Other PPO providers (Tier 2) - inpatient in a general hospital
Service Benefit Category Id
12033
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Other PPO providers (Tier 2) - inpatient in a mental hospital and substance use treatment facility
Service Benefit Category Id
12034
Diabetic devices, related supplies and testing materials
Service Benefit Category Id
12041
Other PPO providers (Tier 3) - hospital services
Service Benefit Category Id
12052
Other PPO providers (Tier 3) - physician and other professional services
Service Benefit Category Id
12053
Steward Providers and Steward Affiliates (Tier 1) - hospital services
Service Benefit Category Id
12054
Steward Providers and Steward Affiliates (Tier 1) - physician and other professional services
Service Benefit Category Id
12055
Steward approved PPO providers (Tier 2) - hospital services
Service Benefit Category Id
12056
Steward approved PPO providers (Tier 2) - physician and other professional services
Service Benefit Category Id
12057
Other PPO providers (Tier 3) - hospital services
Service Benefit Category Id
12058