| Select Payer |
|
| Eval Cost |
|
| Visit Costs |
|
| Total # Visits |
# |
| Total Charge for All Visits |
|
|
Co-pay/Visit
|
$%
|
| Total Patient Co-pay |
|
| Balance Remaining After Co-Pay |
|
| Deductible Remaining |
$ |
| Patient Deductible Responsibility |
|
| Patient Net Cost for Services |
$ |
| Net Cost per Visit |
$ |
|
|
Reimbursement rates are variable and dictated by your insurer's benefit plan.
|
