hospital_name	last_updated_on	version	hospital_location	hospital_address	license_number|MI	"To the best of its knowledge and belief, the 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 indicated."																																																																																																																																																																																																												
"FWBH, LLC"	5/31/2024	2.0.0	"Fort Wayne, Indiana"	 3995 West Washington Center Road	license_ 2097-1-PIP | IN	TRUE																																																																																																																																																																																																												
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]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_AETNA]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_AETNA]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_AETNA]|[plan_COMMERCIAL] 	standard_charge|[payer_AETNA]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_AETNA]|[Plan_COMMERCIAL]	standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_AETNA MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_ANTHEM HIP]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_ANTHEM HIP]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_ANTHEM HIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_ANTHEM HIP]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_ANTHEM HIP]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_ANTHEM HIP]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_ANTHEM HOOSIER CARE CONNE]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_ANTHEM HOOSIER CARE CONNE]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_ANTHEM HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_ANTHEM HOOSIER HEALTHWISE]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_ANTHEM MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_ANTHEM MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_ANTHEM PPO]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_ANTHEM PPO]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_ANTHEM PPO]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_ANTHEM PPO]|[plan_BLUE CROSS] 	standard_charge|[payer_ANTHEM PPO]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_ANTHEM PPO]|[Plan_BLUE CROSS]	standard_charge|[payer_AUTOMATED GROUP ADMIN]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_AUTOMATED GROUP ADMIN]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_AUTOMATED GROUP ADMIN]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_AUTOMATED GROUP ADMIN]|[plan_HMO/PPO] 	standard_charge|[payer_AUTOMATED GROUP ADMIN]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_AUTOMATED GROUP ADMIN]|[Plan_HMO/PPO]	standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] 	standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_BLUE CROSS]	standard_charge|[payer_BCBS OF IN]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_BCBS OF IN]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_BCBS OF IN]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_BCBS OF IN]|[plan_BLUE CROSS] 	standard_charge|[payer_BCBS OF IN]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_BCBS OF IN]|[Plan_BLUE CROSS]	standard_charge|[payer_BCBS OOS]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_BCBS OOS]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_BCBS OOS]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_BCBS OOS]|[plan_BLUE CROSS] 	standard_charge|[payer_BCBS OOS]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_BCBS OOS]|[Plan_BLUE CROSS]	standard_charge|[payer_CARESOURCE HIP]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_CARESOURCE HIP]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_CARESOURCE HIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_CARESOURCE HIP]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_CARESOURCE HIP]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_CARESOURCE HIP]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_CARESOURCE HOOSIER HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_CARESOURCE HOOSIER HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_CARESOURCE HOOSIER HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_CARESOURCE HOOSIER HEALTH]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_CARESOURCE HOOSIER HEALTH]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_CARESOURCE HOOSIER HEALTH]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_CARESOURCE MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_CARESOURCE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_CARESOURCE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_CARESOURCE MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_CARESOURCE MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_CARESOURCE MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_CIGNA-EVERNORTH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_CIGNA-EVERNORTH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_CIGNA-EVERNORTH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_CIGNA-EVERNORTH]|[plan_COMMERCIAL] 	standard_charge|[payer_CIGNA-EVERNORTH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_CIGNA-EVERNORTH]|[Plan_COMMERCIAL]	standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] 	standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO]	standard_charge|[payer_HUMANA MEDICARE HMO]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_HUMANA MEDICARE HMO]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_HUMANA MEDICARE HMO]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_HUMANA MEDICARE HMO]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_HUMANA MEDICARE HMO]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_HUMANA MEDICARE HMO]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_IU HEALTH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_IU HEALTH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_IU HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_IU HEALTH]|[plan_COMMERCIAL] 	standard_charge|[payer_IU HEALTH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_IU HEALTH]|[Plan_COMMERCIAL]	standard_charge|[payer_IU HEALTH MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_IU HEALTH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_IU HEALTH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_IU HEALTH MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_IU HEALTH MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_IU HEALTH MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_LUTHERAN ADVANCED]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_LUTHERAN ADVANCED]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_LUTHERAN ADVANCED]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_LUTHERAN ADVANCED]|[plan_HMO/PPO] 	standard_charge|[payer_LUTHERAN ADVANCED]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_LUTHERAN ADVANCED]|[Plan_HMO/PPO]	standard_charge|[payer_LUTHERAN