Appointment Type | Practice Full Fee | Medicare Refund | Out of Pocket | No Medicare | Gap Only Fee |
---|---|---|---|---|---|
Level A – Brief | $38.85 | $18.95 | $20.00 | $38.95 | $25 |
Level B – Normal | $71.40 | $41.40 | $30.00 | $71.40 | $35 |
Level C – Long | $120.10 | $80.10 | $40.00 | $120.10 | $45 |
Level D – Long | $158.00 | $118.00 | $40.00 | $158.00 | $45 |