pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_c_oon_outpt_group_num_id	pbp_c_oon_outpt_bendesc_cats	pbp_c_oon_outpt_grp_lbl	pbp_c_oon_outpt_coins_yn	pbp_c_oon_outpt_coins_min_pct	pbp_c_oon_outpt_coins_max_pct	pbp_c_oon_outpt_coins_cov	pbp_c_oon_outpt_copay_yn	pbp_c_oon_outpt_copay_min_amt	pbp_c_oon_outpt_copay_max_amt	pbp_c_oon_outpt_ded_yn	pbp_c_oon_outpt_ded_amt
H0104	002	0	1	04	01	H0104_002_0	3	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			2	
H0104	004	0	1	04	01	H0104_004_0	3	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			2	
H0104	006	0	1	04	01	H0104_006_0	4	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			1	2000.00
H0104	007	0	1	04	01	H0104_007_0	4	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			2	
H0104	008	0	1	04	01	H0104_008_0	3	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			2	
H0104	801	0	1	04	01	H0104_801_0	3	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			1	1500.00
H0104	802	0	1	04	01	H0104_802_0	5	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			1	1500.00
H0104	804	0	1	04	01	H0104_804_0	5	1	01111111111111111111110111110000011111111101101		1	30	30	2	2			1	1500.00
H0317	001	0	1	04	01	H0317_001_0	5	6	00000000000000000000000000100000000000000000000		2				1	0.00	25.00	2	
H0317	001	0	1	04	01	H0317_001_0	5	5	00000000000000000000000110000000000000000000000		1	50	50	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	5	4	00000001010001011001000000000000000011111000000		1	15	20	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	5	3	00000110101010000000000000000000011100000101101		1	20	20	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	5	2	00110000000000000110100000000000000000000000000		1	15	15	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	5	1	01001000000000000000000000000000000000000000000		1	40	40	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	5	7	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0317	001	0	1	04	01	H0317_001_0	5	9	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0317	001	0	1	04	01	H0317_001_0	5	8	00000000000000000000000001000000000000000000000		1	20	50	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	1	01111000000000000110100000000000000000000000000		1	40	40	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	2	00000110111000000000000000000000011110000101101		1	20	20	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	3	00000001000001111001000000000000000001111000000		1	20	40	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0317	002	0	1	04	01	H0317_002_0	7	5	00000000000000000000000000100000000000000000000		2				1	25.00	150.00	2	
H0317	002	0	1	04	01	H0317_002_0	7	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0317	002	0	1	04	01	H0317_002_0	7	8	00000000000000000000000001000000000000000000000		1	20	50	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	7	00000000000000000000000110000000000000000000000		1	50	50	6	2			2	
H0317	801	0	1	04	01	H0317_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0317	801	0	1	04	01	H0317_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0317	801	0	1	04	01	H0317_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0317	801	0	1	04	01	H0317_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0317	802	0	1	04	01	H0317_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0317	802	0	1	04	01	H0317_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0317	802	0	1	04	01	H0317_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0317	802	0	1	04	01	H0317_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0317	803	0	1	04	01	H0317_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0317	803	0	1	04	01	H0317_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0317	803	0	1	04	01	H0317_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0317	803	0	1	04	01	H0317_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0317	804	0	1	04	01	H0317_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0317	804	0	1	04	01	H0317_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0317	804	0	1	04	01	H0317_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0317	804	0	1	04	01	H0317_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0319	001	0	1	04	01	H0319_001_0	6	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H0319	001	0	1	04	01	H0319_001_0	6	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H0319	002	0	1	04	01	H0319_002_0	6	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H0319	002	0	1	04	01	H0319_002_0	6	1	01111111111111111111111111110000111111111101101	Group 1	1	30	30	6	2			2	
H0319	004	0	1	04	01	H0319_004_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H0319	004	0	1	04	01	H0319_004_0	5	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H0322	001	0	1	04	01	H0322_001_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H0322	001	0	1	04	01	H0322_001_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0322	002	0	1	04	01	H0322_002_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0322	002	0	1	04	01	H0322_002_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H0322	006	0	1	04	01	H0322_006_0	7	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H0322	006	0	1	04	01	H0322_006_0	7	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0322	801	0	1	04	01	H0322_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H0322	801	0	1	04	01	H0322_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H0322	802	0	1	04	01	H0322_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H0322	802	0	1	04	01	H0322_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H0620	002	0	1	04	01	H0620_002_0	7	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H0620	002	0	1	04	01	H0620_002_0	7	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H0623	001	0	1	04	01	H0623_001_0	4	4	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H0623	001	0	1	04	01	H0623_001_0	4	5	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H0623	001	0	1	04	01	H0623_001_0	4	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	001	0	1	04	01	H0623_001_0	4	3	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H0623	001	0	1	04	01	H0623_001_0	4	1	01111111111011111111100000010000011111111101101		1	20	20	6	2			2	
H0623	001	0	1	04	01	H0623_001_0	4	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	002	0	1	04	01	H0623_002_0	4	3	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H0623	002	0	1	04	01	H0623_002_0	4	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	002	0	1	04	01	H0623_002_0	4	5	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H0623	002	0	1	04	01	H0623_002_0	4	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	002	0	1	04	01	H0623_002_0	4	4	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H0623	002	0	1	04	01	H0623_002_0	4	1	01111111111011111111100000010000011111111101101		1	20	20	6	2			2	
H0623	003	0	1	04	01	H0623_003_0	4	3	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H0623	003	0	1	04	01	H0623_003_0	4	1	01111111111011111111100000000000011111111001101		1	15	15	6	2			2	
H0623	003	0	1	04	01	H0623_003_0	4	5	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H0623	003	0	1	04	01	H0623_003_0	4	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	003	0	1	04	01	H0623_003_0	4	7	00000000000000000000000000000000000000000100000		1	15	20	6	2			2	
H0623	003	0	1	04	01	H0623_003_0	4	4	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H0623	003	0	1	04	01	H0623_003_0	4	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	801	0	1	04	01	H0623_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0623	801	0	1	04	01	H0623_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	801	0	1	04	01	H0623_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0623	801	0	1	04	01	H0623_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0623	802	0	1	04	01	H0623_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0623	802	0	1	04	01	H0623_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	802	0	1	04	01	H0623_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0623	802	0	1	04	01	H0623_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0623	803	0	1	04	01	H0623_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0623	803	0	1	04	01	H0623_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0623	803	0	1	04	01	H0623_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	803	0	1	04	01	H0623_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0623	804	0	1	04	01	H0623_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H0623	804	0	1	04	01	H0623_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H0623	804	0	1	04	01	H0623_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H0623	804	0	1	04	01	H0623_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H0710	001	0	1	04	01	H0710_001_0	3	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H0710	001	0	1	04	01	H0710_001_0	3	2	00000000000000000000000000000000000000000000010	Group 2	2				2			2	
