Tax ID|NPI|Services|Description|REVENUE TYPE|RATE|NOTES
58-6010602|1457392904|Inpatient|Medical|MED|$1250.00 Per Diem|
58-6010602|1457392904|Inpatient|Surgical|SURG|$1550.00 Per Diem|
58-6010602|1457392904|Inpatient|ICU|ICU|$1750.00 Per Diem|
58-6010602|1457392904|Inpatient|Medical/Surgical/ICU|STOPLOSS POINT|$25000.00|Stoploss Applies when Total Billed Charges exceed $25000.00
58-6010602|1457392904|Inpatient|Medical/Surgical/ICU|STOPLOSS|80% Of Charge After Stoploss Point|If Total Billed Charges exceed $25000.00| services paid at 80% of billed charges.
58-6010602|1457392904|Outpatient|ALL||20% Discount off Billed Charges|