Page 17 - GDP - Provider Reimbursement Guide B 2022
P. 17
SUPPLEMENTAL PAYMENT FEE
$30.00
$30.00
$145.00
$145.00
$27.00
$27.00
$150.00
$150.00
$150.00
$150.00
$150.00
$150.00
$150.00
$150.00
$100.00
$100.00
$75.00
$50.00
$50.00
$100.00
$100.00
$145.00
$145.00
$145.00
$145.00
Supplemental Payment Schedule
$50.00
1
1
5
5
