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Insurance Plan: Mountville Health Plan; patient has met annual deductible of $250, 80-20 coinsurance Services: CPT 99215, 93040, 94010 Payer Reimbursement_______ Patient Charge____

Insurance Plan: Mountville Health Plan; patient has met annual deductible of $250, 80-20 coinsurance Services: CPT 99215, 93040, 94010 Payer Reimbursement_______ Patient Charge____

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