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Charge Type Price  
Service Code APR-DRG 7501
Hospital Charge Code APRDRG 7501
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,458.28
Rate for Payer: Buckeye Health Medicaid OOS $2,458.28
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,458.28
Service Code APR-DRG 7502
Hospital Charge Code APRDRG 7502
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,789.38
Rate for Payer: Buckeye Health Medicaid OOS $2,789.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,789.38
Service Code APR-DRG 7503
Hospital Charge Code APRDRG 7503
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $3,970.01
Rate for Payer: Buckeye Health Medicaid OOS $3,970.01
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $3,970.01
Service Code APR-DRG 7504
Hospital Charge Code APRDRG 7504
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $8,601.59
Rate for Payer: Buckeye Health Medicaid OOS $8,601.59
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $8,601.59
Service Code APR-DRG 7511
Hospital Charge Code APRDRG 7511
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $1,767.26
Rate for Payer: Buckeye Health Medicaid OOS $1,767.26
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $1,767.26
Service Code APR-DRG 7512
Hospital Charge Code APRDRG 7512
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,127.50
Rate for Payer: Buckeye Health Medicaid OOS $2,127.50
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,127.50
Service Code APR-DRG 7513
Hospital Charge Code APRDRG 7513
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $3,079.18
Rate for Payer: Buckeye Health Medicaid OOS $3,079.18
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $3,079.18
Service Code APR-DRG 7514
Hospital Charge Code APRDRG 7514
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $5,455.81
Rate for Payer: Buckeye Health Medicaid OOS $5,455.81
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $5,455.81
Service Code APR-DRG 7521
Hospital Charge Code APRDRG 7521
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $1,686.57
Rate for Payer: Buckeye Health Medicaid OOS $1,686.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $1,686.57
Service Code APR-DRG 7522
Hospital Charge Code APRDRG 7522
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $1,766.30
Rate for Payer: Buckeye Health Medicaid OOS $1,766.30
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $1,766.30
Service Code APR-DRG 7523
Hospital Charge Code APRDRG 7523
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,112.13
Rate for Payer: Buckeye Health Medicaid OOS $2,112.13
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,112.13
Service Code APR-DRG 7524
Hospital Charge Code APRDRG 7524
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,112.13
Rate for Payer: Buckeye Health Medicaid OOS $2,112.13
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,112.13
Service Code APR-DRG 7531
Hospital Charge Code APRDRG 7531
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $1,868.45
Rate for Payer: Buckeye Health Medicaid OOS $1,868.45
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $1,868.45
Service Code APR-DRG 7532
Hospital Charge Code APRDRG 7532
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,194.75
Rate for Payer: Buckeye Health Medicaid OOS $2,194.75
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,194.75
Service Code APR-DRG 7533
Hospital Charge Code APRDRG 7533
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,917.47
Rate for Payer: Buckeye Health Medicaid OOS $2,917.47
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,917.47
Service Code APR-DRG 7534
Hospital Charge Code APRDRG 7534
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $5,864.72
Rate for Payer: Buckeye Health Medicaid OOS $5,864.72
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $5,864.72
Service Code APR-DRG 7541
Hospital Charge Code APRDRG 7541
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $1,691.69
Rate for Payer: Buckeye Health Medicaid OOS $1,691.69
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $1,691.69
Service Code APR-DRG 7542
Hospital Charge Code APRDRG 7542
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,234.77
Rate for Payer: Buckeye Health Medicaid OOS $2,234.77
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,234.77
Service Code APR-DRG 7543
Hospital Charge Code APRDRG 7543
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,882.57
Rate for Payer: Buckeye Health Medicaid OOS $2,882.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,882.57
Service Code APR-DRG 7544
Hospital Charge Code APRDRG 7544
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,882.57
Rate for Payer: Buckeye Health Medicaid OOS $2,882.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,882.57
Service Code APR-DRG 7551
Hospital Charge Code APRDRG 7551
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $1,545.67
Rate for Payer: Buckeye Health Medicaid OOS $1,545.67
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $1,545.67
Service Code APR-DRG 7552
Hospital Charge Code APRDRG 7552
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,396.16
Rate for Payer: Buckeye Health Medicaid OOS $2,396.16
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,396.16
Service Code APR-DRG 7553
Hospital Charge Code APRDRG 7553
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $3,344.32
Rate for Payer: Buckeye Health Medicaid OOS $3,344.32
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $3,344.32
Service Code APR-DRG 7554
Hospital Charge Code APRDRG 7554
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $3,344.32
Rate for Payer: Buckeye Health Medicaid OOS $3,344.32
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $3,344.32
Service Code APR-DRG 7561
Hospital Charge Code APRDRG 7561
Min. Negotiated Rate $1,307.20
Max. Negotiated Rate $2,002.30
Rate for Payer: Buckeye Health Medicaid OOS $2,002.30
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $1,307.20
Rate for Payer: Managed Health Services Medicaid $1,307.20
Rate for Payer: MDWise Medicaid $1,307.20
Rate for Payer: Molina Healthcare of OH Medicare $2,002.30