Hospital or facility services
Service Benefit Category Id
12037
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Physician and other covered professional providers
Service Benefit Category Id
12038
Other PPO providers (Tier 2) - other covered services
Service Benefit Category Id
12040
Other PPO providers (Tier 2) - office and health center surgical services
Service Benefit Category Id
12047
Other PPO providers (Tier 3) - hospital or facility services
Service Benefit Category Id
12064
Other PPO providers (Tier 3) - physician and other professional services
Service Benefit Category Id
12065
Steward Providers and Steward Affiliates (Tier 1) - general hospital
Service Benefit Category Id
12066
Steward Providers and Steward Affiliates (Tier 1) - other covered providers
Service Benefit Category Id
12067
Steward approved PPO providers (Tier 2) - general hospital
Service Benefit Category Id
12068
Sort Order 2
Service Benefit Category Id
12084