PREFERRED]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_LUTHERAN PREFERRED]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_LUTHERAN PREFERRED]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_LUTHERAN PREFERRED]|[plan_HMO/PPO] 	standard_charge|[payer_LUTHERAN PREFERRED]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_LUTHERAN PREFERRED]|[Plan_HMO/PPO]	standard_charge|[payer_MDWISE HIP]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MDWISE HIP]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MDWISE HIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MDWISE HIP]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MDWISE HIP]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MDWISE HIP]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MDWISE HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MDWISE HOOSIER HEALTHWISE]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MEDICAID IN]|[plan_MEDICAID ]|negotiated_dollar	standard_charge|[payer_MEDICAID IN]|[plan_MEDICAID ] |negotiated_percentage	standard_charge|[payer_MEDICAID IN]|[plan_MEDICAID ] |negotiated_algorithm	estimated_amount|[payer_MEDICAID IN]|[plan_MEDICAID ] 	standard_charge|[payer_MEDICAID IN]|[plan_MEDICAID ] |methodology	additional_payer_notes |[payer_MEDICAID IN]|[Plan_MEDICAID ]	standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar	standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_percentage	standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_algorithm	estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] 	standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology	additional_payer_notes |[payer_MEDICARE]|[Plan_MEDICARE]	standard_charge|[payer_MHS HIP]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MHS HIP]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MHS HIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MHS HIP]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MHS HIP]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MHS HIP]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MHS HOOSIER CARE CONNECT]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MHS HOOSIER CARE CONNECT]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MHS HOOSIER CARE CONNECT]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MHS HOOSIER CARE CONNECT]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MHS HOOSIER CARE CONNECT]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MHS HOOSIER CARE CONNECT]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MHS HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MHS HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MHS HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MHS HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MHS HOOSIER HEALTHWISE]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MHS HOOSIER HEALTHWISE]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_PHYSICIAN HEALTH PLAN]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_PHYSICIAN HEALTH PLAN]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_PHYSICIAN HEALTH PLAN]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_PHYSICIAN HEALTH PLAN]|[plan_HMO/PPO] 	standard_charge|[payer_PHYSICIAN HEALTH PLAN]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_PHYSICIAN HEALTH PLAN]|[Plan_HMO/PPO]	standard_charge|[payer_THREE RIVERS PREFERRED]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_THREE RIVERS PREFERRED]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_THREE RIVERS PREFERRED]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_THREE RIVERS PREFERRED]|[plan_HMO/PPO] 	standard_charge|[payer_THREE RIVERS PREFERRED]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_THREE RIVERS PREFERRED]|[Plan_HMO/PPO]	standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_UBH MEDICARE HMO]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_UHC MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_UHC MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_UHC MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_UHC MEDICAID]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_UHC MEDICAID]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_UHC MEDICAID]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_COMMERCIAL]|negotiated_dollar	standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_COMMERCIAL] |negotiated_percentage	standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm	estimated_amount|[payer_UNITED BEHAVIORAL HEALTH]|[plan_COMMERCIAL] 	standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_COMMERCIAL] |methodology	additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH]|[Plan_COMMERCIAL]	additional_generic_notes
ROOM AND BOARD PSYCH ADOL 1	124	RC	facility	inpatient				2500	550	915	1450	915				per diem						other	DRG	1371.7				per diem		1371.7				per diem		1371.7				per diem						other	DRG	985				per diem		1000				per diem		985				per diem		985				per diem		985				per diem		1371.7				per diem		1371.7				per diem						other	DRG	925				per diem		950				per diem						other	DRG	1450				per diem						other	DRG	1350				per diem		1350				per diem		1371.7				per diem		1371.7				per diem		1371.7				per diem						other	DRG	1371.7				per diem		1371.7				per diem		1371.7				per diem		1300				per diem		1350				per diem						other	DRG	1371.7				per diem						 		
ROOM AND BOARD PSYCH ADULT 1	124	RC	facility	inpatient				2500	550	915	1450	915				per diem						other	DRG	1371.7				per diem		1371.7				per diem		1371.7				per diem						other	DRG	920				per diem		1000				per diem		920				per diem		920				per diem		920				per diem		1371.7				per diem		1371.7				per diem						other	DRG	1025				per diem		950				per diem						other	DRG	1450				per diem						other	DRG	1350				per diem		1350				per diem		1371.7				per diem		1371.7				per diem		1371.7				per diem						other	DRG	1371.7				per diem		1371.7				per diem		1371.7				per diem		1300				per diem		1350				per diem						other	DRG	1371.7				per diem		975				per diem		
ROOM AND BOARD PSYCH OLDER ADLT	124	RC	facility	inpatient				2500	550	915	1450	915				per diem						other	DRG	1371.7				per diem		1371.7				per diem		1371.7				per diem						other	DRG	920				per diem		1000				per diem		920				per diem		920				per diem		920				per diem		1371.7				per diem		1371.7				per diem						other	DRG	925				per diem		950				per diem						other	DRG	1450				per diem						other	DRG	1350				per diem		1350				per diem		1371.7				per diem		1371.7				per diem		1371.7				per diem						other	DRG	1371.7				per diem		1371.7				per diem		1371.7				per diem		1300				per diem		1350				per diem						other	DRG	1371.7				per diem		975				per diem		
ROOM AND BOARD DETOX ADULT	126	RC	facility	inpatient				2500	550	905	1350	905				per diem						 						 						 						 						 		933.58				per diem		1000				per diem		933.58				per diem		933.58				per diem		933.58				per diem						 						 						 						 		950				per diem								1350				per diem								1350				per diem		1350				per diem						 						 						other	DRG											 						 						 		1300				per diem		1350				per diem