HOSPITAL AND PHARMACY SERVICES ARE AVAILABLE NATIONWIDE
| Regular | Same Day |
|
55. Limited Hospital (3)
(Same day availability if ordered before 2:00pm EST)
|
$72.00
|
$106.00
|
|
56. Basic Hospital (6)
(Same day availability if ordered before 2:00pm EST)
|
$127.00
|
$194.00
|
|
56e. Enhanced Hospital (8)
(Same day availability if ordered before 2:00pm EST)
|
$150.00
|
$217.00
|
|
57. Standard Hospital (12)
(Same day availability if ordered before 2:00pm EST)
|
$194.00
|
$282.00
|
|
58. Extended Hospital (22)
(Same day availability if ordered before 2:00pm EST)
|
$260.00
|
$382.00
|
|
59. Services no longer available
| | |
|
60. Medical Providers
(Call if not below)
|
CALL
|
N/A
|
|
60a. Medical Providers (8)
|
$150.00
|
N/A
|
|
60b. Medical Providers (12)
|
$194.00
|
N/A
|
|
60c. Medical Providers (22)
|
$260.00
|
N/A
|
|
61. Pharmacies
(Call if not below)
|
CALL
|
N/A
|
|
61a. Pharmacies (8)
|
$150.00
|
N/A
|
|
61b. Pharmacies (12)
|
$194.00
|
N/A
|
|
61c. Pharmacies (22)
|
$260.00
|
N/A
|
|
61d. Enhanced Medical
(Call if not below)
|
CALL
|
N/A
|
|
61e. 8 Hospitals & 8 Pharmacies (or 8 providers)
|
$237.00
|
N/A
|
|
61f. 12 Hospitals & 12 Pharmacies (or 12 providers)
|
$315.00
|
N/A
|
|
61g. 22 Hospitals & 22 Pharmacies (or 22 providers)
|
$436.00
|
N/A
|
|
61h. Extended Medical
(Call if not below)
|
CALL
|
N/A
|
|
61i. 8 Hospitals, 8 Pharmacies & 8 Providers
|
$315.00
|
N/A
|
|
61j. 12 Hospitals, 12 Pharmacies & 12 Providers
|
$381.00
|
N/A
|
|
61k. 22 Hospitals, 22 Pharmacies & 22 Providers
|
$597.00
|
N/A
|
Note: Whenever possible, please include a completed release form with orders for or including Hospital or Medical Provider services. Please have the release form completed by the subject and fax, mail or e-mail a scanned copy. This form conforms with Health Information Personal Privacy Act (HIPAA) consent requirements.
Click here to open the Release Form in MS Word format.
Click here to open the Release Form in PDF format.
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