36C10G18R0208-1-0017007.xlsx

XLSX spreadsheet 638 KB Posted May 23, 2019

Attached to: Customer Care Network Region 4
Solicitation number: 36C10G18R02081
Issued by: Department of Veterans Affairs Strategic Acquisition Center Frederick

About this file

Written by GovTribe AI · Dec 30, 2023

This solicitation requests proposals for a Customer Care Network contract to provide medical devices, durable medical equipment, orthotics, and prosthetics to veterans in Region 4. The Department of Veterans Affairs Strategic Acquisition Center is seeking proposals to establish a network of community providers to furnish these items to eligible veterans either in their homes or in non-VA medical facilities. Proposals are due by September 28, 2018. The anticipated period of performance is one base year with four one-year options, from January 1, 2019 to December 31, 2023. Pricing shall be submitted using the attached templates for each contract line item. The awardee must maintain adequate inventory levels and fulfill orders within established timeframes. Clinical and technical support shall be available to both veterans and VA providers.

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36C10G18R0208-1 0017 CCN Reg4 CLIN X002 Pricing Template v1 05202019.xlsx

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36C10G18R0208-1-0019004.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0019000.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0019005.xlsx	XLSX spreadsheet	Jun 3, 2019
36C10G18R0208-1-0019003.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0019001.xlsx	XLSX spreadsheet	Jun 3, 2019
36C10G18R0208-1-0019002.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0018000.pdf	PDF	May 30, 2019
36C10G18R0208-1-0017000.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017004.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017001.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017008.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017002.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017005.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017006.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017003.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0016005.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016007.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016008.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016009.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016006.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016003.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016004.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016002.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016000.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016001.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0015000.pdf	PDF	Apr 8, 2019
36C10G18R0208-1-0015001.pdf	PDF	Apr 8, 2019
36C10G18R0208-1-0014001.pdf	PDF	Apr 6, 2019
36C10G18R0208-1-0014000.pdf	PDF	Apr 6, 2019
36C10G18R0208-1-0013002.pdf	PDF	Apr 5, 2019
36C10G18R0208-1-0013003.xlsx	XLSX spreadsheet	Apr 5, 2019
36C10G18R0208-1-0013005.xlsx	XLSX spreadsheet	Apr 5, 2019
36C10G18R0208-1-0013001.pdf	PDF	Apr 5, 2019
36C10G18R0208-1-0013004.xlsx	XLSX spreadsheet	Apr 5, 2019
36C10G18R0208-1-0013000.pdf	PDF	Apr 5, 2019
36C10G18R0208-1-0012001.pdf	PDF	Feb 27, 2019
36C10G18R0208-1-0012000.pdf	PDF	Feb 27, 2019
36C10G18R0208-1-0011007.pdf	PDF	Feb 26, 2019
36C10G18R0208-1-0011008.pdf	PDF	Feb 26, 2019
36C10G18R0208-1-0011006.pdf	PDF	Feb 26, 2019
36C10G18R0208-1-0010001.pdf	PDF	Nov 7, 2018
36C10G18R0208-1-0010000.pdf	PDF	Nov 7, 2018
36C10G18R0208-1-0009002.xlsx	XLSX spreadsheet	Nov 6, 2018
36C10G18R0208-1-0009001.pdf	PDF	Nov 6, 2018
36C10G18R0208-1-0009000.pdf	PDF	Nov 6, 2018
36C10G18R0208-1-0008000.pdf	PDF	Nov 1, 2018
36C10G18R0208-1-0008001.pdf	PDF	Nov 1, 2018
36C10G18R0208-1-0007001.pdf	PDF	Oct 27, 2018
36C10G18R0208-1-0007003.pdf	PDF	Oct 27, 2018
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Arizona

