Note: this question will not be automatically graded. It will be sent to your instructor for review. Dr. Mary Mandlebaum is a PAR provider in Medicare and in Mountville Health Plan, which has allowed charges for services and does not permit balance billing of plan members. She is not a PAR provider in the Ringdale Medical Plan. Based on the following table of charges, calculate the charges that the payer and the patient will pay in each of the situations. Show your calculations. Mountville Health Plan Medicare Service CPT Usual Charge Allowed Charge Allowed Charge Office/Outpatient Visit, New, Min. 99201 $54 $48 $43 Office/Outpatient Visit, New, Low 99202 $73 $65 $58 Office/Outpatient Visit, New, Mod. 99203 $100 $89 $90 Office/Outpatient Visit, New, Mod. 99204 $147 $129 $116 Office/Outpatient Visit, New, High 99206 $190 $168 $151 Office/Outpatient Visit, Est., Min. 99211 $29 $26 $22 Office/Outpatient Visit, Est., Low 99212 $44 $39 $35 Office/Outpatient Visit, Est., Mod. 99213 $60 $54 $48 Office/Outpatient Visit, Est., Mod. 99214 $87 $78 $70 Office/Outpatient Visit, Est., High 99215 $134 $119 $107 Rhythm ECG with Report 93040 $30 $36 $30 Breathing Capacity Test 94010 $83 $69 $58 DTAP Immunization 90700 $102 $87 $74