| INPATIENT CHARGES | ||
| Item | JDMC Charge | Medicaid Rate |
| Room and Board | $1,500.00 | 1065.67 |
| Inpatient room and board all inclusive to include all medical care, therapy, medication and supplies. | ||
| Self pay : Self pay rates negotiable based on JDMC policy number 6065.6 available after listed charges | ||
| OUTPATIENT CHARGES | ||
| 97163 | $ 150.00 | $ 77.34 |
| 97164 | $ 150.00 | $ 77.34 |
| 97165 | $ 150.00 | $ 77.34 |
| 97167 | $ 150.00 | $ 81.53 |
| 97168 | $ 150.00 | $ 81.53 |
| 97169 | $ 150.00 | $ 81.53 |
| 92523 | $ 200.00 | $ 176.15 |
| 92610 | $ 150.00 | $ 78.92 |
| 97110 | $ 50.00 | $ 27.77 |
| 97530 | $ 50.00 | $ 35.21 |
| 92526 | $ 50.00 | $ 79.38 |
| 92507 | $ 84.00 | $ 72.34 |
| OUTPATIENT NEURO CLINIC OFFICE VISITS | ||
| NEW PATIENT 30 MINUTES 99203 | $ 105.00 | $ 96.11 |
| NEW PATIENT 45 MINUTES 99204 | $ 150.00 | $ 147.84 |
| NEW PATIENT 60+ MINUTES 99205 | $ 225.00 | $ 187.18 |
| EST. PATIENT 15 MINUTES 99213 | $ 75.00 | $ 66.86 |
| EST. PATIENT 25 MINUTES 99214 | $ 105.00 | $ 97.32 |
| EST. PATIENT 40+ MINUTES 99215 | $ 150.00 | $ 131.08 |
| Frequently used outpatient codes | ||
| PT EVALUATION | $ 150.00 | $ 77.34 |
| OT EVALUATION | $ 150.00 | $ 81.53 |
| SPEECH EVALUATION | $ 200.00 | $ 176.15 |
| FEEDING EVALUATION | $ 150.00 | 78.92 |
| PT THERAPY | $ 50.00 | 27.77 |
| OT THERAPY | $ 50.00 | 35.21 |
| SPEECH THERAPY | $ 84.00 | 72.34 |
| FEEDING THERAPY | $ 120.00 | 79.38 |
| Inpatient room and board all inclusive to include all medical care, therapy, medication and supplies. | ||
J. D. McCarty Center
for children with developmental disabilities