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

Arizona

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

Volume Unit

Actual Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

OUTPATIENT/PHYSICIAN SERVICES $0

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	15,668	$244	699	$252	14,136	$260	17,574	$268	18,259	$277	18,971	$285	19,711	$295	20,480	$304	20,392	$314	3,685	$324	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Colonoscopy	proced	1,953	$686	87	$708	1,762	$731	2,191	$754	2,276	$779	2,365	$803	2,457	$829	2,553	$856	2,542	$883	459	$911	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dermatology Services and Diagnostic Exams	proced	732	$124	33	$128	660	$132	821	$136	853	$140	886	$145	921	$149	957	$154	953	$159	172	$164	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Hearing/Speech Exams	exams	792	$87	35	$90	714	$93	888	$96	923	$99	959	$102	996	$106	1,035	$109	1,031	$112	186	$116	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	173	$233	8	$240	156	$248	194	$256	202	$264	209	$272	218	$281	226	$290	225	$299	41	$309	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	123	$355	5	$366	111	$378	138	$390	143	$403	149	$416	155	$429	161	$443	160	$457	29	$471	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - General Services	proced	1,612	$546	72	$564	1,454	$582	1,808	$601	1,879	$620	1,952	$640	2,028	$660	2,107	$681	2,098	$703	379	$726	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	7,483	$383	334	$395	6,751	$408	8,393	$421	8,720	$435	9,060	$448	9,413	$463	9,780	$478	9,738	$493	1,760	$509	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	436	$82	19	$85	393	$88	489	$90	508	$93	528	$96	549	$99	570	$103	567	$106	103	$109	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Vestibular Function Tests	proced	276	$77	12	$79	249	$82	310	$84	322	$87	334	$90	347	$93	361	$96	359	$99	65	$102	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Non-Invasive Vascular Studies	proced	1,798	$187	80	$193	1,622	$200	2,017	$206	2,095	$213	2,177	$219	2,262	$226	2,350	$234	2,340	$241	423	$249	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ophthalmology Services and Diagnostic Exams	proced	26,740	$50	1,193	$52	24,125	$54	29,992	$55	31,162	$57	32,377	$59	33,640	$61	34,952	$63	34,802	$65	6,289	$67	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pathology	proced	148,099	$16	6,608	$16	133,614	$17	166,111	$17	172,589	$18	179,320	$18	186,314	$19	193,580	$20	192,749	$20	34,829	$21	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	6,992	$66	312	$68	6,308	$70	7,842	$72	8,148	$75	8,466	$77	8,796	$80	9,139	$82	9,100	$85	1,644	$88	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - CT	proced	15,953	$153	712	$158	14,393	$163	17,893	$168	18,591	$173	19,316	$179	20,069	$184	20,852	$190	20,763	$196	3,752	$203	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - General	proced	19,251	$51	859	$52	17,368	$54	21,592	$56	22,434	$57	23,309	$59	24,218	$61	25,163	$63	25,055	$65	4,527	$67	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Diagnostic	proced	170	$152	8	$157	153	$162	191	$167	198	$173	206	$178	214	$184	222	$190	221	$196	40	$202	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Screening	proced	551	$117	25	$121	497	$125	618	$129	642	$133	667	$137	693	$142	720	$146	717	$151	130	$156	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - MRI	proced	6,571	$306	293	$315	5,928	$325	7,370	$336	7,658	$347	7,956	$358	8,267	$369	8,589	$381	8,552	$393	1,545	$406	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Nuclear Medicine	proced	956	$700	43	$722	863	$745	1,072	$769	1,114	$794	1,158	$819	1,203	$845	1,250	$872	1,244	$900	225	$929	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - PET & PET/CT	proced	394	$1,508	18	$1,556	355	$1,606	441	$1,657	459	$1,710	476	$1,765	495	$1,821	514	$1,880	512	$1,940	93	$2,002	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Radiation Oncology	proced	31,209	$355	1,392	$367	28,157	$378	35,005	$390	36,370	$403	37,788	$416	39,262	$429	40,793	$443	40,618	$457	7,340	$472	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Ultrasound	proced	5,630	$81	251	$84	5,079	$87	6,315	$89	6,561	$92	6,817	$95	7,083	$98	7,359	$101	7,327	$105	1,324	$108	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Vision Exams	exams	22,085	$151	985	$156	19,925	$161	24,771	$166	25,737	$172	26,741	$177	27,784	$183	28,867	$189	28,744	$195	5,194	$201	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	90,273	$97	4,028	$101	81,444	$104	101,252	$107	105,201	$111	109,304	$114	113,567	$118	117,996	$122	117,490	$125	21,230	$129	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	1,164	$766	52	$791	1,050	$816	1,306	$842	1,357	$869	1,410	$897	1,465	$926	1,522	$955	1,515	$986	274	$1,018	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - ASC Setting	proced	15,368	$240	686	$248	13,865	$256	17,237	$264	17,909	$273	18,608	$281	19,334	$290	20,088	$300	20,001	$309	3,614	$319	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Office Setting	proced	28,572	$173	1,275	$179	25,778	$185	32,047	$191	33,297	$197	34,595	$203	35,945	$210	37,346	$216	37,186	$223	6,719	$230	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Outpatient Setting	proced	10,920	$1,721	487	$1,776	9,852	$1,833	12,249	$1,892	12,726	$1,952	13,223	$2,015	13,738	$2,079	14,274	$2,146	14,213	$2,215	2,568	$2,286	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Emergency Room Visits	visits	7,823	$728	349	$751	7,058	$775	8,774	$800	9,117	$825	9,472	$852	9,842	$879	10,225	$907	10,182	$936	1,840	$966	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Maternity	proced	411	$425	18	$438	371	$452	461	$467	479	$482	498	$497	517	$513	537	$529	535	$546	97	$564	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nutritional Counseling	visits	79	$68	4	$70	71	$72	88	$75	92	$77	95	$80	99	$82	103	$85	103	$87	19	$90	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Observation Care	visits	2,654	$145	118	$149	2,394	$154	2,977	$159	3,093	$164	3,214	$169	3,339	$175	3,469	$180	3,454	$186	624	$192	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Prosthetic and Orthotic Services	visits	60	$49	3	$51	54	$52	67	$54	70	$56	73	$58	75	$60	78	$61	78	$63	14	$65	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	4,703	$36	210	$37	4,243	$39	5,275	$40	5,481	$41	5,694	$42	5,917	$44	6,147	$45	6,121	$47	1,106	$48	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Allergy Testing	proced	437	$275	19	$284	394	$293	490	$302	509	$312	529	$322	550	$332	571	$342	569	$353	103	$365	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Chiropractic	visits	19,555	$43	872	$44	17,642	$46	21,933	$47	22,788	$49	23,677	$50	24,600	$52	25,560	$53	25,450	$55	4,599	$57	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dialysis and Related Services	proced	48,732	$278	2,174	$287	43,966	$296	54,659	$306	56,791	$315	59,006	$325	61,307	$336	63,698	$347	63,425	$358	11,461	$369	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Immunizations	proced	2,109	$44	94	$45	1,903	$47	2,366	$48	2,458	$50	2,554	$52	2,653	$53	2,757	$55	2,745	$57	496	$58	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nephrology – ESRD Services	months	2,488	$257	111	$266	2,245	$274	2,791	$283	2,900	$292	3,013	$301	3,130	$311	3,252	$321	3,238	$331	585	$342	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Office Administered Drugs	proced	52,703	$266	2,351	$275	47,548	$284	59,113	$293	61,418	$302	63,814	$312	66,302	$322	68,888	$332	68,592	$343	12,394	$354	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	PT/OT/SLP	visits	92,197	$90	4,113	$93	83,180	$96	103,410	$99	107,443	$102	111,633	$105	115,987	$109	120,510	$112	119,993	$116	21,682	$119	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

