Inpatient facility services (after $2,000 paid per calendar year)
Service Benefit Category Id
10066
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Inpatient physician and other covered professional provider services
Service Benefit Category Id
10067
(until $2,000 paid for selected services)
Service Benefit Category Id
10068
(after $2,000 paid per calendar year)
Service Benefit Category Id
10069
Diagnostic tests (until $2,000 paid for selected services)
Service Benefit Category Id
10070
Diagnostic tests (after $2,000 paid per calendar year)
Service Benefit Category Id
10071
(until $2,000 paid for selected services)
Service Benefit Category Id
10072
(after $2,000 paid per calendar year)
Service Benefit Category Id
10073
(until $2,000 paid for selected services)
Service Benefit Category Id
10074
(after $2,000 paid per calendar year)
Service Benefit Category Id
10075