Page 56 - Appendices to Donald Pender's Evaluation
P. 56
TESTS, LABS, & IMAGING
Diagnostic tests & $0 copay
procedures
Lab services $0 copay
Diagnostic radiology $0 copay Limits apply
services (like MRI)
Outpatient x-rays $0 copay Limits apply
Emergency care $50 copay per visit (always
covered)
Urgent care $0 copay
HOSPITAL SERVICES
Inpatient hospital $0 copay Limits apply
coverage
Outpatient hospital $50 copay per visit Limits apply
coverage
SKILLED NURSING FACILITY
Skilled nursing facility $0 copay Limits apply
