"hospital_FWBH, LLC"	last_updated_ 2023-12-31	version_1	"hospital_Fort Wayne, Indiana"	hospital_address 3995 West Washington Center Road		license_ 2097-1-PIP | IN	"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"																																																																																																																																								
																																																																																																																																															
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|COMMERCIAL]	standard_charge|[payer_AETNA|COMMERCIAL] |percent	standard_charge|[payer_AETNA|COMMERCIAL] |contracting_method	additional_payer_notes |[payer_AETNA|COMMERCIAL]	standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE]	standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] |percent	standard_charge|[payer_AETNA MEDICARE|MANAGED MEDICARE] |contracting_method	additional_payer_notes |[payer_AETNA MEDICARE|MANAGED MEDICARE]	standard_charge|[payer_ANTHEM HIP|MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HIP|MANAGED MEDICAID] |percent	standard_charge|[payer_ANTHEM HIP|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_ANTHEM HIP|MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE|MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE|MANAGED MEDICAID] |percent	standard_charge|[payer_ANTHEM HOOSIER CARE CONNE|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_ANTHEM HOOSIER CARE CONNE|MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE|MANAGED MEDICAID]	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE|MANAGED MEDICAID] |percent	standard_charge|[payer_ANTHEM HOOSIER HEALTHWISE|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_ANTHEM HOOSIER HEALTHWISE|MANAGED MEDICAID]	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE|MANAGED MEDICARE]	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE|MANAGED MEDICARE] |percent	standard_charge|[payer_ANTHEM MEDICARE ADVANTAGE|MANAGED MEDICARE] |contracting_method	additional_payer_notes |[payer_ANTHEM MEDICARE ADVANTAGE|MANAGED MEDICARE]	standard_charge|[payer_ANTHEM PPO|BLUE CROSS]	standard_charge|[payer_ANTHEM PPO|BLUE CROSS] |percent	standard_charge|[payer_ANTHEM PPO|BLUE CROSS] |contracting_method	additional_payer_notes |[payer_ANTHEM PPO|BLUE CROSS]	standard_charge|[payer_AUTOMATED GROUP ADMIN|HMO/PPO]	standard_charge|[payer_AUTOMATED GROUP ADMIN|HMO/PPO] |percent	standard_charge|[payer_AUTOMATED GROUP ADMIN|HMO/PPO] |contracting_method	additional_payer_notes |[payer_AUTOMATED GROUP ADMIN|HMO/PPO]	standard_charge|[payer_BCBS FEDERAL|BLUE CROSS]	standard_charge|[payer_BCBS FEDERAL|BLUE CROSS] |percent	standard_charge|[payer_BCBS FEDERAL|BLUE CROSS] |contracting_method	additional_payer_notes |[payer_BCBS FEDERAL|BLUE CROSS]	standard_charge|[payer_BCBS OF IN|BLUE CROSS]	standard_charge|[payer_BCBS OF IN|BLUE CROSS] |percent	standard_charge|[payer_BCBS OF IN|BLUE CROSS] |contracting_method	additional_payer_notes |[payer_BCBS OF IN|BLUE CROSS]	standard_charge|[payer_BCBS OOS|BLUE CROSS]	standard_charge|[payer_BCBS OOS|BLUE CROSS] |percent	standard_charge|[payer_BCBS OOS|BLUE CROSS] |contracting_method	additional_payer_notes |[payer_BCBS OOS|BLUE CROSS]	standard_charge|[payer_CARESOURCE HIP|MANAGED MEDICAID]	standard_charge|[payer_CARESOURCE HIP|MANAGED MEDICAID] |percent	standard_charge|[payer_CARESOURCE HIP|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_CARESOURCE HIP|MANAGED MEDICAID]	standard_charge|[payer_CARESOURCE HOOSIER HEALTH|MANAGED MEDICAID]	standard_charge|[payer_CARESOURCE