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All Hospitalizations (including skilled nursing facility, inpatient rehabilitation, inpatient behavioral health, and residential treatment facilities)

Behavioral Health services - Intensive Outpatient Therapy (IOP) and Partial Hospitalization

Outpatient surgery unless performed in a physician office (excluding screening colonoscopy)

Cancer Treatment (Radiation and Chemo therapies)

Advanced Imaging Services (CT/PET/MRI/MRA/SPECT)

Diagnostic Mammograms

Cardiac Rehabilitation Therapy

Private Duty Nursing

Durable Medical Equipment in excess of $500

Genetic Testing/Molecular Pathology

Prosthetics and Orthotics

Sleep Disorder Testing

Injections (including cortisone injections, Botox injections, nerve blocks, Synvisc, and biologic injections) and Infusion Therapy

Home Health care/Home Infusion services

Organ and Tissue Transplant evaluations and transplant admissions

Renal Dialysis

Observation Beds over 2 nights

Hyperbaric Oxygen Therapy

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