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Where a clinical or brachytherapy APC has fewer than 100 single claims that can be used for ratesetting, under our low volume APC payment adjustment policy, we determine the APC cost as the greatest of the geometric mean cost, arithmetic mean cost, or median cost based on up to 4 years of claims data

2011;152(3):S215

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In rare instances, taking large amounts of vitamin B12 orally or by injection can cause anaphylaxis, a severe allergic reaction

Seems more of an indication of the level they might question

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