H0710	002	0	1	04	01	H0710_002_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H0710	003	0	1	04	01	H0710_003_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H0710	003	0	1	04	01	H0710_003_0	5	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H0902	002	0	1	04	01	H0902_002_0	7	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H0902	002	0	1	04	01	H0902_002_0	7	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0902	003	0	1	04	01	H0902_003_0	7	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H0902	003	0	1	04	01	H0902_003_0	7	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0902	801	0	1	04	01	H0902_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H0902	801	0	1	04	01	H0902_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H0902	802	0	1	04	01	H0902_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H0902	802	0	1	04	01	H0902_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H1108	001	0	1	04	01	H1108_001_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H1108	002	0	1	04	01	H1108_002_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H1108	006	0	1	04	01	H1108_006_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H1108	006	0	1	04	01	H1108_006_0	5	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H1110	001	0	1	04	01	H1110_001_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H1110	801	0	1	04	01	H1110_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H1110	801	0	1	04	01	H1110_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H1110	802	0	1	04	01	H1110_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H1110	802	0	1	04	01	H1110_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H1302	001	0	1	04	01	H1302_001_0	4	2	00000000000000000000010000100000000000000000000		1	10	10	1	2			2	
H1302	001	0	1	04	01	H1302_001_0	4	3	00111111111111111111101111010000011111111100101		1	25	25	2	2			2	
H1302	001	0	1	04	01	H1302_001_0	4	1	01000000000000000000000000000000000000000000000		2				1	50.00	50.00	2	
H1302	001	0	1	04	01	H1302_001_0	4	4	00000000000000000000000000000000000000000000010	Eye Wear	2				2			2	
H1302	001	0	1	04	01	H1302_001_0	4	5	00000000000000000000000000000000100000000000000		2				2			2	
H1302	002	0	1	04	01	H1302_002_0	3	3	00111111111111111111101111010000011111111100101		1	25	25	2	2			2	
H1302	002	0	1	04	01	H1302_002_0	3	1	01000000000000000000000000000000000000000000000		2				1	50.00	50.00	2	
H1302	002	0	1	04	01	H1302_002_0	3	2	00000000000000000000010000100000000000000000000		1	10	10	1	2			2	
H1302	002	0	1	04	01	H1302_002_0	3	4	00000000000000000000000000000000000000000000010	Eye Wear	2				2			2	
H1302	002	0	1	04	01	H1302_002_0	3	5	00000000000000000000000000000000100000000000000		2				2			2	
H1302	004	0	1	04	01	H1302_004_0	1	5	00000000000000000000000000000000100000000000000		2				2			2	
H1302	004	0	1	04	01	H1302_004_0	1	2	00000000000000000000010000100000000000000000000		1	10	10	1	2			2	
H1302	004	0	1	04	01	H1302_004_0	1	4	00000000000000000000000000000000000000000000010	Eye Wear	2				2			2	
H1302	004	0	1	04	01	H1302_004_0	1	1	01000000000000000000000000000000000000000000000		2				1	50.00	50.00	2	
H1302	004	0	1	04	01	H1302_004_0	1	3	00111111111111111111101111010000011111111100101		1	25	25	2	2			2	
H1302	005	0	1	04	01	H1302_005_0	1	4	00000000000000000000000000000000000000000000010	Eye Wear	2				2			2	
H1302	005	0	1	04	01	H1302_005_0	1	5	00000000000000000000000000000000100000000000000		2				2			2	
H1302	005	0	1	04	01	H1302_005_0	1	1	01000000000000000000000000000000000000000000000		2				1	50.00	50.00	2	
H1302	005	0	1	04	01	H1302_005_0	1	3	00111111111111111111101111010000011111111100101		1	25	25	2	2			2	
H1302	005	0	1	04	01	H1302_005_0	1	2	00000000000000000000010000100000000000000000000		1	10	10	1	2			2	
H1303	001	0	1	04	01	H1303_001_0	6	2	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H1303	001	0	1	04	01	H1303_001_0	6	3	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H1303	001	0	1	04	01	H1303_001_0	6	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1303	001	0	1	04	01	H1303_001_0	6	5	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H1303	001	0	1	04	01	H1303_001_0	6	1	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1303	001	0	1	04	01	H1303_001_0	6	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1303	001	0	1	04	01	H1303_001_0	6	8	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H1303	001	0	1	04	01	H1303_001_0	6	9	00000000000000000000000000010000100000000000000		2				2			2	
H1303	001	0	1	04	01	H1303_001_0	6	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	9	00000000000000000000000000010000100000000000000		2				2			2	
H1303	003	0	1	04	01	H1303_003_0	3	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	6	00000010101100000000000000000000000000000001101		2				1	30.00	30.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	5	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	3	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	2	00101001000001000110100111100000010111111100010		1	30	30	6	2			2	
H1303	003	0	1	04	01	H1303_003_0	3	1	01000000000000000000000000000000000000000000000		2				1	100.00	100.00	2	
H1303	004	0	1	04	01	H1303_004_0	4	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	2	10000000000000000000000000000000000000000000010		2				2			2	
H1303	801	0	1	04	01	H1303_801_0	5	3	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H1303	801	0	1	04	01	H1303_801_0	5	2	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H1303	801	0	1	04	01	H1303_801_0	5	1	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1303	801	0	1	04	01	H1303_801_0	5	8	00000000000000000000000000010000100000000000000		2				2			2	
H1303	801	0	1	04	01	H1303_801_0	5	5	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H1303	801	0	1	04	01	H1303_801_0	5	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1303	801	0	1	04	01	H1303_801_0	5	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1303	801	0	1	04	01	H1303_801_0	5	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
H1304	001	0	1	04	01	H1304_001_0	3	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H1304	001	0	1	04	01	H1304_001_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H1304	002	0	1	04	01	H1304_002_0	3	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H1304	002	0	1	04	01	H1304_002_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H1304	004	0	1	04	01	H1304_004_0	3	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H1304	004	0	1	04	01	H1304_004_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H1417	001	0	1	04	01	H1417_001_0	3	1	01000000000000000000000000000000000000000000000	SNF	2				1	100.00	100.00	2	
H1417	001	0	1	04	01	H1417_001_0	3	2	00001000000000000000000000000000000000000000000	Home Health	2				1	10.00	10.00	2	
H1417	001	0	1	04	01	H1417_001_0	3	3	00000000000000000000010000000000000000000000000	Ambulance	2				2			2	
H1417	001	0	1	04	01	H1417_001_0	3	7	00000000000000000110000000000000000000000000000	OP Surgery	2				1	100.00	100.00	2	
H1417	001	0	1	04	01	H1417_001_0	3	5	00110111111111111001100000000000001100001001101	Copay Group	2				1	30.00	30.00	2	
H1417	001	0	1	04	01	H1417_001_0	3	6	00000000000000000000000000110000110011110100010	$0 Group	2				2			2	
H1417	001	0	1	04	01	H1417_001_0	3	4	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	20	20	2	2			2	
H1417	002	0	1	04	01	H1417_002_0	5	4	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	20	20	2	2			2	
H1417	002	0	1	04	01	H1417_002_0	5	5	00110111111111111001100000000000001100001001101	Copay Group	2				1	30.00	30.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	6	00000000000000000000000000110000110011110100010	$0 Group	2				2			2	
H1417	002	0	1	04	01	H1417_002_0	5	7	00000000000000000110000000000000000000000000000	OP Surgery	2				1	100.00	100.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	1	01000000000000000000000000000000000000000000000	SNF	2				1	100.00	100.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	2	00001000000000000000000000000000000000000000000	Home Health	2				1	10.00	10.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	3	00000000000000000000010000000000000000000000000	Ambulance	2				2			2	
H1417	003	0	1	04	01	H1417_003_0	3	1	01000000000000000000000000000000000000000000000	SNF	2				1	115.00	115.00	2	
H1417	003	0	1	04	01	H1417_003_0	3	4	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	20	20	2	2			2	
H1417	003	0	1	04	01	H1417_003_0	3	2	00001000000000000000000000000000000000000000000	Home Health	2				1	20.00	20.00	2	
H1417	003	0	1	04	01	H1417_003_0	3	5	00110111111111111111100000000000001100001101000	Coinsurance Group	1	15	15	2	2			2	
H1417	003	0	1	04	01	H1417_003_0	3	3	00000000000000000000010000000000000000000000000	Ambulance	1	15	15	2	2			2	
H1417	003	0	1	04	01	H1417_003_0	3	6	00000000000000000000000000110000110011110000010	$0 Group	2				2			2	
H1417	004	0	1	04	01	H1417_004_0	5	3	00000000000000000000010000000000000000000000000	Ambulance	1	15	15	2	2			2	
H1417	004	0	1	04	01	H1417_004_0	5	2	00001000000000000000000000000000000000000000000	Home Health	2				1	20.00	20.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	1	01000000000000000000000000000000000000000000000	SNF	2				1	115.00	115.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	5	00110111111111111111100000000000001100001101000	Coinsurance Group	1	15	15	2	2			2	
H1417	004	0	1	04	01	H1417_004_0	5	6	00000000000000000000000000110000110011110000010	$0 Group	2				2			2	
H1417	004	0	1	04	01	H1417_004_0	5	4	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	20	20	2	2			2	
H1417	005	0	1	04	01	H1417_005_0	5	2	00001000000000000000000000000000000000000000000	Home Health	2				1	10.00	10.00	2	
H1417	005	0	1	04	01	H1417_005_0	5	1	01000000000000000000000000000000000000000000000	SNF	2				1	100.00	100.00	2	
H1417	005	0	1	04	01	H1417_005_0	5	4	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	20	20	2	2			2	
