<>84
Abortion
<>CG
Mental Health Facility - Inpatient
<>51
Hospital - Emergency Accident
<>73
Diagnostic Medical
<>15
Alternate Method Dialysis
<>37
Dental Accident
<>A5
Psychiatric - Room and Board
<>48
Hospital - Inpatient
<>RN
Renal
<>AE
Physical Medicine
<>BN
Gastrointestinal
<>61
In-vitro Fertilization
<>BU
Obstetrical
<>AN
Routine Exam
<>DS
Diabetic Supplies
<>96
Professional (Physician)
<>BE
Massage Therapy
<>7
Anesthesia
<>CL
Screening laboratory
<>TC
Transitional Care
<>NI
Neonatal Intensive Care
<>25
Restorative
<>78
Chemotherapy
<>43
Home Health Prescriptions
<>BX
Mail Order Prescription Drug: Generic
<>AC
Rehabilitation - Outpatient
<>BH
Pediatric
<>82
Family Planning
<>C1
Coronary Care
<>CA
Private Duty Nursing - Inpatient
<>TN
Transitional Nursery Care
<>28
Adjunctive Dental Services
<>57
Air Transportation
<>75
Prosthetic Device
<>13
Ambulatory Service Center Facility
<>CQ
Case Management
<>A3
Professional (Physician) Visit - Home
<>31
Benefit Disclaimer
<>14
Renal Supplies in the Home
<>MH
Mental Health
<>36
Dental Crowns
<>A4
Psychiatric
<>49
Hospital - Room and Board
<>AD
Occupational Therapy
<>85
AIDS
<>CF
Mental Health Provider - Outpatient
<>50
Hospital - Outpatient
<>72
Inhalation Therapy
<>CK
Screening X-ray
<>22
Social Work
<>B2
Brand Name Prescription Drug - Formulary
<>19
Pneumonia Vaccine
<>A9
Rehabilitation
<>44
Home Health Visits
<>66
Pathology
<>BR
Eye
<>AI
Substance Abuse
<>91
Brand Name Prescription Drug
<>BB
Partial Hospitalization (Psychiatric)
<>88
Pharmacy
<>83
Infertility
<>56
Medically Related Transportation
<>74
Private Duty Nursing
<>CP
Eyewear and Eyewear Accessories
<>12
Durable Medical Equipment Purchase
<>30
Health Benefit Plan Coverage
<>A2
Professional (Physician) Visit - Skilled Nursing Facility
<>AR
Experimental Drug Therapy
<>BY
Physician Visit - Office: Sick
<>AB
Rehabilitation - Inpatient
<>BI
Nursery
<>BL
Cardiac
<>86
Emergency Services
<>CE
Mental Health Provider - Inpatient
<>53
Hospital - Ambulatory Surgical
<>71
Audiology Exam
<>17
Pre-Admission Testing
<>35
Dental Care
<>A7
Psychiatric - Inpatient
<>UC
Urgent Care
<>68
Well Baby Care
<>AG
Skilled Nursing Care
<>45
Hospice
<>67
Smoking Cessation
<>BS
Invasive Procedures
<>AH
Skilled Nursing Care - Room and Board
<>GN
Generic Prescription Drug - Non-Formulary
<>90
Mail Order Prescription Drug
<>BC
Day Care (Psychiatric)
<>89
Free Standing Prescription Drug
<>1
Medical Care
<>CJ
Substance Abuse Facility - Outpatient
<>23
Diagnostic Dental
<>B3
Brand Name Prescription Drug - Non-Formulary
<>18
Durable Medical Equipment Rental
<>A8
Psychiatric - Outpatient
<>PT
Physical Therapy
<>40
Oral Surgery
<>62
MRI/CAT Scan
<>BV
Obstetrical/Gynecological
<>AM
Frames
<>95
Podiatry - Nursing Home Visits
<>BF
Pulmonary Rehabilitation
<>4
Diagnostic X-Ray
<>CO
Flu Vaccination
<>26
Endodontics
<>59
Licensed Ambulance
<>52
Hospital - Emergency Medical
<>70
Transplants
<>16
Chronic Renal Disease (CRD) Equipment
<>34
Chiropractic Office Visits
<>A6
Psychotherapy
<>69
Maternity
<>AF
Speech Therapy
<>BM
Lymphatic
<>87
Cancer
<>CD
Surgical Benefits - Facility
<>B
Non-escrow or Non-impound Service
<>2
Surgical
<>CI
Substance Abuse Facility - Inpatient
<>20
Second Surgical Opinion
<>IC
Intensive Care
<>39
Prosthodontics
<>46
Respite Care
<>64
Acupuncture
<>BP
Endocrine
<>AK
Drug Addiction
<>93
Podiatry
<>94
Podiatry - Office Visits
<>BG
Cardiac Rehabilitation
<>5
Diagnostic Lab
<>CN
Mammogram, Low Risk Patient
<>58
Cabulance
<>27
Maxillofacial Prosthetics
<>PU
Pulmonary
<>41
Routine (Preventive) Dental
<>63
Donor Procedures
<>BW
Mail Order Prescription Drug: Brand Name
<>AL
Vision (Optometry)
<>BZ
Physician Visit - Office: Well
<>AA
Rehabilitation - Room and Board
<>99
Professional (Physician) Visit - Inpatient
<>BJ
Skin
<>80
Immunizations
<>8
Surgical Assistance
<>CC
Surgical Benefits - Professional (Physician)
<>55
Major Medical
<>77
Otological Exam
<>11
Used Durable Medical Equipment
<>33
Chiropractic
<>A1
Professional (Physician) Visit - Nursing Home
<>AQ
Nonmedically Necessary Physical
<>38
Orthodontics
<>47
Hospital
<>DG
Dermatology
<>65
Newborn Care
<>BQ
Neurology
<>AJ
Alcoholism
<>92
Generic Prescription Drug
<>BA
Independent Medical Evaluation
<>C
Escrow or Impound Service
<>3
Consultation
<>CH
Mental Health Facility - Outpatient
<>21
Third Surgical Opinion
<>B1
Burn Care
<>24
Periodontics
<>79
Allergy Testing
<>42
Home Health Care
<>60
General Benefits
<>BT
Gynecological
<>AO
Lenses
<>RT
Residential Psychiatric Treatment
<>97
Anesthesiologist
<>BD
Cognitive Therapy
<>GY
Allergy
<>6
Radiation Therapy
<>CM
Mammogram, High Risk Patient
<>9
Other Medical
<>CB
Private Duty Nursing - Home
<>54
Long Term Care
<>76
Dialysis
<>ON
Oncology
<>10
Blood Charges
<>A0
Professional (Physician) Visit - Outpatient
<>32
Plan Waiting Period
<>AP
Routine Eye Exam
<>DM
Durable Medical Equipment
<>GF
Generic Prescription Drug - Formulary
<>98
Professional (Physician) Visit - Office
<>BK
Orthopedic
<>81
Routine Physical