MH & HOMELESS - AMBULATORY
	Outpatient Mental Health	visits	1,238	$143	55	$147	1,117	$152	1,389	$157	1,443	$162	1,499	$167	1,557	$172	1,618	$178	1,611	$184	291	$189	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Outpatient Substance Abuse	visits	83	$123	4	$127	75	$131	93	$135	97	$139	100	$144	104	$148	108	$153	108	$158	20	$163	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Psychotherapy (Ind. 45+ min / Group)	visits	8,984	$125	401	$129	8,105	$133	10,077	$137	10,470	$142	10,878	$146	11,302	$151	11,743	$156	11,693	$161	2,113	$166	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

INPATIENT PROFESSIONAL SERVICES various 60,614 $133 2,704 $137 54,686 $141 67,986 $146 70,638 $150 73,393 $155 76,255 $160 79,229 $165 78,889 $171 14,255 $176 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0

INPATIENT FACILITY SERVICES

INPATIENT MEDICINE AND SURGERY
	IP Acute Medical	days	12,993	$1,875	580	$1,935	11,722	$1,997	14,573	$2,061	15,142	$2,127	15,732	$2,195	16,346	$2,265	16,983	$2,337	16,910	$2,412	3,056	$2,489	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Surgical	days	11,176	$3,875	499	$3,999	10,083	$4,127	12,535	$4,259	13,024	$4,395	13,532	$4,536	14,060	$4,681	14,608	$4,831	14,545	$4,985	2,628	$5,145	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Maternity Deliveries	days	290	$2,096	13	$2,163	262	$2,232	325	$2,304	338	$2,377	351	$2,454	365	$2,532	379	$2,613	377	$2,697	68	$2,783	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Maternity Non-Deliveries	days	34	$2,531	2	$2,612	31	$2,696	38	$2,782	40	$2,871	41	$2,963	43	$3,058	44	$3,155	44	$3,256	8	$3,361	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

MH & HOMELESS - INPATIENT
	IP Acute Mental Health	days	2,556	$905	114	$934	2,306	$964	2,867	$995	2,979	$1,026	3,095	$1,059	3,216	$1,093	3,341	$1,128	3,327	$1,164	601	$1,201	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Mental Health Extended Stays	days	1,188	$195	53	$201	1,072	$208	1,332	$214	1,384	$221	1,438	$228	1,495	$236	1,553	$243	1,546	$251	279	$259	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Substance Abuse	days	2,442	$662	109	$683	2,203	$705	2,739	$728	2,846	$751	2,957	$775	3,072	$800	3,192	$826	3,178	$852	574	$879	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

Enrollment and Patient Summary

ENROLLMENT
	Unique Enrollment	239,405	10,681	215,990	268,522	278,994	289,875	301,180	312,926	311,583	56,302
	Unique Highly Rural	1,411	63	1,273	1,583	1,644	1,708	1,775	1,844	1,836	332

ENROLLED PATIENTS
	Unique Community Care Patients	8,185	365	7,384	9,180	9,539	9,911	10,297	10,699	10,653	1,925

&"Times New Roman,Regular"&8&F &A &D &T &"Times New Roman,Bold"Milliman &"Times New Roman,Regular"Page &P of &N

*FY18 historical data is the basis of the FY19-FY27 projections. The projected state-wide Community Care volumes and enrollment/patient summary data are adjusted to reflect contractual period of performance considerations in FY19, FY20, and FY27 (e.g., SHCD). The volumes and enrollment/patient summary data also reflect anticipated growth in the Veteran population over the life of the contract. The Medicare Allowable Unit Price includes inflationary impacts over the Period Of Performance.

California

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

California

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

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Actual Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

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Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Proposed Service Distribution

Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

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Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

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Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