H1417	005	0	1	04	01	H1417_005_0	5	7	00000000000000000110000000000000000000000000000	OP Surgery	2				1	100.00	100.00	2	
H1417	005	0	1	04	01	H1417_005_0	5	6	00000000000000000000000000110000110011110100010	$0 Group	2				2			2	
H1417	005	0	1	04	01	H1417_005_0	5	5	00110111111111111001100000000000001100001001101	Copay Group	2				1	30.00	30.00	2	
H1417	005	0	1	04	01	H1417_005_0	5	3	00000000000000000000010000000000000000000000000	Ambulance	2				2			2	
H1417	006	0	1	04	01	H1417_006_0	5	1	01000000000000000000000000000000000000000000000	SNF	2				1	115.00	115.00	2	
H1417	006	0	1	04	01	H1417_006_0	5	3	00000000000000000000010000000000000000000000000	Ambulance	1	15	15	2	2			2	
H1417	006	0	1	04	01	H1417_006_0	5	4	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	20	20	2	2			2	
H1417	006	0	1	04	01	H1417_006_0	5	5	00110111111111111111100000000000001100001101000	Coinsurance Group	1	15	15	2	2			2	
H1417	006	0	1	04	01	H1417_006_0	5	6	00000000000000000000000000110000110011110000010	$0 Group	2				2			2	
H1417	006	0	1	04	01	H1417_006_0	5	2	00001000000000000000000000000000000000000000000	Home Health	2				1	20.00	20.00	2	
H1417	801	0	1	04	01	H1417_801_0	5	2	00000000010000000000000000000000000000000000000		1	50	50	1	2			2	
H1417	801	0	1	04	01	H1417_801_0	5	1	11111111101111111111111111110000111111111111111		1	20	20	1	2			2	
H1417	802	0	1	04	01	H1417_802_0	6	1	11111111101111111111111111110000111111111111111		1	20	20	1	2			2	
H1417	802	0	1	04	01	H1417_802_0	6	2	00000000010000000000000000000000000000000000000		1	50	50	1	2			2	
H1417	808	0	1	04	01	H1417_808_0	6	1	11111111101111111111111111110000111111111111111		1	20	20	1	2			2	
H1417	808	0	1	04	01	H1417_808_0	6	2	00000000010000000000000000000000000000000000000		1	50	50	1	2			2	
H1418	002	0	1	04	01	H1418_002_0	6	2	00000110111010000000000000000000011110000000101		2				1	35.00	35.00	2	
H1418	002	0	1	04	01	H1418_002_0	6	1	01111000000000000110100110000000000000000000000		1	30	30	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	6	4	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	6	5	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H1418	002	0	1	04	01	H1418_002_0	6	6	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	6	7	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1418	002	0	1	04	01	H1418_002_0	6	8	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1418	002	0	1	04	01	H1418_002_0	6	3	00000001000001111001000000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
H1418	801	0	1	04	01	H1418_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1418	801	0	1	04	01	H1418_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1418	801	0	1	04	01	H1418_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1418	801	0	1	04	01	H1418_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1418	802	0	1	04	01	H1418_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1418	802	0	1	04	01	H1418_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1418	802	0	1	04	01	H1418_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1418	802	0	1	04	01	H1418_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1418	803	0	1	04	01	H1418_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1418	803	0	1	04	01	H1418_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1418	803	0	1	04	01	H1418_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1418	803	0	1	04	01	H1418_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1418	804	0	1	04	01	H1418_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1418	804	0	1	04	01	H1418_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1418	804	0	1	04	01	H1418_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1418	804	0	1	04	01	H1418_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1420	001	0	1	04	01	H1420_001_0	4	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
H1420	001	0	1	04	01	H1420_001_0	4	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
H1420	002	0	1	04	01	H1420_002_0	4	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
H1420	002	0	1	04	01	H1420_002_0	4	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
H1420	801	0	1	04	01	H1420_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H1420	801	0	1	04	01	H1420_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H1420	802	0	1	04	01	H1420_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H1420	802	0	1	04	01	H1420_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	1	01000000000000000000000000000000000000000000000		2				1	185.00	185.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	2	00101001000001010110100111100000010111111100010		1	30	30	6	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	3	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	4	00000010101100000000000000000000000000000001101		2				1	40.00	40.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	9	00000000000000000000000000010000100000000000000		2				2			2	
H1509	001	0	1	04	01	H1509_001_0	5	6	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	7	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	8	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	1	01000000000000000000000000000000000000000000000	Group One	2				1	185.00	185.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	9	00000000000000000000000000010000100000000000000		2				2			2	
H1509	003	0	1	04	01	H1509_003_0	4	2	00101001000001010110100111100000010111111100010	Group Two	1	30	30	6	2			2	
H1509	003	0	1	04	01	H1509_003_0	4	3	00000100000000000000000000000000001000000000000	Group Three	2				1	20.00	20.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	4	00000010101100000000000000000000000000000001101	Group Four	2				1	40.00	40.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	5	00000000010010000001000000000000000000000000000	Group Five	2				1	35.00	45.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	6	00000000000000111000000000000000000000000000000	Group Six	1	0	30	6	1	0.00	20.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	7	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1509	003	0	1	04	01	H1509_003_0	4	8	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1509	004	0	1	04	01	H1509_004_0	6	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H1509	004	0	1	04	01	H1509_004_0	6	2	10000000000000000000000000000000000000000000010		2				2			2	
H1509	801	0	1	04	01	H1509_801_0	4	1	01101001000001010110100000000000010111111100010		1	40	40	6	2			2	
H1509	801	0	1	04	01	H1509_801_0	4	2	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H1509	801	0	1	04	01	H1509_801_0	4	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1509	801	0	1	04	01	H1509_801_0	4	4	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
H1509	801	0	1	04	01	H1509_801_0	4	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1509	801	0	1	04	01	H1509_801_0	4	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1509	801	0	1	04	01	H1509_801_0	4	7	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H1509	801	0	1	04	01	H1509_801_0	4	8	00000000000000000000000000010000100000000000000		2				2			2	
H1510	001	0	1	04	01	H1510_001_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1510	001	0	1	04	01	H1510_001_0	3	3	00000000000000000000000001000000000000000100000		1	20	25	6	2			2	
H1510	001	0	1	04	01	H1510_001_0	3	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1510	001	0	1	04	01	H1510_001_0	3	1	01111111111011111111100110010000011111111001101		1	25	25	6	2			2	
H1510	001	0	1	04	01	H1510_001_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	75.00	2	
H1510	801	0	1	04	01	H1510_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1510	801	0	1	04	01	H1510_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1510	801	0	1	04	01	H1510_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1510	801	0	1	04	01	H1510_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1510	802	0	1	04	01	H1510_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1510	802	0	1	04	01	H1510_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1510	802	0	1	04	01	H1510_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1510	802	0	1	04	01	H1510_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1510	803	0	1	04	01	H1510_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1510	803	0	1	04	01	H1510_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1510	803	0	1	04	01	H1510_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1510	803	0	1	04	01	H1510_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1510	804	0	1	04	01	H1510_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1510	804	0	1	04	01	H1510_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1510	804	0	1	04	01	H1510_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1510	804	0	1	04	01	H1510_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1607	001	0	1	04	01	H1607_001_0	6	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H1607	001	0	1	04	01	H1607_001_0	6	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H1607	001	0	1	04	01	H1607_001_0	6	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H1607	001	0	1	04	01	H1607_001_0	6	5	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H1607	001	0	1	04	01	H1607_001_0	6	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H1607	002	0	1	04	01	H1607_002_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H1607	002	0	1	04	01	H1607_002_0	7	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H1607	002	0	1	04	01	H1607_002_0	7	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H1607	002	0	1	04	01	H1607_002_0	7	5	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
