TAX ID|SERVICE|REV CODE|PER DIEM|NOTE1|NOTE2
58-0655369|Skilled Nursing/Hi-Tech|553|$105.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Skilled Nursing/Follow-up visit|551|$95.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Physical Therapy|421|$110.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Occupational Therapy|431|$110.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Speech Therapy|441|$110.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Medical Social Services|561|$110.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Home Health Aide visit|571|$45.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Hospice/Routine Home Visit|651|$100.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Hospice/IP Non-Respite|656|$100.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Hospice/IP Respite|655|$100.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Hospice/CTNS Home|652|$100.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Hospice/Physician|657|$100.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount
58-0655369|Hospice/Other|659|$100.00|Other professional services billed on HCFA 1500: 2022 FS 60001 |Other hospital services billed on UB 04: 28% discount