Page 15 - GDP - Provider Reimbursement Guide B 2022
P. 15
Supplemental Payment Schedule
SUPPLEMENTAL PAYMENT FEE
$11.00
$13.00
$16.00
$19.00
$13.00
$16.00
$19.00
$30.00
$25.00
$15.00
$30.00
$8.00
$40.00
$33.00
$18.00
$75.00
$150.00
$300.00
$75.00
$150.00
$300.00
$45.00
$23.00
$30.00
$30.00
13
