KA

TIER 1

2

3

Premier 200

$80

Plus 250A

$147

Premier 400

$50

Plus 450C

$87

4

C

Please note the figures quoted herein are subject to the Final Bid Approval by CMS.

7

TIER 1

2

3

4

Premier 200

$35

$60

$70

$95

Premier Plus 250A

$98

$119 $114 $139 $165 $159

Premier 400

$0

$25

Premier Plus 450B

$41

$60

Premier Plus 450C Premier Plus 450D Premier Plus 450E

$35

$60

5

6

$110 $125

$75

$56

$90

$102 $82 $108

Please note the figures quoted herein are subject to the Final Bid Approval by CMS.

12