Physical therapy (after $2,000 paid per calendar year)
Service Benefit Category Id
10086
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Other covered services
Service Benefit Category Id
10087
Inpatient hospital services (until $2,000 paid for selected services)
Service Benefit Category Id
10088
Inpatient hospital services (after $2,000 paid per calendar year)
Service Benefit Category Id
10089
Inpatient physician and other covered professional provider services
Service Benefit Category Id
10090
Inpatient facility services (until $2,000 paid for selected services)
Service Benefit Category Id
10091
Inpatient facility services (after $2,000 paid per calendar year)
Service Benefit Category Id
10092
Inpatient physician and other professional provider services
Service Benefit Category Id
10093
Preoperative lab tests and x-rays
Service Benefit Category Id
10094
Outpatient surgery
Service Benefit Category Id
10095