OUTPATIENT/PHYSICIAN SERVICES $0

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	23,550	$139	1,051	$143	21,247	$148	26,414	$153	27,444	$158	28,515	$163	29,627	$168	30,782	$173	30,650	$179	5,538	$185	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Colonoscopy	proced	1,984	$587	89	$605	1,790	$625	2,225	$645	2,312	$665	2,402	$687	2,496	$709	2,593	$731	2,582	$755	467	$779	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dermatology Services and Diagnostic Exams	proced	2,110	$110	94	$114	1,904	$118	2,367	$121	2,459	$125	2,555	$129	2,654	$133	2,758	$138	2,746	$142	496	$147	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Hearing/Speech Exams	exams	1,780	$80	79	$83	1,606	$85	1,997	$88	2,075	$91	2,156	$94	2,240	$97	2,327	$100	2,317	$103	419	$106	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	432	$152	19	$157	390	$162	485	$167	503	$172	523	$178	543	$184	565	$189	562	$195	102	$202	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	220	$284	10	$293	198	$302	247	$312	256	$322	266	$332	277	$343	288	$354	286	$365	52	$377	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - General Services	proced	4,926	$410	220	$423	4,444	$437	5,525	$451	5,741	$465	5,964	$480	6,197	$496	6,439	$511	6,411	$528	1,158	$545	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	5,966	$390	266	$403	5,383	$416	6,692	$429	6,953	$443	7,224	$457	7,505	$472	7,798	$487	7,765	$502	1,403	$518	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	480	$90	21	$93	433	$96	538	$99	559	$102	581	$105	604	$108	627	$112	625	$116	113	$119	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Vestibular Function Tests	proced	79	$72	4	$74	71	$76	89	$79	92	$81	96	$84	99	$87	103	$89	103	$92	19	$95	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Non-Invasive Vascular Studies	proced	2,065	$225	92	$232	1,863	$239	2,316	$247	2,406	$255	2,500	$263	2,598	$271	2,699	$280	2,688	$289	486	$298	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ophthalmology Services and Diagnostic Exams	proced	16,166	$56	721	$58	14,585	$60	18,132	$62	18,839	$64	19,574	$66	20,337	$68	21,131	$70	21,040	$72	3,802	$75	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pathology	proced	256,948	$13	11,464	$13	231,818	$14	288,199	$14	299,438	$14	311,116	$15	323,250	$15	335,857	$16	334,415	$16	60,427	$17	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	7,878	$62	351	$63	7,108	$66	8,836	$68	9,181	$70	9,539	$72	9,911	$74	10,297	$77	10,253	$79	1,853	$82	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - CT	proced	19,073	$192	851	$198	17,208	$205	21,393	$211	22,227	$218	23,094	$225	23,995	$232	24,930	$239	24,823	$247	4,485	$255	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - General	proced	30,781	$52	1,373	$54	27,771	$56	34,525	$57	35,871	$59	37,270	$61	38,724	$63	40,234	$65	40,061	$67	7,239	$69	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Diagnostic	proced	621	$151	28	$156	560	$161	697	$166	724	$172	752	$177	781	$183	812	$189	808	$195	146	$201	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Screening	proced	1,517	$138	68	$143	1,369	$147	1,702	$152	1,768	$157	1,837	$162	1,908	$167	1,983	$173	1,974	$178	357	$184	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - MRI	proced	5,410	$356	241	$367	4,881	$379	6,068	$391	6,305	$403	6,551	$416	6,806	$429	7,071	$443	7,041	$457	1,272	$472	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Nuclear Medicine	proced	896	$1,010	40	$1,042	808	$1,076	1,005	$1,110	1,044	$1,146	1,085	$1,182	1,127	$1,220	1,171	$1,259	1,166	$1,299	211	$1,341	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - PET & PET/CT	proced	101	$1,721	5	$1,776	91	$1,833	113	$1,892	118	$1,952	122	$2,015	127	$2,079	132	$2,146	131	$2,214	24	$2,285	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Radiation Oncology	proced	50,987	$429	2,275	$443	46,000	$457	57,188	$472	59,418	$487	61,735	$502	64,143	$518	66,644	$535	66,358	$552	11,991	$570	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Ultrasound	proced	8,092	$115	361	$118	7,301	$122	9,076	$126	9,430	$130	9,798	$134	10,180	$139	10,577	$143	10,532	$148	1,903	$152	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Vision Exams	exams	12,436	$199	555	$205	11,220	$211	13,949	$218	14,493	$225	15,058	$232	15,645	$240	16,255	$248	16,186	$255	2,925	$264	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	159,783	$127	7,129	$132	144,156	$136	179,216	$140	186,206	$145	193,468	$149	201,013	$154	208,852	$159	207,956	$164	37,577	$169	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	4,628	$602	206	$622	4,176	$641	5,191	$662	5,394	$683	5,604	$705	5,823	$728	6,050	$751	6,024	$775	1,088	$800	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - ASC Setting	proced	9,191	$261	410	$270	8,292	$278	10,308	$287	10,710	$297	11,128	$306	11,562	$316	12,013	$326	11,962	$336	2,161	$347	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Office Setting	proced	29,818	$185	1,330	$191	26,902	$197	33,445	$203	34,749	$210	36,104	$217	37,512	$224	38,975	$231	38,808	$238	7,012	$246	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Outpatient Setting	proced	12,327	$1,458	550	$1,505	11,121	$1,553	13,826	$1,603	14,365	$1,654	14,926	$1,707	15,508	$1,762	16,113	$1,818	16,043	$1,876	2,899	$1,936	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Emergency Room Visits	visits	22,020	$553	982	$571	19,866	$589	24,698	$608	25,661	$627	26,662	$647	27,702	$668	28,782	$689	28,659	$711	5,179	$734	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Maternity	proced	1,285	$541	57	$559	1,159	$577	1,441	$595	1,497	$614	1,556	$634	1,617	$654	1,680	$675	1,672	$697	302	$719	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nutritional Counseling	visits	322	$110	14	$114	291	$117	361	$121	375	$125	390	$129	405	$133	421	$137	419	$142	76	$146	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Observation Care	visits	1,753	$146	78	$151	1,582	$156	1,966	$161	2,043	$166	2,123	$171	2,205	$177	2,291	$183	2,282	$188	412	$194	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Prosthetic and Orthotic Services	visits	273	$56	12	$58	246	$59	306	$61	318	$63	331	$65	343	$67	357	$70	355	$72	64	$74	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	5,172	$79	231	$82	4,666	$84	5,801	$87	6,027	$90	6,262	$92	6,507	$95	6,760	$98	6,731	$102	1,216	$105	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Allergy Testing	proced	978	$272	44	$281	882	$290	1,097	$299	1,140	$309	1,184	$319	1,230	$329	1,278	$340	1,273	$350	230	$362	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Chiropractic	visits	53,695	$47	2,396	$48	48,444	$50	60,226	$51	62,574	$53	65,015	$55	67,550	$56	70,185	$58	69,884	$60	12,628	$62	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dialysis and Related Services	proced	153,287	$351	6,839	$362	138,295	$374	171,930	$385	178,635	$398	185,602	$411	192,840	$424	200,361	$437	199,501	$451	36,049	$466	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Immunizations	proced	2,832	$44	126	$46	2,555	$47	3,176	$49	3,300	$50	3,429	$52	3,563	$53	3,702	$55	3,686	$57	666	$59	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nephrology – ESRD Services	months	7,462	$284	333	$293	6,732	$302	8,369	$312	8,696	$322	9,035	$332	9,387	$343	9,753	$354	9,711	$365	1,755	$377	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Office Administered Drugs	proced	68,255	$230	3,045	$238	61,579	$245	76,556	$253	79,542	$261	82,644	$270	85,867	$278	89,216	$287	88,833	$297	16,052	$306	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	PT/OT/SLP	visits	262,304	$92	11,703	$95	236,650	$98	294,206	$101	305,680	$104	317,601	$108	329,988	$111	342,857	$115	341,386	$118	61,687	$122	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

