TAX ID|NPI|Services|ASC Category Grouper |RATE|ASC Payment Terms (Revenue Code 490)|Implants (Revenue Code 278)|Implant Threshold|High Cost Drugs (Revenue Code 636)|High Cost Drug Threshold|Supplies (Rev Codes 274|275|276)|Percent of Charge
85-3448933|1376115279|ASC|12164.00|1st Procedure           100%|Cost + 10%|$500 Total Billed Charges|Cost + 10%|$500.00 Total Billed Charges|Included in ASC Payment|
85-3448933|1376115279|ASC|22814.00|2nd Procedure          50%||||||
85-3448933|1376115279|ASC|33463.00|3rd Procedure           25%||||||
85-3448933|1376115279|ASC|44111.00|All Others                    25%||||||
85-3448933|1376115279|ASC|54761.00|||||||
85-3448933|1376115279|ASC|65411.00|||||||
85-3448933|1376115279|ASC|76059.00|||||||
85-3448933|1376115279|ASC|86710.00|||||||
85-3448933|1376115279|ASC|97359.00|||||||
85-3448933|1376115279|ASC|108466.00|||||||
85-3448933|1376115279|ASC|Ungrouped|4244.00|||||||
85-3448933|1376115279|All Other ASC Services|||||||||50% of Billed Charges (50% Discount)