Date *
First name *
Middle name
Last name *
Member ID *
Phone *
Email address *
Re-type email *
Home Health Care (HHC)Bone DensityCT scanFluoroscopyMammographyMRIPET scanPhysical, speech, and occupational therapiesRadiology / X-ray servicesRN, NA, and MSW visitsUltrasoundX-ray – basic such as a chest x-ray
Laboratory servicesCBC (Complete Blood Count)Chemistry panels (Chem 8, Chem 14, Electrolytes, Lipids, Kidney function)Disease markers/factorsLiver function tests (LFTs)Urine analysis (UA)
Durable medical equipment (DME)Bedside commode (BSC)CaneContinuous positive airway pressure (CPAP) equipment and suppliesHospital bedOxygen equipmentWalkerWheelchair
Outpatient proceduresDiagnostic tests (biopsy, colonoscopy, endoscopy)Outpatient surgery
Inpatient servicesCost per bed per facility
Best time to callAMPM
Other procedures