MH & HOMELESS - AMBULATORY
	Outpatient Mental Health	visits	10,252	$123	457	$126	9,250	$131	11,499	$135	11,948	$139	12,414	$143	12,898	$148	13,401	$153	13,343	$158	2,411	$163	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Outpatient Substance Abuse	visits	1,015	$164	45	$170	916	$175	1,139	$181	1,183	$186	1,230	$192	1,278	$199	1,327	$205	1,322	$211	239	$218	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Psychotherapy (Ind. 45+ min / Group)	visits	93,980	$129	4,193	$133	84,788	$137	105,410	$142	109,521	$146	113,792	$151	118,230	$156	122,841	$161	122,314	$166	22,102	$171	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

INPATIENT PROFESSIONAL SERVICES various 88,884 $156 3,966 $161 80,191 $167 99,695 $172 103,583 $177 107,622 $183 111,820 $189 116,181 $195 115,682 $201 20,903 $208 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0

INPATIENT FACILITY SERVICES

INPATIENT MEDICINE AND SURGERY
	IP Acute Medical	days	27,872	$2,730	1,244	$2,818	25,146	$2,908	31,262	$3,001	32,481	$3,097	33,748	$3,196	35,064	$3,298	36,431	$3,404	36,275	$3,513	6,555	$3,625	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Surgical	days	16,065	$5,558	717	$5,736	14,494	$5,920	18,019	$6,109	18,722	$6,305	19,452	$6,506	20,210	$6,715	20,999	$6,929	20,908	$7,151	3,778	$7,380	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Maternity Deliveries	days	535	$3,522	24	$3,634	483	$3,751	600	$3,871	623	$3,994	648	$4,122	673	$4,254	699	$4,390	696	$4,531	126	$4,676	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Maternity Non-Deliveries	days	91	$2,329	4	$2,403	82	$2,480	102	$2,560	106	$2,642	110	$2,726	114	$2,813	119	$2,903	118	$2,996	21	$3,092	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

MH & HOMELESS - INPATIENT
	IP Acute Mental Health	days	4,786	$1,565	214	$1,615	4,318	$1,667	5,368	$1,720	5,577	$1,775	5,795	$1,832	6,021	$1,891	6,256	$1,951	6,229	$2,014	1,126	$2,078	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Mental Health Extended Stays	days	1,798	$186	80	$192	1,622	$198	2,017	$204	2,095	$211	2,177	$217	2,262	$224	2,350	$231	2,340	$239	423	$247	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Substance Abuse	days	4,920	$1,456	220	$1,503	4,439	$1,551	5,518	$1,600	5,734	$1,652	5,957	$1,704	6,190	$1,759	6,431	$1,815	6,403	$1,873	1,157	$1,933	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

Enrollment and Patient Summary

ENROLLMENT
	Unique Enrollment	764,029	34,087	689,305	856,952	890,373	925,098	961,176	998,662	994,376	179,679
	Unique Highly Rural	3,891	174	3,510	4,364	4,534	4,711	4,895	5,086	5,064	915

ENROLLED PATIENTS
	Unique Community Care Patients	115,497	5,153	104,201	129,544	134,596	139,845	145,299	150,966	150,318	27,162

&"Times New Roman,Regular"&8&F &A &D &T &"Times New Roman,Bold"Milliman &"Times New Roman,Regular"Page &P of &N

Colorado

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

Colorado

FY18 Historical Data*

FY19/ Base

FY20/OY1

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FY23/OY4

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FY22/OY3

FY23/OY4

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OUTPATIENT/PHYSICIAN SERVICES $0