HOOSIER HEALTH|MANAGED MEDICAID] |percent	standard_charge|[payer_CARESOURCE HOOSIER HEALTH|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_CARESOURCE HOOSIER HEALTH|MANAGED MEDICAID]	standard_charge|[payer_CARESOURCE MEDICARE|MANAGED MEDICARE]	standard_charge|[payer_CARESOURCE MEDICARE|MANAGED MEDICARE] |percent	standard_charge|[payer_CARESOURCE MEDICARE|MANAGED MEDICARE] |contracting_method	additional_payer_notes |[payer_CARESOURCE MEDICARE|MANAGED MEDICARE]	standard_charge|[payer_CIGNA-EVERNORTH|COMMERCIAL]	standard_charge|[payer_CIGNA-EVERNORTH|COMMERCIAL] |percent	standard_charge|[payer_CIGNA-EVERNORTH|COMMERCIAL] |contracting_method	additional_payer_notes |[payer_CIGNA-EVERNORTH|COMMERCIAL]	standard_charge|[payer_HUMANA|HMO/PPO]	standard_charge|[payer_HUMANA|HMO/PPO] |percent	standard_charge|[payer_HUMANA|HMO/PPO] |contracting_method	additional_payer_notes |[payer_HUMANA|HMO/PPO]	standard_charge|[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE]	standard_charge|[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE] |percent	standard_charge|[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE] |contracting_method	additional_payer_notes |[payer_HUMANA MEDICARE HMO|MANAGED MEDICARE]	standard_charge|[payer_IU HEALTH|COMMERCIAL]	standard_charge|[payer_IU HEALTH|COMMERCIAL] |percent	standard_charge|[payer_IU HEALTH|COMMERCIAL] |contracting_method	additional_payer_notes |[payer_IU HEALTH|COMMERCIAL]	standard_charge|[payer_IU HEALTH MEDICARE|MANAGED MEDICARE]	standard_charge|[payer_IU HEALTH MEDICARE|MANAGED MEDICARE] |percent	standard_charge|[payer_IU HEALTH MEDICARE|MANAGED MEDICARE] |contracting_method	additional_payer_notes |[payer_IU HEALTH MEDICARE|MANAGED MEDICARE]	standard_charge|[payer_LUTHERAN ADVANCED|HMO/PPO]	standard_charge|[payer_LUTHERAN ADVANCED|HMO/PPO] |percent	standard_charge|[payer_LUTHERAN ADVANCED|HMO/PPO] |contracting_method	additional_payer_notes |[payer_LUTHERAN ADVANCED|HMO/PPO]	standard_charge|[payer_LUTHERAN PREFERRED|HMO/PPO]	standard_charge|[payer_LUTHERAN PREFERRED|HMO/PPO] |percent	standard_charge|[payer_LUTHERAN PREFERRED|HMO/PPO] |contracting_method	additional_payer_notes |[payer_LUTHERAN PREFERRED|HMO/PPO]	standard_charge|[payer_MDWISE HIP|MANAGED MEDICAID]	standard_charge|[payer_MDWISE HIP|MANAGED MEDICAID] |percent	standard_charge|[payer_MDWISE HIP|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_MDWISE HIP|MANAGED MEDICAID]	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE|MANAGED MEDICAID]	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE|MANAGED MEDICAID] |percent	standard_charge|[payer_MDWISE HOOSIER HEALTHWISE|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_MDWISE HOOSIER HEALTHWISE|MANAGED MEDICAID]	standard_charge|[payer_MEDICAID IN|MEDICAID ]	standard_charge|[payer_MEDICAID IN|MEDICAID ] |percent	standard_charge|[payer_MEDICAID IN|MEDICAID ] |contracting_method	additional_payer_notes |[payer_MEDICAID IN|MEDICAID ]	standard_charge|[payer_MEDICARE|MEDICARE]	standard_charge|[payer_MEDICARE|MEDICARE] |percent	standard_charge|[payer_MEDICARE|MEDICARE] |contracting_method	additional_payer_notes |[payer_MEDICARE|MEDICARE]	standard_charge|[payer_MHS HIP|MANAGED MEDICAID]	standard_charge|[payer_MHS HIP|MANAGED MEDICAID] |percent	standard_charge|[payer_MHS HIP|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_MHS HIP|MANAGED MEDICAID]	standard_charge|[payer_MHS HOOSIER CARE CONNECT|MANAGED MEDICAID]	standard_charge|[payer_MHS HOOSIER CARE CONNECT|MANAGED MEDICAID] |percent	standard_charge|[payer_MHS HOOSIER CARE