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$250. Toe. $250. Nose. $250. Non-surgical. 75% of surgical benefit. Chip fracture. 25% of non- surgical benefit. Gunshot wound. $200. Lacerations. With stitches
TOE 250. PHYSICIANS/MEDICAL OFFICERS STATEMENT OF PATIENTS CAPABILITY TO MANAGE BENEFITS. NAME OF WAGE EARNER OR SELF-. EMPLOYED PERSON. IDENTIFYING