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	10,166	$124	454	$128	9,172	$132	11,402	$136	11,847	$141	12,309	$145	12,789	$150	13,288	$155	13,231	$159	2,391	$165	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Colonoscopy	proced	944	$494	42	$510	852	$526	1,059	$543	1,100	$560	1,143	$578	1,188	$597	1,234	$616	1,229	$636	222	$656	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dermatology Services and Diagnostic Exams	proced	396	$112	18	$115	357	$119	444	$123	461	$127	479	$131	498	$135	518	$139	515	$144	93	$148	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Hearing/Speech Exams	exams	642	$67	29	$69	579	$71	720	$73	748	$76	777	$78	808	$80	839	$83	836	$86	151	$88	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	111	$270	5	$278	100	$287	125	$296	129	$306	134	$316	140	$326	145	$336	144	$347	26	$358	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	101	$407	5	$420	91	$433	113	$447	118	$461	122	$476	127	$491	132	$507	131	$523	24	$540	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - General Services	proced	967	$1,075	43	$1,109	872	$1,145	1,085	$1,181	1,127	$1,219	1,171	$1,258	1,217	$1,299	1,264	$1,340	1,259	$1,383	227	$1,427	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	2,491	$309	111	$319	2,247	$329	2,794	$340	2,903	$351	3,016	$362	3,134	$374	3,256	$385	3,242	$398	586	$411	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	227	$82	10	$85	205	$88	255	$90	265	$93	275	$96	286	$99	297	$103	295	$106	53	$109	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Vestibular Function Tests	proced	69	$88	3	$91	62	$94	77	$97	80	$100	84	$103	87	$106	90	$110	90	$113	16	$117	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Non-Invasive Vascular Studies	proced	1,393	$190	62	$196	1,257	$203	1,562	$209	1,623	$216	1,687	$223	1,752	$230	1,821	$237	1,813	$245	328	$253	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ophthalmology Services and Diagnostic Exams	proced	11,017	$53	492	$55	9,940	$57	12,357	$59	12,839	$60	13,340	$62	13,860	$64	14,400	$66	14,339	$68	2,591	$71	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pathology	proced	109,414	$14	4,882	$14	98,713	$15	122,721	$15	127,507	$16	132,480	$16	137,647	$17	143,015	$17	142,401	$18	25,731	$18	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	4,983	$45	222	$46	4,496	$48	5,589	$49	5,807	$51	6,033	$53	6,269	$54	6,513	$56	6,485	$58	1,172	$60	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - CT	proced	10,721	$156	478	$161	9,672	$166	12,025	$172	12,494	$177	12,981	$183	13,487	$189	14,013	$195	13,953	$201	2,521	$207	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - General	proced	13,688	$61	611	$63	12,349	$65	15,353	$67	15,952	$69	16,574	$71	17,220	$73	17,892	$76	17,815	$78	3,219	$81	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Diagnostic	proced	782	$158	35	$163	706	$168	877	$173	911	$179	947	$185	984	$191	1,022	$197	1,018	$203	184	$209	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Screening	proced	2,284	$130	102	$134	2,061	$138	2,562	$142	2,662	$147	2,766	$152	2,873	$157	2,985	$162	2,973	$167	537	$172	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - MRI	proced	3,894	$334	174	$344	3,513	$355	4,368	$367	4,538	$378	4,715	$390	4,899	$403	5,090	$416	5,068	$429	916	$443	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Nuclear Medicine	proced	798	$762	36	$786	720	$811	895	$837	930	$864	966	$891	1,004	$920	1,043	$949	1,039	$980	188	$1,011	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - PET & PET/CT	proced	512	$1,625	23	$1,677	461	$1,731	574	$1,786	596	$1,844	619	$1,903	643	$1,964	669	$2,026	666	$2,091	120	$2,158	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Radiation Oncology	proced	18,779	$371	838	$383	16,942	$395	21,062	$408	21,884	$421	22,737	$434	23,624	$448	24,545	$462	24,440	$477	4,416	$492	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Ultrasound	proced	4,129	$91	184	$94	3,725	$97	4,631	$100	4,812	$103	4,999	$106	5,194	$110	5,397	$113	5,374	$117	971	$121	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Vision Exams	exams	11,190	$206	499	$213	10,095	$220	12,550	$227	13,040	$234	13,548	$242	14,077	$249	14,626	$257	14,563	$265	2,631	$274	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	38,531	$102	1,719	$105	34,762	$109	43,217	$112	44,903	$116	46,654	$120	48,473	$123	50,364	$127	50,148	$131	9,061	$136	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	2,476	$552	110	$570	2,234	$588	2,777	$607	2,885	$626	2,998	$646	3,115	$667	3,236	$688	3,222	$710	582	$733	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - ASC Setting	proced	8,773	$254	391	$262	7,915	$270	9,840	$279	10,224	$288	10,622	$297	11,037	$307	11,467	$317	11,418	$327	2,063	$337	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Office Setting	proced	12,941	$169	577	$175	11,675	$180	14,515	$186	15,081	$192	15,669	$198	16,280	$204	16,915	$211	16,843	$218	3,043	$225	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Outpatient Setting	proced	9,501	$1,203	424	$1,241	8,572	$1,281	10,657	$1,322	11,073	$1,364	11,505	$1,408	11,953	$1,453	12,419	$1,500	12,366	$1,548	2,235	$1,597	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Emergency Room Visits	visits	10,438	$585	466	$604	9,417	$623	11,707	$643	12,164	$664	12,638	$685	13,131	$707	13,644	$729	13,585	$753	2,455	$777	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Maternity	proced	300	$523	13	$540	271	$557	336	$575	350	$593	363	$612	377	$632	392	$652	390	$673	71	$694	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nutritional Counseling	visits	100	$98	4	$101	90	$104	112	$108	117	$111	121	$115	126	$118	131	$122	130	$126	24	$130	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Observation Care	visits	1,576	$150	70	$154	1,422	$159	1,768	$164	1,837	$170	1,909	$175	1,983	$181	2,061	$187	2,052	$193	371	$199	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Prosthetic and Orthotic Services	visits	27	$48	1	$49	24	$51	30	$53	31	$54	33	$56	34	$58	35	$60	35	$61	6	$63	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	1,528	$48	68	$49	1,379	$51	1,714	$52	1,781	$54	1,850	$56	1,922	$58	1,997	$60	1,989	$61	359	$63	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Allergy Testing	proced	286	$253	13	$261	258	$269	321	$278	333	$286	346	$296	360	$305	374	$315	372	$325	67	$335	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Chiropractic	visits	7,164	$44	320	$46	6,463	$47	8,035	$49	8,349	$50	8,674	$52	9,013	$53	9,364	$55	9,324	$57	1,685	$59	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dialysis and Related Services	proced	34,655	$284	1,546	$293	31,265	$303	38,869	$313	40,385	$323	41,960	$333	43,597	$343	45,297	$354	45,102	$366	8,150	$378	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Immunizations	proced	1,643	$37	73	$39	1,482	$40	1,843	$41	1,915	$42	1,989	$44	2,067	$45	2,148	$47	2,138	$48	386	$50	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nephrology – ESRD Services	months	2,291	$265	102	$274	2,067	$283	2,570	$292	2,670	$301	2,774	$311	2,882	$321	2,995	$331	2,982	$341	539	$352	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Office Administered Drugs	proced	42,583	$280	1,900	$289	38,418	$299	47,761	$308	49,624	$318	51,560	$328	53,570	$339	55,660	$349	55,421	$361	10,014	$372	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	PT/OT/SLP	visits	70,086	$87	3,127	$90	63,231	$93	78,610	$96	81,675	$99	84,861	$102	88,170	$106	91,609	$109	91,216	$112	16,482	$116	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

