Page 49 - APPENDICES for Stephen Spero

AMBULANCE

Ground ambulance

$250 copay

THERAPY SERVICES

Occupational therapy visit

$35 copay

Limits apply

Physical therapy & speech & language therapy visit
$35 copay

Limits apply

MENTAL HEALTH SERVICES

Outpatient group therapy with a psychiatrist
$20 copay

Limits apply

Outpatient individual therapy with a psychiatrist
$20 copay

Limits apply

Outpatient group therapy visit
$20 copay

Limits apply

Outpatient individual therapy visit
$20 copay

Limits apply

OPIOID TREATMENT PROGRAM SERVICES