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NOT FOR USE IN NEONATES LOT #####AA EXP DMMMYYYY PRINCIPAL DISPLAY PANEL - 30 mL Vial Tray 30 mL Multiple-dose NDC 0409-3977-03 Contains 25 of NDC 0409-3977-01 Rx only BACTERIOSTATIC WATER for Injection, USP WARNING: NOT FOR USE IN NEONATES

As discussed previously, we proposed that if the negotiated percentage or algorithm associated with the allowed amounts was only used for a portion of the 12-month time period prior to posting the file, the hospital would encode the median allowed amount, 10th and 90th percentile allowed amounts, and count of allowed amounts from the EDI 835 ERA transaction data for the portion of time that the percentage or algorithm was used

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