Page 48 - Appendices for Eric Hartman
P. 48
OTHER SERVICES
Durable medical 20% coinsurance per item Limits apply
equipment (like
wheelchairs & oxygen)
Prosthetics (like braces, 20% coinsurance per item Limits apply
arti cial limbs)
Dialysis In-network: $25 copay Limits apply
Diabetes supplies $0 copay Limits apply
