Class Only Model Document ***
Common Medical Event Services You May Need Your cost if you use a Tier 1 Provider Your cost if you use a Tier 2 Provider Your cost if you use a Tier 3 Provider Your cost if you use a Tier 4 Provider Limitations & Exceptions ... or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov. ... If you aren’t ... ................
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