Designated Facilities (Tier 2)
Service Benefit Category Id
11978
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PPO providers except Designated Facilities (Tier 1)
Service Benefit Category Id
11981
Designated Facilities (Tier 2)
Service Benefit Category Id
11982
Other PPO providers (Tier 2)
Service Benefit Category Id
11985
PPO providers except Designated Facilities (Tier 1)
Service Benefit Category Id
11988
Other covered providers
Service Benefit Category Id
11992
Other covered providers
Service Benefit Category Id
11993
Other covered providers
Service Benefit Category Id
11994
Other covered providers
Service Benefit Category Id
11995
Other covered providers
Service Benefit Category Id
11996