MH & HOMELESS - AMBULATORY
	Outpatient Mental Health	visits	1,903	$137	85	$141	1,717	$146	2,135	$151	2,218	$155	2,305	$160	2,395	$166	2,488	$171	2,477	$176	448	$182	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Outpatient Substance Abuse	visits	749	$91	33	$94	676	$97	840	$100	873	$103	907	$107	943	$110	979	$114	975	$117	176	$121	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Psychotherapy (Ind. 45+ min / Group)	visits	14,757	$127	658	$131	13,314	$135	16,552	$139	17,197	$144	17,868	$148	18,565	$153	19,289	$158	19,206	$163	3,470	$168	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

INPATIENT PROFESSIONAL SERVICES various 38,193 $140 1,704 $144 34,458 $149 42,839 $154 44,509 $159 46,245 $164 48,049 $169 49,923 $174 49,708 $180 8,982 $186 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0

INPATIENT FACILITY SERVICES

INPATIENT MEDICINE AND SURGERY
	IP Acute Medical	days	7,830	$2,174	349	$2,244	7,064	$2,315	8,782	$2,390	9,125	$2,466	9,481	$2,545	9,850	$2,626	10,235	$2,710	10,191	$2,797	1,841	$2,887	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Surgical	days	6,382	$4,130	285	$4,262	5,758	$4,399	7,158	$4,539	7,437	$4,685	7,727	$4,835	8,029	$4,989	8,342	$5,149	8,306	$5,314	1,501	$5,484	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Maternity Deliveries	days	267	$2,849	12	$2,940	241	$3,034	299	$3,131	311	$3,231	323	$3,335	336	$3,441	349	$3,551	347	$3,665	63	$3,782	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Maternity Non-Deliveries	days	58	$893	3	$922	52	$951	65	$982	68	$1,013	70	$1,045	73	$1,079	76	$1,113	75	$1,149	14	$1,186	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

MH & HOMELESS - INPATIENT
	IP Acute Mental Health	days	3,589	$1,246	160	$1,286	3,238	$1,327	4,026	$1,369	4,182	$1,413	4,346	$1,458	4,515	$1,505	4,691	$1,553	4,671	$1,603	844	$1,654	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Mental Health Extended Stays	days	934	$126	42	$130	843	$134	1,048	$138	1,088	$143	1,131	$147	1,175	$152	1,221	$157	1,216	$162	220	$167	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	IP Acute Substance Abuse	days	682	$1,475	30	$1,522	615	$1,571	765	$1,621	795	$1,673	826	$1,727	858	$1,782	891	$1,839	888	$1,898	160	$1,958	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

Enrollment and Patient Summary

ENROLLMENT
	Unique Enrollment	174,361	7,779	157,308	195,567	203,194	211,119	219,353	227,907	226,929	41,005
	Unique Highly Rural	2,399	107	2,164	2,691	2,796	2,905	3,018	3,136	3,122	564

ENROLLED PATIENTS
	Unique Community Care Patients	8,185	365	7,384	9,180	9,539	9,911	10,297	10,699	10,653	1,925

&"Times New Roman,Regular"&8&F &A &D &T &"Times New Roman,Bold"Milliman &"Times New Roman,Regular"Page &P of &N

Hawaii

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

Hawaii

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

Volume Unit

Actual Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Proposed Service Distribution

Proposed % of Medicare

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Proposed % of Medicare

Proposed Service Distribution

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Proposed % of Medicare

Proposed Service Distribution

Proposed % of Medicare

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

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CLIN X002 Total Evaluated Price

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CLIN X002 Total Evaluated Price