CONNECT|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_MHS HOOSIER CARE CONNECT|MANAGED MEDICAID]	standard_charge|[payer_MHS HOOSIER HEALTHWISE|MANAGED MEDICAID]	standard_charge|[payer_MHS HOOSIER HEALTHWISE|MANAGED MEDICAID] |percent	standard_charge|[payer_MHS HOOSIER HEALTHWISE|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_MHS HOOSIER HEALTHWISE|MANAGED MEDICAID]	standard_charge|[payer_PHYSICIAN HEALTH PLAN|HMO/PPO]	standard_charge|[payer_PHYSICIAN HEALTH PLAN|HMO/PPO] |percent	standard_charge|[payer_PHYSICIAN HEALTH PLAN|HMO/PPO] |contracting_method	additional_payer_notes |[payer_PHYSICIAN HEALTH PLAN|HMO/PPO]	standard_charge|[payer_THREE RIVERS PREFERRED|HMO/PPO]	standard_charge|[payer_THREE RIVERS PREFERRED|HMO/PPO] |percent	standard_charge|[payer_THREE RIVERS PREFERRED|HMO/PPO] |contracting_method	additional_payer_notes |[payer_THREE RIVERS PREFERRED|HMO/PPO]	standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE]	standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] |percent	standard_charge|[payer_UBH MEDICARE HMO|MANAGED MEDICARE] |contracting_method	additional_payer_notes |[payer_UBH MEDICARE HMO|MANAGED MEDICARE]	standard_charge|[payer_UHC MEDICAID|MANAGED MEDICAID]	standard_charge|[payer_UHC MEDICAID|MANAGED MEDICAID] |percent	standard_charge|[payer_UHC MEDICAID|MANAGED MEDICAID] |contracting_method	additional_payer_notes |[payer_UHC MEDICAID|MANAGED MEDICAID]	standard_charge|[payer_UNITED BEHAVIORAL HEALTH|COMMERCIAL]	standard_charge|[payer_UNITED BEHAVIORAL HEALTH|COMMERCIAL] |percent	standard_charge|[payer_UNITED BEHAVIORAL HEALTH|COMMERCIAL] |contracting_method	additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH|COMMERCIAL]
ROOM AND BOARD PSYCH ADOL 1	124	RC	facility	inpatient				2500.00	550	915	1450	915		per diem		DRG		DRG		1371.7		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		985		per diem		1000		per diem		985		per diem		985		per diem		985		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		925		per diem		950		per diem		DRG		DRG		1450		per diem		DRG		DRG		1350		per diem		1350		per diem		1371.7		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		1371.7		per diem		1371.7		per diem		1371.7		per diem		1300		per diem		1350		per diem		DRG		DRG		1371.7		per diem				 	
ROOM AND BOARD PSYCH ADULT 1	124	RC	facility	inpatient				2500.00	550	915	1450	915		per diem		DRG		DRG		1371.7		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		920		per diem		1000		per diem		920		per diem		920		per diem		920		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		1025		per diem		950		per diem		DRG		DRG		1450		per diem		DRG		DRG		1350		per diem		1350		per diem		1371.7		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		1371.7		per diem		1371.7		per diem		1371.7		per diem		1300		per diem		1350		per diem		DRG		DRG		1371.7		per diem		975		per diem	
ROOM AND BOARD PSYCH OLDER ADLT	124	RC	facility	inpatient				2500.00	550	915	1450	915		per diem		DRG		DRG		1371.7		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		920		per diem		1000		per diem		920		per diem		920		per diem		920		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		925		per diem		950		per diem		DRG		DRG		1450		per diem		DRG		DRG		1350		per diem		1350		per diem		1371.7		per diem		1371.7		per diem		1371.7		per diem		DRG		DRG		1371.7		per diem		1371.7		per diem		1371.7		per diem		1300		per diem		1350		per diem		DRG		DRG		1371.7		per diem		975		per diem	
ROOM AND BOARD DETOX ADULT	126	RC	facility	inpatient				2500.00	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				 				 		DRG		DRG								 				 				 		1300		per diem		1350		per diem