Member for 7 years 1 month Submitted by Site Factory admin on Fri, 10/20/2023 - 18:47 Covered Service Text 12374 12108 194 12109 12375 196 197 198 199 200 202 203 12117 12420 11398 Plan ID 10141 Plan Name Preferred Blue PPO Basic Copayment Product Type Medical Service Benefit Category Id 33 Service Benefit Category Name Routine Pediatric Care
