The facility and / or professional-related costs of an outpatient (ambulatory) surgery. Some benefit designs specify different cost-shares for the "facility component" as opposed to the "professional component." If so, use this category to enter the professional-component cost-share (that is, the part that applies to the doctor or surgeon).
If there is just one cost-share specified for ambulatory surgery, enter that cost-share information (the same information that you entered in the Ambulatory Surgery Outpatient Facility in the Required Coverage Details section) in this category.
However, the benefit might be differentiated in another way: by place of service (facility vs. free-standing / physician-owned).
If there is differentiation based on place-of-service, then enter the facility setting (that is, hospital) for this benefit service category and the free-standing or physician-owned setting under Ambulatory Surgery Outpatient Facility.
You can find the benefit designs for Ambulatory Surgery Outpatient Facility and Ambulatory Surgery Outpatient Professional in the “If you have outpatient surgery” section of your SBC: