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Outlier payment calculation

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Reference no: EM131214443

The Safe-Cross® guidewire is present on the following claim. Complete an outlier payment calculation to determine whether this claim would qualify for a high cost outlier payment. If the claim qualifies for outlier payment, calculate the total reimbursement for this claim, including the additional amount that the facility would receive for the high cost outlier.

Reference no: EM131214443

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