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Total Cost of Svcs. Rendered General Service Care 10. Other 22. Subtotal Inpatient Care Svcs. Lines 2 through 21 Outpatient Subtotal Outpatient Care Svcs. Inpatient Operating Services BHF Page 4 Line 25 3. Interns and Residents Not in an Approved Teaching Program BHF Page 5 Line 27 Cols. Excess Reasonable Cost Applicable to Inpatient and Outpatient Line 8 Each Column X Line 14 18 030 15 382 19 091 Allowable Cost BHF Page 7 Line 7 Cols. 27. Total Sum of Lines 22 and 26 of Assignable Time CMS...
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