Practice Fees

DESCRIPTION ITEM NO. PRIVATE FEE* MEDICARE FEE PERSONAL GAP
 

LEVEL A

 

3

 

$51.00

 

$17.45

 

$33.55

   
Standard        
LEVEL B 23 $74.00 $38.20 $35.80
 

LEVEL C

 

36

 

$108.00

 

$73.95

 

$34.05

 

LEVEL D

 

44

 

$142.00

 

$108.85

 

$33.15