H1607	002	0	1	04	01	H1607_002_0	7	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H1607	801	0	1	04	01	H1607_801_0	4	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H1607	801	0	1	04	01	H1607_801_0	4	5	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H1607	801	0	1	04	01	H1607_801_0	4	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H1607	801	0	1	04	01	H1607_801_0	4	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H1607	801	0	1	04	01	H1607_801_0	4	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H1608	001	0	1	04	01	H1608_001_0	7	1	01111111111111111111100000110000111111111111111	OON	1	20	20	2	2			2	
H1608	001	0	1	04	01	H1608_001_0	7	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	115.00	115.00	2	
H1608	001	0	1	04	01	H1608_001_0	7	3	00000000000000000000000111000000000000000000000	DME/Prosthetics/Diabetic	1	30	30	2	2			2	
H1608	801	0	1	04	01	H1608_801_0	7	1	01000000000000000000000000000000000000000000000	SNF	1	14	14	2	2			2	
H1608	801	0	1	04	01	H1608_801_0	7	2	00111111111111111111110111110000011111111101101	Other	1	24	24	2	2			2	
H1608	802	0	1	04	01	H1608_802_0	5	2	00111111111111111111110111110000011111111101101	Other	1	24	24	2	2			2	
H1608	802	0	1	04	01	H1608_802_0	5	1	01000000000000000000000000000000000000000000000	SNF	1	14	14	2	2			2	
H1608	803	0	1	04	01	H1608_803_0	5	2	00111111111111111111110111110000011111111101101	Other	1	24	24	2	2			2	
H1608	803	0	1	04	01	H1608_803_0	5	1	01000000000000000000000000000000000000000000000	SNF	1	14	14	2	2			2	
H1608	806	0	1	04	01	H1608_806_0	7	1	01000000000000000000000000000000000000000000000	SNF	1	14	14	2	2			2	
H1608	806	0	1	04	01	H1608_806_0	7	2	00111111111111111111110111110000011111111101101	Other	1	24	24	2	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	6	10000000000000000000000000000000000000000000001		1	50	50	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	1	01111111111011111111100110010000011111111101100		1	25	25	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1716	001	0	1	04	01	H1716_001_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H1716	001	0	1	04	01	H1716_001_0	3	2	00000000000000000000000001000000000000000000000		1	20	25	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1716	801	0	1	04	01	H1716_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1716	801	0	1	04	01	H1716_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1716	801	0	1	04	01	H1716_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1716	801	0	1	04	01	H1716_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1716	803	0	1	04	01	H1716_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1716	803	0	1	04	01	H1716_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1716	803	0	1	04	01	H1716_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1716	803	0	1	04	01	H1716_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1716	804	0	1	04	01	H1716_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1716	804	0	1	04	01	H1716_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1716	804	0	1	04	01	H1716_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1716	804	0	1	04	01	H1716_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1717	001	0	1	04	01	H1717_001_0	7	7	00000000000000000000000000010000100000000000000		2				2			2	
H1717	001	0	1	04	01	H1717_001_0	7	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1717	001	0	1	04	01	H1717_001_0	7	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H1717	001	0	1	04	01	H1717_001_0	7	5	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H1717	001	0	1	04	01	H1717_001_0	7	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1717	001	0	1	04	01	H1717_001_0	7	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1717	001	0	1	04	01	H1717_001_0	7	2	00000000000000101000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H1717	001	0	1	04	01	H1717_001_0	7	1	01101001000001010110100111100000010111111100010		1	30	30	6	2			2	
H1717	003	0	1	04	01	H1717_003_0	5	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1717	003	0	1	04	01	H1717_003_0	5	7	00000000000000000000000000010000100000000000010		2				2			2	
H1717	003	0	1	04	01	H1717_003_0	5	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H1717	003	0	1	04	01	H1717_003_0	5	5	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H1717	003	0	1	04	01	H1717_003_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1717	003	0	1	04	01	H1717_003_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1717	003	0	1	04	01	H1717_003_0	5	2	00000000000000101000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H1717	003	0	1	04	01	H1717_003_0	5	1	01101001000001010110100111100000010111111100010		1	30	30	6	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	2	10000000000000000000000000000000000000000000010		2				2			2	
H1717	006	0	1	04	01	H1717_006_0	4	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H1717	801	0	1	04	01	H1717_801_0	8	7	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H1717	801	0	1	04	01	H1717_801_0	8	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H1717	801	0	1	04	01	H1717_801_0	8	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H1717	801	0	1	04	01	H1717_801_0	8	4	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H1717	801	0	1	04	01	H1717_801_0	8	9	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H1717	801	0	1	04	01	H1717_801_0	8	2	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H1717	801	0	1	04	01	H1717_801_0	8	1	01101001000001010110100000000000010111111000010		1	40	40	6	2			2	
H1717	801	0	1	04	01	H1717_801_0	8	8	00000000000000000000000000010000100000000000000		2				2			2	
H1717	801	0	1	04	01	H1717_801_0	8	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H1806	001	0	1	04	01	H1806_001_0	3	2	00000000000000000000000001000000000000000100000		1	20	25	6	2			2	
H1806	001	0	1	04	01	H1806_001_0	3	1	01111111111011111111100110010000011111111001101		1	25	25	6	2			2	
H1806	001	0	1	04	01	H1806_001_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1806	001	0	1	04	01	H1806_001_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	75.00	2	
H1806	001	0	1	04	01	H1806_001_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1806	002	0	1	04	01	H1806_002_0	3	1	01111111111011111111100110010000011111111001101		1	25	25	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	3	2	00000000000000000000000001000000000000000100000		1	20	25	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	3	3	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
H1806	002	0	1	04	01	H1806_002_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	75.00	2	
H1806	002	0	1	04	01	H1806_002_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1806	801	0	1	04	01	H1806_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1806	801	0	1	04	01	H1806_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1806	801	0	1	04	01	H1806_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1806	801	0	1	04	01	H1806_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1806	803	0	1	04	01	H1806_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1806	803	0	1	04	01	H1806_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1806	803	0	1	04	01	H1806_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1806	803	0	1	04	01	H1806_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1806	804	0	1	04	01	H1806_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1806	804	0	1	04	01	H1806_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1806	804	0	1	04	01	H1806_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H1806	804	0	1	04	01	H1806_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1806	805	0	1	04	01	H1806_805_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H1806	805	0	1	04	01	H1806_805_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H1806	805	0	1	04	01	H1806_805_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H1806	805	0	1	04	01	H1806_805_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H2001	001	0	1	04	01	H2001_001_0	7	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H2001	001	0	1	04	01	H2001_001_0	7	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H2001	001	0	1	04	01	H2001_001_0	7	7	10000000000000000000000000010000100000000000000		2				2			2	
H2001	001	0	1	04	01	H2001_001_0	7	1	01101001000001000110100111100000010111111100010		1	30	30	6	2			2	
H2001	001	0	1	04	01	H2001_001_0	7	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H2001	001	0	1	04	01	H2001_001_0	7	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H2001	001	0	1	04	01	H2001_001_0	7	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H2001	001	0	1	04	01	H2001_001_0	7	5	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	7	00000000000000000000000000010000100000000000000		2				2			2	
H2001	003	0	1	04	01	H2001_003_0	6	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	5	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	2	00000000000000101000000000000000000000000000000		1	0	25	6	1	0.00	20.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	10	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H2001	003	0	1	04	01	H2001_003_0	6	9	00101001000001000110100000000000010111111000010		1	25	25	6	2			2	
