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Docusign Envelope lD: CEBCOB3C-DFA1-4B6C-AFE8-6A4A63440086 <br />ExHrsrr B-1-A <br />Mnnrcm <br />RBTMBURSnMENT RA,TNS <br />1. Rates. Subject to the terms and conditions of the Agreement, reimbursement rates for <br />Covered Services billed under Facility's tax ID number for the Apple Health program <br />shall be the lesser of billed charges or the following and will be less any applicable Cost <br />Sharing Amounts: <br />Network Name: CHPW AH Network <br />Inpatient Services: l00o/o of HCA's Fee Schedule. <br />Outpatient Services: l00o of HCA's Fee Schedule. <br />Professional Services: l00o of HCA's Fee Schedule. <br />2. Pavment. All payments under this Agreement shall be made in accordance with the <br />terms of this Agreement , the Provider Manual and the applicable billing instructions and <br />policy guidelines published and periodically updated by applicable state and federal <br />agencies as set forth in Section 4 of the Agreement. <br />Effective Date: 7 11 12025 <br />(CHPWTO COMPLETE) <br />2020 Factllty Exh B1A - McaidRates Page 29 of51 Contract #5908-662684