Other PPO providers (Tier 3) - hospital or other day surgical facility services
Service Benefit Category Id
12090
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Other PPO providers (Tier 3) - professional (physician) day surgical services
Service Benefit Category Id
12091
Steward Providers and Steward Affiliates (Tier 1) - facility services
Service Benefit Category Id
12092
Steward Providers and Steward Affiliates (Tier 1) - physician and other professional services
Service Benefit Category Id
12093
Other PPO providers (Tier 3) - facility services
Service Benefit Category Id
12096
Other PPO providers (Tier 3) - physician and other professional services
Service Benefit Category Id
12097
Steward Providers and Steward Affiliates (Tier 1) - inpatient hospital or facility services
Service Benefit Category Id
12098
Steward Providers and Steward Affiliates (Tier 1) - inpatient professional (physician) services
Service Benefit Category Id
12105
Steward approved PPO providers (Tier 2) - inpatient hospital or facility services
Service Benefit Category Id
12106
Other PPO providers (Tier 3) - inpatient hospital or facility services
Service Benefit Category Id
12108