Proposed CLIN X002 Volume

CLIN X002 Total Evaluated Price

OUTPATIENT/PHYSICIAN SERVICES $0

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	5,414	$157	242	$162	4,884	$167	6,072	$172	6,309	$178	6,555	$183	6,811	$189	7,077	$195	7,046	$201	1,273	$208	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Colonoscopy	proced	1,536	$577	69	$596	1,386	$615	1,723	$634	1,790	$655	1,860	$676	1,932	$697	2,008	$719	1,999	$742	361	$766	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dermatology Services and Diagnostic Exams	proced	437	$92	19	$95	394	$98	490	$101	509	$104	529	$108	550	$111	571	$115	569	$118	103	$122	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Hearing/Speech Exams	exams	1,510	$50	67	$51	1,363	$53	1,694	$55	1,760	$56	1,829	$58	1,900	$60	1,974	$62	1,966	$64	355	$66	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	83	$335	4	$346	75	$357	93	$369	97	$380	100	$393	104	$405	108	$418	108	$432	20	$445	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	79	$259	4	$267	71	$276	89	$285	92	$294	96	$303	99	$313	103	$323	103	$333	19	$344	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - General Services	proced	664	$199	30	$206	599	$212	745	$219	774	$226	804	$233	835	$241	868	$248	864	$256	156	$264	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	1,524	$529	68	$545	1,375	$563	1,709	$581	1,776	$599	1,845	$619	1,917	$638	1,992	$659	1,983	$680	358	$702	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	365	$76	16	$78	329	$81	409	$84	425	$86	442	$89	459	$92	477	$95	475	$98	86	$101	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	MM - Vestibular Function Tests	proced	12	$90	1	$93	11	$96	13	$99	14	$102	15	$105	15	$109	16	$112	16	$116	3	$120	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Non-Invasive Vascular Studies	proced	1,293	$193	58	$199	1,167	$206	1,450	$212	1,507	$219	1,566	$226	1,627	$233	1,690	$241	1,683	$248	304	$256	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ophthalmology Services and Diagnostic Exams	proced	7,946	$56	355	$57	7,169	$59	8,912	$61	9,260	$63	9,621	$65	9,996	$67	10,386	$69	10,342	$71	1,869	$74	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pathology	proced	71,563	$18	3,193	$19	64,564	$19	80,267	$20	83,397	$21	86,650	$21	90,029	$22	93,540	$23	93,139	$23	16,830	$24	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	1,225	$62	55	$64	1,105	$66	1,374	$68	1,428	$70	1,483	$73	1,541	$75	1,601	$77	1,594	$80	288	$82	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - CT	proced	2,559	$245	114	$252	2,309	$260	2,870	$269	2,982	$277	3,098	$286	3,219	$295	3,345	$305	3,331	$315	602	$325	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - General	proced	10,086	$55	450	$56	9,100	$58	11,313	$60	11,754	$62	12,212	$64	12,689	$66	13,183	$68	13,127	$70	2,372	$73	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Diagnostic	proced	56	$148	2	$153	51	$158	63	$163	65	$168	68	$173	70	$179	73	$185	73	$190	13	$197	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Mammography Screening	proced	131	$138	6	$143	118	$147	147	$152	153	$157	159	$162	165	$167	171	$173	170	$178	31	$184	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - MRI	proced	2,574	$339	115	$350	2,322	$361	2,887	$373	3,000	$385	3,117	$397	3,238	$410	3,364	$423	3,350	$437	605	$451	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Nuclear Medicine	proced	605	$1,167	27	$1,204	546	$1,243	679	$1,282	705	$1,323	733	$1,366	761	$1,409	791	$1,455	787	$1,501	142	$1,549	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - PET & PET/CT	proced	134	$841	6	$868	121	$896	150	$924	156	$954	162	$984	169	$1,016	175	$1,048	174	$1,082	32	$1,116	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Radiation Oncology	proced	1,765	$395	79	$408	1,592	$421	1,980	$434	2,057	$448	2,137	$463	2,220	$477	2,307	$493	2,297	$508	415	$525	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Radiology - Ultrasound	proced	2,109	$109	94	$112	1,903	$116	2,366	$120	2,458	$123	2,554	$127	2,653	$131	2,757	$136	2,745	$140	496	$144	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Vision Exams	exams	4,633	$161	207	$166	4,179	$172	5,196	$177	5,399	$183	5,609	$189	5,828	$195	6,055	$201	6,029	$208	1,089	$214	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	76,360	$87	3,407	$89	68,891	$92	85,647	$95	88,987	$98	92,457	$101	96,063	$105	99,810	$108	99,381	$111	17,958	$115	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	330	$535	15	$552	298	$570	370	$588	385	$607	400	$626	415	$646	431	$667	429	$688	78	$710	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - ASC Setting	proced	2,332	$193	104	$199	2,104	$206	2,616	$212	2,718	$219	2,824	$226	2,934	$233	3,048	$241	3,035	$248	548	$256	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Office Setting	proced	12,263	$140	547	$144	11,064	$149	13,754	$153	14,291	$158	14,848	$163	15,427	$169	16,029	$174	15,960	$180	2,884	$185	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Ambulatory Surgery - Outpatient Setting	proced	3,767	$1,537	168	$1,586	3,399	$1,637	4,225	$1,689	4,390	$1,743	4,561	$1,799	4,739	$1,856	4,924	$1,916	4,903	$1,977	886	$2,040	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Emergency Room Visits	visits	2,771	$649	124	$669	2,500	$691	3,108	$713	3,229	$736	3,355	$759	3,486	$784	3,622	$809	3,606	$835	652	$861	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Maternity	proced	64	$616	3	$636	58	$656	72	$677	75	$699	77	$721	81	$744	84	$768	83	$793	15	$818	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nutritional Counseling	visits	166	$86	7	$88	150	$91	186	$94	193	$97	201	$100	209	$103	217	$107	216	$110	39	$114	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Observation Care	visits	296	$133	13	$137	267	$141	332	$146	345	$151	358	$156	372	$160	387	$166	385	$171	70	$176	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Prosthetic and Orthotic Services	visits	37	$54	2	$56	33	$58	42	$60	43	$62	45	$64	47	$66	48	$68	48	$70	9	$72	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	282	$29	13	$30	254	$31	316	$32	329	$33	341	$34	355	$35	369	$36	367	$37	66	$39	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Allergy Testing	proced	101	$308	5	$318	91	$328	113	$339	118	$350	122	$361	127	$372	132	$384	131	$397	24	$409	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Chiropractic	visits	28,826	$44	1,286	$46	26,007	$47	32,332	$49	33,593	$50	34,903	$52	36,265	$53	37,679	$55	37,517	$57	6,779	$59	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Dialysis and Related Services	proced	10,482	$327	468	$337	9,456	$348	11,756	$359	12,215	$371	12,691	$383	13,186	$395	13,700	$407	13,642	$421	2,465	$434	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Immunizations	proced	770	$38	34	$39	695	$40	864	$41	897	$43	932	$44	969	$45	1,006	$47	1,002	$48	181	$50	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0
	Nephrology – ESRD Services	months	758	$266	34	$274	684	$283	850	$292	884	$301	918	$311	954	$321	991	$331	987	$342	178	$353	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	0	$0	$0

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