Recno Valid To

Inst.

Svce Cat.

Service Service Text

Valid From

Alt. Text Long Text Comment Ext. ID Svce Group Expand Grp Entry Blck Price-IP / PKG Price-OP Price-MRA OP Price-RETAIL Package Cost RVU (CO) RC Fees-IP RC Fees-OP RC Fees-MRA OP Exam Class Stats Class Ext. Svce Formula Alt.Price Bill.I/P Bill.O/P Tax Class. CO-Rel. CostObject SvceCtgry Chrg. Type SvceCgry 2 SvcSum.Cde Op.Table Med. Svce Perf. svce Req. Svce Ext.ChrgTy 1 GHL 1 2100000001 20110101 99991231 DAILY TREATMENT FEE DAILY TREATMENT FEE 130.99 130.99 130.99 0 6 0 3 210 0 X 0 X 1 210 X 0 X

11TMNT 2 GHL 1 2100000003 20110101 99991231 DAILY TREATMENT FEES(IVF OUTPATIENT) DAILY TREATMENT FEES(IVF OUTPATIENT) 32.99 0 0 3 210 0 X 32.99 X 32.99 0 1 210 0 X

3 GHL 1 DAILY TREATMENT FEE-DS

WS0001 2100000004 20110101 99991231 DAILY TREATMENT FEE-DS 71.88 71.88 71.88 1 210 0 X 0 X

0 3 210

0 X

0 X

4 GHL 1 DAILY TREATMENT FEE (RH)

11TMNT 2100000005 20031101 99991231 DAILY TREATMENT FEE (RH) 0.99 0.99 0.99 1 210 0 X 99991231 0 X

0 3 210

0 X

0 X 1 11TMNT 2100000006 20050912 ICU MONITORING CHARGE 100.88 100.88 100.88 0

5 GHL ICU MONITORING CHARGE INT-G 6 0 3 210 0 X

0 X WS0001 1 220 X

0 X