Lucy is Having a Baby Below are typical medical care services for prenatal care and a hospital delivery. Medical Care Service Medical Charge Specialist office visits (14 prenatal care visits with Obstetrician) $3,233 Diagnostic test (3 ultrasounds as part of prenatal care, 4 lab tests) $388 Childbirth/Delivery Professional Services (Obstetrician charges for delivery) $2,050 Childbirth/Delivery Facility Services (Hospital stay for delivery) $15,190 Newborn Care (Inpatient pediatric care) $183 Specialist visit (Anesthesiology): $525 In this example, Lucy’s annual expected out-of-pocket expenses would be: ___________ Mia’s Simple Leg Fracture Below are typical medical care services for in-network emergency room care and follow up. Medical Care Service Medical Charge Emergency Room Care Facility Services $1300 Emergency Room Professional Services (Physician charges during visit) $345 Diagnostic test (x-ray): $215 Orthopedic Specialty Care (specialist): (Bone setting, casts) $250 Orthopedic Specialty – Diagnostic Test (x-ray): $215 Durable Medical Equipment (crutches): $250 Physical Therapy (specialist) (6 sessions) $90 In this example, Mia’s annual expected out-of-pocket expenses would be: ___________
Lucy is Having a Baby |
|
Below are typical medical care services for prenatal care and a hospital delivery. |
|
Medical Care Service |
Medical Charge |
Specialist office visits (14 prenatal care visits with Obstetrician) |
$3,233 |
Diagnostic test (3 ultrasounds as part of prenatal care, 4 lab tests) |
$388 |
Childbirth/Delivery Professional Services (Obstetrician charges for delivery) |
$2,050 |
Childbirth/Delivery Facility Services (Hospital stay for delivery) |
$15,190 |
Newborn Care (Inpatient pediatric care) |
$183 |
Specialist visit (Anesthesiology): |
$525 |
In this example, Lucy’s annual expected out-of-pocket expenses would be: ___________
Mia’s Simple Leg Fracture |
|
Below are typical medical care services for in-network emergency room care and follow up. |
|
Medical Care Service |
Medical Charge |
Emergency Room Care Facility Services |
$1300 |
Emergency Room Professional Services (Physician charges during visit) |
$345 |
Diagnostic test (x-ray): |
$215 |
Orthopedic Specialty Care (specialist): (Bone setting, casts) |
$250 |
Orthopedic Specialty – Diagnostic Test (x-ray): |
$215 |
Durable Medical Equipment (crutches): |
$250 |
Physical Therapy (specialist) (6 sessions) |
$90 |
In this example, Mia’s annual expected out-of-pocket expenses would be: ___________
Lucy is Having a Baby | |||
Below are typical medical care services for prenatal care and a hospital delivery. | |||
Medical Care Service | Medical Charge | ||
Specialist office visits (14 prenatal care visits with Obstetrician) | $ 3,233.00 | ||
Diagnostic test (3 ultrasounds as part of prenatal care, 4 lab tests) | $ 388.00 | ||
Childbirth/Delivery Professional Services (Obstetrician charges for delivery) | $ 2,050.00 | ||
Childbirth/Delivery Facility Services (Hospital stay for delivery) | $ 15,190.00 | ||
Newborn Care (Inpatient pediatric care) | $ 183.00 | ||
Specialist visit (Anesthesiology) | $ 525.00 |
Mia’s Simple Leg Fracture | |||
Below are typical medical care services for in-network emergency room care and follow up. | |||
Medical Care Service | Medical Charge | ||
Emergency Room Care Facility Services | $ 1,300.00 | ||
Emergency Room Professional Services (Physician charges during visit) | $ 345.00 | ||
Diagnostic test (x-ray) | $ 215.00 | ||
Orthopedic Specialty Care (specialist) (Bone setting, casts) | $ 250.00 | ||
Orthopedic Specialty – Diagnostic Test (x-ray): | $ 215.00 | ||
Durable Medical Equipment (crutches) | $ 250.00 | ||
Physical Therapy (specialist) (6 sessions) | $ 90.00 |
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