Page 54 - Appendices for Barbara Pender
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OPIOID TREATMENT PROGRAM SERVICES
Opioid treatment program In-network: $10 copay Limits apply
services
OTHER SERVICES
Durable medical 0-20% coinsurance per item Limits apply
equipment (like
wheelchairs & oxygen)
Prosthetics (like braces, 0-20% coinsurance per item Limits apply
arti cial limbs)
Dialysis In-network: $25 copay Limits apply
Diabetes supplies $0 copay Limits apply
