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%

TIER 1

2

3

Premier 200

$20

$50

$80

Premier Plus 250A

$72

$112

$147

Premier 400

$0

$20

$50

Premier Plus 450B

$27

$59

Premier Plus 450C

4

C

$87

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

18

*

TIER 1

2

3

4

5

6

Premier 200

$35

$60

$70

$95

$110

$125

Premier Plus 250A

$98

$119

$114

$139

$165

$159

Premier 400

$0

$25

$35

$60

$75

$90

Premier Plus 450B

$41

$60

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

$56

$102 $82 $108

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

31

*

TIER 1

Advantage 300

3

$0

$10

$90

$101

$63

Advantage Plus 450G Advantage Plus 550B Advantage Plus 650B

4

C

$0

Advantage 400 Advantage Plus 150A

2

$36 $0 $0

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

17

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