Supplementary Exhibit 12 provides the details of the incentive payment your TIN earned as a 						
"participant in the 2014 Group Practice Reporting Option (GPRO), based on a review of all data submitted for your TIN."						
						
Supplementary Exhibit 12. Summary of 2014 GPRO Earned Incentive						
						
Total Earned Incentive Amount	Total Estimated Allowed Medicare Part B Physician Fee Schedule Charges	Incentive as a Percentage of Total Part B Physician Fee Schedule Charges				
$	$	#.##%				
						
						
						
						
						
