dollar": 8.13, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "PEIA", "plan_name": "PEIA", "standard_charge_dollar": 8.82, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN", "plan_name": "THE HEALTH PLAN", "standard_charge_dollar": 6.45, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 6.45, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC MEDICARE ADVANTAGE", "plan_name": "UHC MEDICARE ADVANTAGE", "standard_charge_dollar": 8.13, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UNICARE", "plan_name": "UNICARE", "standard_charge_dollar": 6.14, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UnitedHealthcare Shared Services", "plan_name": "UnitedHealthcare Shared Services", "standard_charge_dollar": 44.85, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 6.13, "maximum": 44.85 } ] }, { "description": "INIT HOSP CARE 30 MIN", "code_information": [ { "code": "99221", "type": "CPT" }, { "code": "99221", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 114.77, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 114.77, "maximum": 114.77 } ] }, { "description": "INIT HOSP CARE 50 MIN", "code_information": [ { "code": "99222", "type": "CPT" }, { "code": "99222", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 151.94, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 151.94, "maximum": 151.94 } ] }, { "description": "RESIDENTIAL (RES)", "code_information": [ { "code": "H2036", "type": "HCPCS" }, { "code": "331", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UNICARE", "plan_name": "UNICARE", "standard_charge_dollar": 2400.0, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 2400.0, "maximum": 2400.0 } ] }, { "description": "SUBSEQ HOSP (25 MIN)", "code_information": [ { "code": "99232", "type": "CPT" }, { "code": "99232", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 77.59, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 77.59, "maximum": 77.59 } ] }, { "description": "Tri/Medi Adult Psych PHP - 3 u", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "730", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "ABH - CHIP", "plan_name": "ABH - CHIP", "standard_charge_dollar": 54.45, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "PEIA", "plan_name": "PEIA", "standard_charge_dollar": 54.45, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 54.45, "maximum": 54.45 } ] }, { "description": "Childrens Residential R&B", "code_information": [ { "code": "1001", "type": "RC" }, { "code": "221", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "ABH - CHIP", "plan_name": "ABH - CHIP", "standard_charge_dollar": 720.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - COVENTRY", "plan_name": "ABH - COVENTRY", "standard_charge_dollar": 819.91, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - IMD", "plan_name": "ABH - IMD", "standard_charge_dollar": 762.71, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - PROMISES", "plan_name": "ABH - PROMISES", "standard_charge_dollar": 819.91, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 725.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AETNA MEDICARE", "plan_name": "AETNA MEDICARE", "standard_charge_dollar": 725.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ALLIED BENEFIT SYSTEMS", "plan_name": "ALLIED BENEFIT SYSTEMS", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Anthem HIP Indiana Medicaid", "plan_name": "Anthem HIP Indiana Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS", "plan_name": "BCBS", "standard_charge_dollar": 812.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS FEDERAL", "plan_name": "BCBS FEDERAL", "standard_charge_dollar": 812.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS OUT OF STATE", "plan_name": "BCBS OUT OF STATE", "standard_charge_dollar": 812.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BEACON", "plan_name": "BEACON", "standard_charge_dollar": 1088.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Behavioral Health Systems", "plan_name": "Behavioral Health Systems", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CareSource Commerical", "plan_name": "CareSource Commerical", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "DCF Of Massachusetts", "plan_name": "DCF Of Massachusetts", "standard_charge_dollar": 877.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "EVERNORTH", "plan_name": "EVERNORTH", "standard_charge_dollar": 750.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GIC - NC Medicaid", "plan_name": "GIC - NC Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Highmark WV Medicaid", "plan_name": "Highmark WV Medicaid", "standard_charge_dollar": 819.91, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HUMANA", "plan_name": "HUMANA", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HUMANA MEDICARE", "plan_name": "HUMANA MEDICARE", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HUMANA MILITARY", "plan_name": "HUMANA MILITARY", "standard_charge_dollar": 685.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Key Benefit Administrators", "plan_name": "Key Benefit Administrators", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedBen", "plan_name": "MedBen", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medicaid Of AZ - Blue Exchange", "plan_name": "Medicaid Of AZ - Blue Exchange", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medicaid Of TN- UHC", "plan_name": "Medicaid Of TN- UHC", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 1000.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Ohio Medicaid - Molina", "plan_name": "Ohio Medicaid - Molina", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "PEIA", "plan_name": "PEIA", "standard_charge_dollar": 880.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Surest-UHC", "plan_name": "Surest-UHC", "standard_charge_dollar": 740.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN", "plan_name": "THE HEALTH PLAN", "standard_charge_dollar": 1085.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 1085.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "TPA", "plan_name": "TPA", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "TRICARE", "plan_name": "TRICARE", "standard_charge_dollar": 731.74, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC/Optum", "plan_name": "UHC/Optum", "standard_charge_dollar": 740.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 625.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMWA", "plan_name": "UMWA", "standard_charge_dollar": 731.74, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UNICARE", "plan_name": "UNICARE", "standard_charge_dollar": 560.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UnitedHealthcare Shared Services", "plan_name": "UnitedHealthcare Shared Services", "standard_charge_dollar": 740.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "VA - Huntington", "plan_name": "VA - Huntington", "standard_charge_dollar": 731.74, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Virginia Medicaid - UHC", "plan_name": "Virginia Medicaid - UHC", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare KY Medicaid", "plan_name": "Wellcare KY Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 1400.0, "discounted_cash": 743.0, "minimum": 500.0, "maximum": 1088.0 } ] }, { "description": "Pre-Teen Residential R&B", "code_information": [ { "code": "1001", "type": "RC" }, { "code": "222", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "ABH - CHIP", "plan_name": "ABH - CHIP", "standard_charge_dollar": 720.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "ABH - COVENTRY", "plan_name": "ABH - 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MEDICARE", "plan_name": "THE HEALTH PLAN - MEDICARE", "standard_charge_dollar": 69.17, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 54.69, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "TRICARE", "plan_name": "TRICARE", "standard_charge_dollar": 39.1, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC MEDICARE ADVANTAGE", "plan_name": "UHC MEDICARE ADVANTAGE", "standard_charge_dollar": 69.79, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 75.44, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UNICARE", "plan_name": "UNICARE", "standard_charge_dollar": 52.08, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UnitedHealthcare Shared Services", "plan_name": "UnitedHealthcare Shared Services", "standard_charge_dollar": 117.87, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 160.0, "minimum": 39.1, "maximum": 130.0 } ] }, { "description": "SUBSEQ HOSP (15 MIN)", "code_information": [ { "code": "99231", "type": "CPT" }, { "code": "99231", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "THE HEALTH PLAN-COMM", "plan_name": "THE HEALTH PLAN-COMM", "standard_charge_dollar": 43.41, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 140.0, "minimum": 43.41, "maximum": 43.41 } ] } ] }