H2001	003	0	1	04	01	H2001_003_0	6	1	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H2001	005	0	1	04	01	H2001_005_0	5	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H2001	005	0	1	04	01	H2001_005_0	5	5	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H2001	005	0	1	04	01	H2001_005_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H2001	005	0	1	04	01	H2001_005_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H2001	005	0	1	04	01	H2001_005_0	5	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H2001	005	0	1	04	01	H2001_005_0	5	1	01101001000001010110100111100000010111111100010		1	30	30	6	2			2	
H2001	005	0	1	04	01	H2001_005_0	5	7	00000000000000000000000000010000100000000000000		2				2			2	
H2001	005	0	1	04	01	H2001_005_0	5	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	1	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H2001	006	0	1	04	01	H2001_006_0	5	10	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	2	00000000000000101000000000000000000000000000000		1	0	25	6	1	0.00	20.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	9	00101001000001000110100000000000010111111000010		1	25	25	6	2			2	
H2001	006	0	1	04	01	H2001_006_0	5	5	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	7	00000000000000000000000000010000100000000000000		2				2			2	
H2001	006	0	1	04	01	H2001_006_0	5	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H2001	006	0	1	04	01	H2001_006_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H2001	007	0	1	04	01	H2001_007_0	5	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H2001	007	0	1	04	01	H2001_007_0	5	2	10000000000000000000000000000000000000000000010		2				2			2	
H2001	801	0	1	04	01	H2001_801_0	5	1	01101001000001000110100111100000010111111100010		1	30	30	6	2			2	
H2001	801	0	1	04	01	H2001_801_0	5	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H2001	801	0	1	04	01	H2001_801_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H2001	801	0	1	04	01	H2001_801_0	5	4	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H2001	801	0	1	04	01	H2001_801_0	5	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H2001	801	0	1	04	01	H2001_801_0	5	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H2001	801	0	1	04	01	H2001_801_0	5	8	00000000000000000000000000010000100000000000000		2				2			2	
H2001	801	0	1	04	01	H2001_801_0	5	7	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H2003	001	0	1	04	01	H2003_001_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2003	001	0	1	04	01	H2003_001_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2003	002	0	1	04	01	H2003_002_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2003	002	0	1	04	01	H2003_002_0	5	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2111	001	0	1	04	01	H2111_001_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2111	002	0	1	04	01	H2111_002_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2111	002	0	1	04	01	H2111_002_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2111	003	0	1	04	01	H2111_003_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2111	003	0	1	04	01	H2111_003_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2228	001	0	1	04	01	H2228_001_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2228	001	0	1	04	01	H2228_001_0	5	2	00000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2228	002	0	1	04	01	H2228_002_0	6	1	01111111111111111111111111110000011111111111101	Group 1	1	30	30	6	2			2	
H2228	002	0	1	04	01	H2228_002_0	6	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2228	004	0	1	04	01	H2228_004_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2228	004	0	1	04	01	H2228_004_0	4	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H2228	006	0	1	04	01	H2228_006_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2228	006	0	1	04	01	H2228_006_0	5	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H2228	007	0	1	04	01	H2228_007_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2228	007	0	1	04	01	H2228_007_0	5	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H2228	008	0	1	04	01	H2228_008_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2228	008	0	1	04	01	H2228_008_0	5	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H2229	001	1	1	04	01	H2229_001_1	2	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	001	1	1	04	01	H2229_001_1	2	4	00000110101100000000000000000000001000000000101	Services: Copayment	2				1	30.00	30.00	2	
H2229	001	1	1	04	01	H2229_001_1	2	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	001	1	1	04	01	H2229_001_1	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	001	1	1	04	01	H2229_001_1	2	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	001	2	1	04	01	H2229_001_2	2	4	00000110101100000000000000000000001000000000101	Services: Copayment	2				1	30.00	30.00	2	
H2229	001	2	1	04	01	H2229_001_2	2	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	001	2	1	04	01	H2229_001_2	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	001	2	1	04	01	H2229_001_2	2	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	001	2	1	04	01	H2229_001_2	2	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	010	1	1	04	01	H2229_010_1	3	4	00000110101100000000000000000000001000000000101	Services: Copayment	2				1	30.00	30.00	2	
H2229	010	1	1	04	01	H2229_010_1	3	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	010	1	1	04	01	H2229_010_1	3	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	010	1	1	04	01	H2229_010_1	3	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	010	1	1	04	01	H2229_010_1	3	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	010	2	1	04	01	H2229_010_2	3	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	010	2	1	04	01	H2229_010_2	3	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	010	2	1	04	01	H2229_010_2	3	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	010	2	1	04	01	H2229_010_2	3	4	00000110101100000000000000000000001000000000101	Services: Copayment	2				1	30.00	30.00	2	
H2229	010	2	1	04	01	H2229_010_2	3	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	011	1	1	04	01	H2229_011_1	3	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	011	1	1	04	01	H2229_011_1	3	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	011	1	1	04	01	H2229_011_1	3	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	011	1	1	04	01	H2229_011_1	3	4	00000110101100000000000000000000001000000000101	Services: Copayment	2				1	30.00	30.00	2	
H2229	011	1	1	04	01	H2229_011_1	3	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	011	2	1	04	01	H2229_011_2	3	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	011	2	1	04	01	H2229_011_2	3	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	011	2	1	04	01	H2229_011_2	3	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	011	2	1	04	01	H2229_011_2	3	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	011	2	1	04	01	H2229_011_2	3	4	00000110101100000000000000000000001000000000101	Services: Copayment	2				1	30.00	30.00	2	
H2229	801	0	1	04	01	H2229_801_0	2	4	00000110101100000000000000000000001000000001101	Services: Copayment	2				1	30.00	30.00	2	
H2229	801	0	1	04	01	H2229_801_0	2	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	801	0	1	04	01	H2229_801_0	2	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	801	0	1	04	01	H2229_801_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	801	0	1	04	01	H2229_801_0	2	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	802	0	1	04	01	H2229_802_0	2	4	00000110101100000000000000000000001000000001101	Services: Copayment	2				1	30.00	30.00	2	
H2229	802	0	1	04	01	H2229_802_0	2	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	802	0	1	04	01	H2229_802_0	2	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	802	0	1	04	01	H2229_802_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	802	0	1	04	01	H2229_802_0	2	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	803	0	1	04	01	H2229_803_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	803	0	1	04	01	H2229_803_0	2	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	803	0	1	04	01	H2229_803_0	2	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	803	0	1	04	01	H2229_803_0	2	4	00000110101100000000000000000000001000000001101	Services: Copayment	2				1	30.00	30.00	2	
H2229	803	0	1	04	01	H2229_803_0	2	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2229	804	0	1	04	01	H2229_804_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				1	0.00	50.00	2	
H2229	804	0	1	04	01	H2229_804_0	2	2	00001000000000000110000100000000000000000000000	Services: Coinsur & Requested Prior Auth	1	20	20	6	2			2	
H2229	804	0	1	04	01	H2229_804_0	2	4	00000110101100000000000000000000001000000001101	Services: Copayment	2				1	30.00	30.00	2	
H2229	804	0	1	04	01	H2229_804_0	2	3	00000000000000111000000011110000010111111100000	Services: Coinsurance	1	20	20	6	2			2	
H2229	804	0	1	04	01	H2229_804_0	2	5	00110001010011000001100000000000000000000001000	Services: Copay & Prior Auth Requested	2				1	30.00	30.00	2	
H2230	002	0	1	04	01	H2230_002_0	5	5	00000000000000000000000000000000000000000000010		2				2			2	
H2230	002	0	1	04	01	H2230_002_0	5	4	10000000000000000000000000000000000000000000000		2				2			2	
H2230	002	0	1	04	01	H2230_002_0	5	3	00000000000000000000010000000000000000000000000		2				1	0.00	100.00	2	
H2230	002	0	1	04	01	H2230_002_0	5	2	00000100101000000000000000000000001000000010101		2				1	40.00	40.00	2	
H2230	002	0	1	04	01	H2230_002_0	5	1	01111011010111111111100111110000010110110000000		1	20	20	1	2			2	
