services_rates.json

[
  {
    "service": "Primary Care Visit to Treat an Injury or Illness",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Specialist Visit",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Other Practitioner Office Visit (Nurse, Physician Assistant)",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)",
    "copay": "$250.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Outpatient Surgery Physician/Surgical Services",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Hospice Services",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Routine Dental Services (Adult)",
    "copay": "$30.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Routine Eye Exam (Adult)",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Urgent Care Centers or Facilities",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Home Health Care Services",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Emergency Room Services",
    "copay": "$150.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Emergency Transportation/Ambulance",
    "copay": "$150.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Inpatient Hospital Services (e.g., Hospital Stay)",
    "copay": "$250.00 Copay per Day",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Inpatient Physician and Surgical Services",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Bariatric Surgery",
    "copay": "$250.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Skilled Nursing Facility",
    "copay": "$150.00 Copay per Day",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Prenatal and Postnatal Care",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Delivery and All Inpatient Services for Maternity Care",
    "copay": "$250.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Mental/Behavioral Health Outpatient Services",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Mental/Behavioral Health Inpatient Services",
    "copay": "$250.00 Copay per Day",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Substance Abuse Disorder Outpatient Services",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Substance Abuse Disorder Inpatient Services",
    "copay": "$250.00 Copay per Day",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Generic Drugs",
    "copay": "$5.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Preferred Brand Drugs",
    "copay": "$15.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Non-Preferred Brand Drugs",
    "copay": "$25.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Specialty Drugs",
    "copay": "$100.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Outpatient Rehabilitation Services",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Habilitation Services",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Chiropractic Care",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Durable Medical Equipment",
    "copay": "Not Applicable",
    "coinsurance": "10.00%"
  },
  {
    "service": "Imaging (CT/PET Scans, MRIs)",
    "copay": "$150.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Preventive Care/Screening/Immunization",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Weight Loss Programs",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Routine Eye Exam for Children",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Eye Glasses for Children",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Dental Check-Up for Children",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Rehabilitative Speech Therapy",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Rehabilitative Occupational and Rehabilitative Physical Therapy",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Well Baby Visits and Care",
    "copay": "No Charge",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Laboratory Outpatient and Professional Services",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "X-rays and Diagnostic Imaging",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Basic Dental Care - Child",
    "copay": "Not Applicable",
    "coinsurance": "31.00%"
  },
  {
    "service": "Orthodontia - Child",
    "copay": "Not Applicable",
    "coinsurance": "55.00%"
  },
  {
    "service": "Major Dental Care - Child",
    "copay": "Not Applicable",
    "coinsurance": "38.00%"
  },
  {
    "service": "Basic Dental Care - Adult",
    "copay": "Not Applicable",
    "coinsurance": "44.00%"
  },
  {
    "service": "Orthodontia - Adult",
    "copay": "Not Applicable",
    "coinsurance": "55.00%"
  },
  {
    "service": "Major Dental Care - Adult",
    "copay": "Not Applicable",
    "coinsurance": "49.00%"
  },
  {
    "service": "Abortion for Which Public Funding is Prohibited",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Transplant",
    "copay": "$250.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Accidental Dental",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Dialysis",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Allergy Testing",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Chemotherapy",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Radiation",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Diabetes Education",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Prosthetic Devices",
    "copay": "Not Applicable",
    "coinsurance": "10.00%"
  },
  {
    "service": "Infusion Therapy",
    "copay": "$40.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Nutritional Counseling",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Reconstructive Surgery",
    "copay": "$250.00",
    "coinsurance": "Not Applicable"
  },
  {
    "service": "Mental Health Other",
    "copay": "$20.00",
    "coinsurance": "Not Applicable"
  }
]