Designated Facilities (Tier 2)
Service Benefit Category Id
11987
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Wayfair PPO providers (Tier 1) - facility services
Service Benefit Category Id
11999
Other PPO providers (Tier 2) - inpatient professional (physician) services
Service Benefit Category Id
12042
Other PPO providers (Tier 2) - inpatient professional (physician) services
Service Benefit Category Id
12043
Other PPO providers (Tier 2) - inpatient professional (physician) services
Service Benefit Category Id
12044
Sort Order 1
Service Benefit Category Id
12082
Steward approved PPO providers (Tier 2) - hospital or other day surgical facility services
Service Benefit Category Id
12087
Steward approved PPO providers (Tier 2) - inpatient hospital or facility services
Service Benefit Category Id
12100
Steward approved PPO providers (Tier 2) - inpatient professional (physician) services
Service Benefit Category Id
12101
Steward approved PPO providers (Tier 2) - oxygen and equipment for administration
Service Benefit Category Id
12122