H2230	002	0	1	04	01	H2230_002_0	5	6	00000000000000000000000000000000000001000000000		1	20	20	1	1	40.00	40.00	2	
H2230	006	0	1	04	01	H2230_006_0	5	5	00000000000000000000000000000000000000000000010		2				2			2	
H2230	006	0	1	04	01	H2230_006_0	5	4	10000000000000000000000000000000000000000000000		2				2			2	
H2230	006	0	1	04	01	H2230_006_0	5	3	00000000000000000000010000000000000000000000000		2				1	0.00	100.00	2	
H2230	006	0	1	04	01	H2230_006_0	5	2	00000100101000000000000000000000001000000010101		2				1	40.00	40.00	2	
H2230	006	0	1	04	01	H2230_006_0	5	1	01111011010111111111100111110000010110110000000		1	20	20	1	2			2	
H2230	006	0	1	04	01	H2230_006_0	5	6	00000000000000000000000000000000000001000000000		1	20	20	1	1	40.00	40.00	2	
H2230	010	0	1	04	01	H2230_010_0	2	1	01111011010111111111100111110000010110110000000		1	20	20	1	2			2	
H2230	010	0	1	04	01	H2230_010_0	2	2	00000100101000000000000000000000001000000010101		2				1	40.00	40.00	2	
H2230	010	0	1	04	01	H2230_010_0	2	3	00000000000000000000010000000000000000000000000		2				1	0.00	100.00	2	
H2230	010	0	1	04	01	H2230_010_0	2	4	10000000000000000000000000000000000000000000000		2				2			2	
H2230	010	0	1	04	01	H2230_010_0	2	5	00000000000000000000000000000000000000000000010		2				2			2	
H2230	010	0	1	04	01	H2230_010_0	2	6	00000000000000000000000000000000000001000000000		1	20	20	1	1	40.00	40.00	2	
H2230	801	0	1	04	01	H2230_801_0	4	1	01111011010111111111100111110000010110110000000		1	20	20	1	2			2	
H2230	801	0	1	04	01	H2230_801_0	4	2	00000100101000000000000000000000001000000010101		2				1	40.00	40.00	2	
H2230	801	0	1	04	01	H2230_801_0	4	3	00000000000000000000010000000000000000000000000		2				1	0.00	100.00	2	
H2230	801	0	1	04	01	H2230_801_0	4	4	10000000000000000000000000000000000000000000000		2				2			2	
H2230	801	0	1	04	01	H2230_801_0	4	5	00000000000000000000000000000000000000000000010		2				2			2	
H2230	801	0	1	04	01	H2230_801_0	4	6	00000000000000000000000000000000000001000000000		1	20	20	1	1	40.00	40.00	2	
H2230	809	0	1	04	01	H2230_809_0	2	3	00000000000000000000010000000000000000000000000		2				1	0.00	100.00	2	
H2230	809	0	1	04	01	H2230_809_0	2	4	10000000000000000000000000000000000000000000000		2				2			2	
H2230	809	0	1	04	01	H2230_809_0	2	5	00000000000000000000000000000000000000000000010		2				2			2	
H2230	809	0	1	04	01	H2230_809_0	2	6	00000000000000000000000000000000000001000000000		1	20	20	1	1	40.00	40.00	2	
H2230	809	0	1	04	01	H2230_809_0	2	1	01111011010111111111100111110000010110110000000		1	20	20	1	2			2	
H2230	809	0	1	04	01	H2230_809_0	2	2	00000100101000000000000000000000001000000010101		2				1	40.00	40.00	2	
H2322	001	0	1	04	01	H2322_001_0	6	1	00111111111111111111111001110100111111111101111		1	20	20	2	2			2	
H2322	001	0	1	04	01	H2322_001_0	6	2	01000000000000000000000000000000000000000000000		2				1	100.00	119.00	2	
H2322	001	0	1	04	01	H2322_001_0	6	3	00000000000000000000000110000000000000000000000		1	50	50	2	2			2	
H2322	003	0	1	04	01	H2322_003_0	4	2	01000000000000000000000000000000000000000000000		2				1	100.00	119.00	2	
H2322	003	0	1	04	01	H2322_003_0	4	1	00111111111111111111111001110100111111111101111		1	20	20	2	2			2	
H2322	003	0	1	04	01	H2322_003_0	4	3	00000000000000000000000110000000000000000000000		1	50	50	2	2			2	
H2322	004	0	1	04	01	H2322_004_0	8	1	00111111111111111111111001110100111111111101111		1	20	20	2	2			2	
H2322	004	0	1	04	01	H2322_004_0	8	2	01000000000000000000000000000000000000000000000		2				1	100.00	119.00	2	
H2322	004	0	1	04	01	H2322_004_0	8	3	00000000000000000000000110000000000000000000000		1	50	50	2	2			2	
H2322	005	0	1	04	01	H2322_005_0	4	1	00111111111111111111111001110100111111111101111		1	20	20	2	2			1	500.00
H2322	005	0	1	04	01	H2322_005_0	4	2	01000000000000000000000000000000000000000000000		2				1	100.00	119.00	2	
H2322	005	0	1	04	01	H2322_005_0	4	3	00000000000000000000000110000000000000000000000		1	50	50	2	2			1	500.00
H2322	006	0	1	04	01	H2322_006_0	6	2	01000000000000000000000000000000000000000000000		2				1	100.00	119.00	2	
H2322	006	0	1	04	01	H2322_006_0	6	1	00111111111111111111111001110100111111111101111		1	20	20	2	2			1	500.00
H2322	006	0	1	04	01	H2322_006_0	6	3	00000000000000000000000110000000000000000000000		1	50	50	2	2			1	500.00
H2322	007	0	1	04	01	H2322_007_0	8	1	00111111111111111111111001110100111111111101111		1	20	20	2	2			1	500.00
H2322	007	0	1	04	01	H2322_007_0	8	2	01000000000000000000000000000000000000000000000		2				1	100.00	119.00	2	
H2322	007	0	1	04	01	H2322_007_0	8	3	00000000000000000000000110000000000000000000000		1	50	50	2	2			1	500.00
H2322	801	0	1	04	01	H2322_801_0	4	1	01000000000000000000000000000000000000000000000		2				1	100.00	125.00	2	
H2322	801	0	1	04	01	H2322_801_0	4	2	00111111101101111110111111110100111111111101111		1	20	20	2	2			2	
H2322	801	0	1	04	01	H2322_801_0	4	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H2322	802	0	1	04	01	H2322_802_0	4	1	01000000000000000000000000000000000000000000000		2				1	100.00	125.00	2	
H2322	802	0	1	04	01	H2322_802_0	4	2	00111111101101111110111111110100111111111101111		1	20	20	2	2			2	
H2322	802	0	1	04	01	H2322_802_0	4	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H2322	803	0	1	04	01	H2322_803_0	6	1	01000000000000000000000000000000000000000000000		2				1	100.00	125.00	2	
H2322	803	0	1	04	01	H2322_803_0	6	2	00111111101101111110111111110100111111111101111		1	20	20	2	2			2	
H2322	803	0	1	04	01	H2322_803_0	6	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H2322	804	0	1	04	01	H2322_804_0	6	1	01000000000000000000000000000000000000000000000		2				1	100.00	125.00	2	
H2322	804	0	1	04	01	H2322_804_0	6	2	00111111101101111110111111110100111111111101111		1	20	20	2	2			2	
H2322	804	0	1	04	01	H2322_804_0	6	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H2406	001	0	1	04	01	H2406_001_0	6	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H2406	001	0	1	04	01	H2406_001_0	6	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H2411	002	0	1	04	01	H2411_002_0	5	4	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H2411	002	0	1	04	01	H2411_002_0	5	3	00000000000000000000000000000000000000000000010		2				2			2	
H2411	002	0	1	04	01	H2411_002_0	5	1	01111111111111111111100111110000011111111001101		1	20	20	2	2			2	
H2411	002	0	1	04	01	H2411_002_0	5	2	00000000000000000000000000000000100000000000000		2				1	0.00	15.00	2	
H2411	801	0	1	04	01	H2411_801_0	3	1	01111111111111111111100111110000011111111001101		1	20	20	2	2			2	
H2411	801	0	1	04	01	H2411_801_0	3	2	00000000000000000000000000000000100000000000000		2				1	0.00	20.00	2	
H2411	801	0	1	04	01	H2411_801_0	3	3	00000000000000000000000000000000000000000000010		2				2			2	
H2411	801	0	1	04	01	H2411_801_0	3	4	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H2411	802	0	1	04	01	H2411_802_0	4	3	00000000000000000000000000000000000000000000010		2				2			2	
H2411	802	0	1	04	01	H2411_802_0	4	2	00000000000000000000000000000000100000000000000		2				1	0.00	20.00	2	
H2411	802	0	1	04	01	H2411_802_0	4	1	01111111111111111111100111110000011111111001101		1	20	20	2	2			2	
H2411	802	0	1	04	01	H2411_802_0	4	4	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H2411	803	0	1	04	01	H2411_803_0	4	3	00000000000000000000000000000000000000000000010		2				2			2	
H2411	803	0	1	04	01	H2411_803_0	4	4	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H2411	803	0	1	04	01	H2411_803_0	4	1	01111111111111111111100111110000011111111001101		1	20	20	2	2			2	
H2411	803	0	1	04	01	H2411_803_0	4	2	00000000000000000000000000000000100000000000000		2				1	0.00	20.00	2	
H2611	001	0	1	04	01	H2611_001_0	9	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	002	0	1	04	01	H2611_002_0	9	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	003	0	1	04	01	H2611_003_0	9	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	004	0	1	04	01	H2611_004_0	7	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	005	0	1	04	01	H2611_005_0	6	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	006	0	1	04	01	H2611_006_0	6	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	007	0	1	04	01	H2611_007_0	9	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	801	0	1	04	01	H2611_801_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	802	0	1	04	01	H2611_802_0	2	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	803	0	1	04	01	H2611_803_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	804	0	1	04	01	H2611_804_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	805	0	1	04	01	H2611_805_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	806	0	1	04	01	H2611_806_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	807	0	1	04	01	H2611_807_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	808	0	1	04	01	H2611_808_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	809	0	1	04	01	H2611_809_0	2	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	810	0	1	04	01	H2611_810_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	811	0	1	04	01	H2611_811_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2611	812	0	1	04	01	H2611_812_0	1	1	01111111111111111111110111110000111111111100101		1	20	20	1	2			2	
H2701	001	0	1	04	01	H2701_001_0	6	2	01000000000000000000000000000000000000000000000		2				1	30.00	30.00	2	
H2701	001	0	1	04	01	H2701_001_0	6	1	00111111111111111001100001110000011111111000101		2				1	25.00	25.00	2	
