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G0249

Labs, X-Rays and Other Tests

PROVIDE INR TEST MATER/EQUIP

PROVIDE INR TEST MATER/EQUIP

G0482

Inpatient Medical and Surgical Care in a General Hospital

DRUG TEST DEF 15-21 CLASSES

DRUG TEST DEF 15-21 CLASSES

G0500

Inpatient Medical and Surgical Care in a General Hospital

Surgery as an Outpatient

MOD SEDAT ENDO SERVICE >5YRS

MOD SEDAT ENDO SERVICE >5YRS

G6012

Radiation Therapy and Chemotherapy

RADIATION TREATMENT DELIVERY

RADIATION TREATMENT DELIVERY

G6015

Radiation Therapy and Chemotherapy

RADIATION TX DELIVERY IMRT

RADIATION TX DELIVERY IMRT

L3260

Durable Medical Equipment

AMBULATORY SURGICAL BOOT EAC

AMBULATORY SURGICAL BOOT EAC

Basic Benefit Services - Children Until End Of Calendar Month Age 13

Member for

7 years 5 months

Submitted by Site Factory admin on Mon, 04/15/2024 - 15:19

Service Benefit Category Id

12880

Servicios con beneficios básicos - Niños hasta el final del mes calendario en el que cumplan 13 años

Member for

7 years 5 months

Submitted by Site Factory admin on Mon, 04/15/2024 - 15:19

Service Benefit Category Id

12880

Major Benefit Services - Children Until End Of Calendar Month Age 13

Member for

7 years 5 months

Submitted by Site Factory admin on Mon, 04/15/2024 - 15:19

Service Benefit Category Id

12881

Servicios con beneficios principales - Niños hasta el final del mes calendario en el que cumplan 13 años

Member for

7 years 5 months

Submitted by Site Factory admin on Mon, 04/15/2024 - 15:19

Service Benefit Category Id

12881