TAX ID|NPI|SERVICE|DRG Base Rate|Stop Loss Threshold|Revenue Code|DISCOUNT|NOTE
58-2149128|1043270564|INPATIENT|12360|70000|||
58-2149128|1043270564|OUTPATIENT|||636||Payable at 100% of CMS ASP Base Rate If code not priced by ASP reimbursement payable at 65% discount
58-2149128|1043270564|ALL OTHER||||65%|