H2701	001	0	1	04	01	H2701_001_0	6	3	00000000000000000000000110000000000000000000000		1	50	50	1	2			2	
H2701	001	0	1	04	01	H2701_001_0	6	4	00000000000000000110000000000000000000000000000		2				1	150.00	150.00	2	
H2701	001	0	1	04	01	H2701_001_0	6	5	00000000000000000000000000000000000000000100000		1	20	20	1	2			2	
H2701	001	0	1	04	01	H2701_001_0	6	6	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H2701	003	0	1	04	01	H2701_003_0	8	2	01000000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H2701	003	0	1	04	01	H2701_003_0	8	1	00111111111111111001100001110000011111111000101		2				1	50.00	50.00	2	
H2701	003	0	1	04	01	H2701_003_0	8	3	00000000000000000000000110000000000000000000000		1	50	50	1	2			2	
H2701	003	0	1	04	01	H2701_003_0	8	6	00000000000000000000000000000000000000000100000		1	30	30	1	2			2	
H2701	003	0	1	04	01	H2701_003_0	8	5	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H2701	003	0	1	04	01	H2701_003_0	8	4	00000000000000000110000000000000000000000000000		2				1	200.00	200.00	2	
H2701	805	0	1	04	01	H2701_805_0	1	1	00110111111111111111110111100000011111111100101		1	20	20	2	2			2	
H2701	805	0	1	04	01	H2701_805_0	1	2	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H2701	805	0	1	04	01	H2701_805_0	1	3	00001000000000000000000000010000000000000000000		2				2			2	
H2701	806	0	1	04	01	H2701_806_0	1	2	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H2701	806	0	1	04	01	H2701_806_0	1	1	00110111111111111111110111100000011111111100101		1	20	20	2	2			2	
H2701	806	0	1	04	01	H2701_806_0	1	3	00001000000000000000000000010000000000000000000		2				2			2	
H2905	001	0	1	04	01	H2905_001_0	6	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
H2905	001	0	1	04	01	H2905_001_0	6	2	01001011111011111111100000100000000001111001111	40% Group	1	40	40	2	2			2	
H2905	001	0	1	04	01	H2905_001_0	6	3	00000000000100000000000000000000010110000000000	20-40% Group	1	20	40	2	2			2	
H2905	001	0	1	04	01	H2905_001_0	6	5	00000000000000000000010000000000000000000000000	Ambulance Group	1	40	40	2	1	100.00	100.00	2	
H2905	001	0	1	04	01	H2905_001_0	6	6	00110000000000000000000000010000000000000000000	$0 Group	2				2			2	
H2905	001	0	1	04	01	H2905_001_0	6	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
H2905	801	0	1	04	01	H2905_801_0	3	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
H2905	801	0	1	04	01	H2905_801_0	3	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
H2905	801	0	1	04	01	H2905_801_0	3	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
H2905	801	0	1	04	01	H2905_801_0	3	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
H2905	802	0	1	04	01	H2905_802_0	3	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
H2905	802	0	1	04	01	H2905_802_0	3	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
H2905	802	0	1	04	01	H2905_802_0	3	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
H2905	802	0	1	04	01	H2905_802_0	3	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
H2905	803	0	1	04	01	H2905_803_0	3	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
H2905	803	0	1	04	01	H2905_803_0	3	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
H2905	803	0	1	04	01	H2905_803_0	3	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
H2905	803	0	1	04	01	H2905_803_0	3	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
H2905	804	0	1	04	01	H2905_804_0	3	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
H2905	804	0	1	04	01	H2905_804_0	3	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
H2905	804	0	1	04	01	H2905_804_0	3	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
H2905	804	0	1	04	01	H2905_804_0	3	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
H2906	003	0	1	04	01	H2906_003_0	5	1	01111111111111111111101111110100111111111100001	Out of Network Services	1	20	20	1	2			2	
H2906	003	0	1	04	01	H2906_003_0	5	5	00000000000000000000000000000000000000000001000	Out of Network Comprehensive Dental	1	20	50	2	2			1	50.00
H2906	003	0	1	04	01	H2906_003_0	5	4	00000000000000000000000000000000000000000000010	Eye Wear	1	0	20	2	2			2	
H2906	003	0	1	04	01	H2906_003_0	5	3	00000000000000000000000000000000000000000000100	Eye exams	2				1	15.00	15.00	2	
H2906	003	0	1	04	01	H2906_003_0	5	2	00000000000000000000010000000000000000000010000	Out of Network Ambulance & Prev Dental	2				2			2	
H3206	001	0	1	04	01	H3206_001_0	4	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	001	0	1	04	01	H3206_001_0	4	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	001	0	1	04	01	H3206_001_0	4	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	001	0	1	04	01	H3206_001_0	4	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	001	0	1	04	01	H3206_001_0	4	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	001	0	1	04	01	H3206_001_0	4	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	001	0	1	04	01	H3206_001_0	4	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3206	001	0	1	04	01	H3206_001_0	4	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	001	0	1	04	01	H3206_001_0	4	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	801	0	1	04	01	H3206_801_0	3	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	801	0	1	04	01	H3206_801_0	3	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	801	0	1	04	01	H3206_801_0	3	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	802	0	1	04	01	H3206_802_0	2	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	802	0	1	04	01	H3206_802_0	2	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	802	0	1	04	01	H3206_802_0	2	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	115.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	8	00000000000000010110000000000000000000000000000	Outpatient Services + Radiation Therapy	1	20	20	2	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	7	00000000000000101000000001000000000000001000000	Lab, Xray + Diabetes Moniotiring	1	10	10	2	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	6	00000000100000000000010000000000000000000001100	Eye Exams + Physician Specialist Serv	2				1	50.00	50.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	9	00010000010010000001000000000000000000000000000	Mental Health + Substance Abuse Services	1	50	50	2	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	4	00000000000000000000000000000000001000000000000	Routine Physical Exams	2				1	30.00	30.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	3	00100101000001000000100110000000000000000000010	Rehabiliation, PCP, + DME Services	2				1	25.00	25.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	2	00001000000000000000000000110000110111110000000	Home Health Renal Dial + Preventive Serv	2				1	0.00	0.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	5	00000010001000000000000000000000000000000000001	Chiroptractic, Podiatry + Hearing	2				1	35.00	35.00	2	
H3207	001	0	1	04	01	H3207_001_0	6	8	00000000100000000000000000000000000000000000000		2				1	40.00	40.00	2	
H3207	001	0	1	04	01	H3207_001_0	6	7	00000000000000000110000000100000000000000000000		2				1	150.00	150.00	2	
H3207	001	0	1	04	01	H3207_001_0	6	6	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3207	001	0	1	04	01	H3207_001_0	6	5	00000000000100000000000000000000000000000001000		2				1	20.00	150.00	2	
H3207	001	0	1	04	01	H3207_001_0	6	9	00100001000001010000100110000000001000000100111		1	20	20	2	2			2	
H3207	001	0	1	04	01	H3207_001_0	6	3	00000000000000000000000000000000000001110000000		2				1	10.00	10.00	2	
H3207	001	0	1	04	01	H3207_001_0	6	2	01000000000000000000000000000000000110000000000		1	0	20	2	2			2	
H3207	001	0	1	04	01	H3207_001_0	6	1	00000000000000100000000000000000000000000000000		1	10	10	2	2			2	
H3207	001	0	1	04	01	H3207_001_0	6	4	00010110011010000001000001000000000000000000000		2				1	20.00	20.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	8	00000000100000000000000000000000000000000000000		2				1	40.00	40.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	7	00000000000000000110000000100000000000000000000		2				1	150.00	150.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	6	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	5	00000000000100000000000000000000000000000001000		2				1	20.00	150.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	4	00010110011010000001000001000000000000000000000		2				1	20.00	20.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	3	00000000000000000000000000000000000001110000000		2				1	10.00	10.00	2	
H3207	002	0	1	04	01	H3207_002_0	6	2	01000000000000000000000000000000000110000000000		1	0	20	2	2			2	
H3207	002	0	1	04	01	H3207_002_0	6	1	00000000000000100000000000000000000000000000000		1	10	10	2	2			2	
H3207	002	0	1	04	01	H3207_002_0	6	9	00100001000001010000100110000000001000000100111		1	20	20	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	7	1	00000000000000100000000000000000000000000000000		1	10	10	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	7	2	01000000000000000000000000000000000110000000000		1	0	20	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	7	9	00100001000001010000100110000000001000000100111		1	20	20	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	7	8	00000000100000000000000000000000000000000000000		2				1	40.00	40.00	2	
H3207	003	0	1	04	01	H3207_003_0	7	7	00000000000000000110000000100000000000000000000		2				1	150.00	150.00	2	
H3207	003	0	1	04	01	H3207_003_0	7	6	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3207	003	0	1	04	01	H3207_003_0	7	5	00000000000100000000000000000000000000000001000		2				1	20.00	150.00	2	
H3207	003	0	1	04	01	H3207_003_0	7	4	00010110011010000001000001000000000000000000000		2				1	20.00	20.00	2	
H3207	003	0	1	04	01	H3207_003_0	7	3	00000000000000000000000000000000000001110000000		2				1	10.00	10.00	2	
H3207	004	0	1	04	01	H3207_004_0	7	1	00000000000000100000000000000000000000000000000		1	10	10	2	2			2	
H3207	004	0	1	04	01	H3207_004_0	7	8	00000000100000000000000000000000000000000000000		2				1	40.00	40.00	2	
H3207	004	0	1	04	01	H3207_004_0	7	7	00000000000000000110000000100000000000000000000		2				1	150.00	150.00	2	
H3207	004	0	1	04	01	H3207_004_0	7	6	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3207	004	0	1	04	01	H3207_004_0	7	9	00100001000001010000100110000000001000000100111		1	20	20	2	2			2	
H3207	004	0	1	04	01	H3207_004_0	7	4	00010110011010000001000001000000000000000000000		2				1	20.00	20.00	2	
H3207	004	0	1	04	01	H3207_004_0	7	3	00000000000000000000000000000000000001110000000		2				1	10.00	10.00	2	
H3207	004	0	1	04	01	H3207_004_0	7	2	01000000000000000000000000000000000110000000000		1	0	20	2	2			2	
H3207	004	0	1	04	01	H3207_004_0	7	5	00000000000100000000000000000000000000000001000		2				1	20.00	150.00	2	
H3208	001	0	1	04	01	H3208_001_0	5	1	01111111111111111111100110110000011111110100000	OON:  20% coinsurance	1	20	20	1	2			2	
H3208	001	0	1	04	01	H3208_001_0	5	2	00000000000000000000000000000000000000000000101	OON:  $50 copayment	2				1	50.00	50.00	2	
H3208	801	0	1	04	01	H3208_801_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H3208	802	0	1	04	01	H3208_802_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H3208	803	0	1	04	01	H3208_803_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H3208	804	0	1	04	01	H3208_804_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H3209	002	0	1	04	01	H3209_002_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H3335	002	0	1	04	01	H3335_002_0	3	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	002	0	1	04	01	H3335_002_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	002	0	1	04	01	H3335_002_0	3	3	00000010000000000000000000000000000000000000010		2				1	20.00	20.00	2	
H3335	003	0	1	04	01	H3335_003_0	4	1	01011000010010111111100111110000000000000100000		1	20	20	2	2			2	
H3335	003	0	1	04	01	H3335_003_0	4	2	00100111101101000000000000000000011111111000111		2				1	25.00	25.00	2	
H3335	003	0	1	04	01	H3335_003_0	4	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	004	0	1	04	01	H3335_004_0	2	1	01111000010000111111000111110000000000001100000		1	20	20	2	2			2	
H3335	004	0	1	04	01	H3335_004_0	2	2	00000111101101000000100000000000011111110000111		2				1	25.00	25.00	2	
H3335	004	0	1	04	01	H3335_004_0	2	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3335	005	0	1	04	01	H3335_005_0	3	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	005	0	1	04	01	H3335_005_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	005	0	1	04	01	H3335_005_0	3	3	00000010000000000000000000000000000000000000110		2				1	20.00	20.00	2	
H3335	006	0	1	04	01	H3335_006_0	3	1	01011000010010111111100111110000000000000100000		1	20	20	2	2			2	
H3335	006	0	1	04	01	H3335_006_0	3	2	00100111101101000000000000000000011111111000111		2				1	25.00	25.00	2	
H3335	006	0	1	04	01	H3335_006_0	3	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	007	0	1	04	01	H3335_007_0	2	1	01111000010000111111000111110000000000001100000		1	20	20	2	2			2	
H3335	007	0	1	04	01	H3335_007_0	2	2	00000111101101000000100000000000011111110000111		2				1	25.00	25.00	2	
H3335	007	0	1	04	01	H3335_007_0	2	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3335	008	0	1	04	01	H3335_008_0	3	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	008	0	1	04	01	H3335_008_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	008	0	1	04	01	H3335_008_0	3	3	00000010000000000000000000000000000000000000110		2				1	20.00	20.00	2	
H3335	009	0	1	04	01	H3335_009_0	3	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	009	0	1	04	01	H3335_009_0	3	1	01011000010010111111100111110000000000000100000		1	20	20	2	2			2	
H3335	009	0	1	04	01	H3335_009_0	3	2	00100111101101000000000000000000011111111000111		2				1	25.00	25.00	2	
H3335	013	0	1	04	01	H3335_013_0	2	1	01111000010000111111000111110000000000001100000		1	20	20	2	2			2	
H3335	013	0	1	04	01	H3335_013_0	2	2	00000111101101000000100000000000011111110000111		2				1	25.00	25.00	2	
H3335	013	0	1	04	01	H3335_013_0	2	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3335	014	0	1	04	01	H3335_014_0	3	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	014	0	1	04	01	H3335_014_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	014	0	1	04	01	H3335_014_0	3	3	00000010000000000000000000000000000000000000110		2				1	20.00	20.00	2	
H3335	015	0	1	04	01	H3335_015_0	3	1	01011000010010111111100111110000000000000100000		1	20	20	2	2			2	
H3335	015	0	1	04	01	H3335_015_0	3	2	00100111101101000000000000000000011111111000111		2				1	25.00	25.00	2	
H3335	015	0	1	04	01	H3335_015_0	3	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	016	0	1	04	01	H3335_016_0	2	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3335	016	0	1	04	01	H3335_016_0	2	1	01111000010000111111000111110000000000001100000		1	20	20	2	2			2	
H3335	016	0	1	04	01	H3335_016_0	2	2	00000111101101000000100000000000011111110000111		2				1	25.00	25.00	2	
H3335	017	0	1	04	01	H3335_017_0	4	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	017	0	1	04	01	H3335_017_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	017	0	1	04	01	H3335_017_0	4	3	00000010000000000000000000000000000000000000110		2				1	20.00	20.00	2	
H3335	018	0	1	04	01	H3335_018_0	4	1	01011000010010111111100111110000000000000100000		1	20	20	2	2			2	
H3335	018	0	1	04	01	H3335_018_0	4	2	00100111101101000000000000000000011111111000111		2				1	25.00	25.00	2	
H3335	018	0	1	04	01	H3335_018_0	4	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	019	0	1	04	01	H3335_019_0	3	2	00000111101101000000100000000000011111110000111		2				1	25.00	25.00	2	
H3335	019	0	1	04	01	H3335_019_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3335	019	0	1	04	01	H3335_019_0	3	1	01111000010000111111000111110000000000001100000		1	20	20	2	2			2	
H3335	020	0	1	04	01	H3335_020_0	3	3	00000010000000000000000000000000000000000000110		2				1	20.00	20.00	2	
H3335	020	0	1	04	01	H3335_020_0	3	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	020	0	1	04	01	H3335_020_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	021	0	1	04	01	H3335_021_0	3	2	00100111101101000000000000000000011111111000111		2				1	25.00	25.00	2	
H3335	021	0	1	04	01	H3335_021_0	3	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	021	0	1	04	01	H3335_021_0	3	1	01011000010010111111100111110000000000000100000		1	20	20	2	2			2	
H3335	031	0	1	04	01	H3335_031_0	2	1	01111000010010111111000111110000000000000100000		1	20	20	2	2			2	
H3335	031	0	1	04	01	H3335_031_0	2	2	00000111101101000000100000000000011111111000111		2				1	25.00	25.00	2	
H3335	031	0	1	04	01	H3335_031_0	2	3	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	032	0	1	04	01	H3335_032_0	3	1	01111101111111111111100111110000011111111100001		1	20	20	2	2			2	
H3335	032	0	1	04	01	H3335_032_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3335	032	0	1	04	01	H3335_032_0	3	3	00000010000000000000000000000000000000000000110		2				1	20.00	20.00	2	
H3335	801	0	1	04	01	H3335_801_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	801	0	1	04	01	H3335_801_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	801	0	1	04	01	H3335_801_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	802	0	1	04	01	H3335_802_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	802	0	1	04	01	H3335_802_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	802	0	1	04	01	H3335_802_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	803	0	1	04	01	H3335_803_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	803	0	1	04	01	H3335_803_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	803	0	1	04	01	H3335_803_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	805	0	1	04	01	H3335_805_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	805	0	1	04	01	H3335_805_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	805	0	1	04	01	H3335_805_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	806	0	1	04	01	H3335_806_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	806	0	1	04	01	H3335_806_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	806	0	1	04	01	H3335_806_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	807	0	1	04	01	H3335_807_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	807	0	1	04	01	H3335_807_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	807	0	1	04	01	H3335_807_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	811	0	1	04	01	H3335_811_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	811	0	1	04	01	H3335_811_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	811	0	1	04	01	H3335_811_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	813	0	1	04	01	H3335_813_0	1	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	813	0	1	04	01	H3335_813_0	1	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	813	0	1	04	01	H3335_813_0	1	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	814	0	1	04	01	H3335_814_0	1	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	814	0	1	04	01	H3335_814_0	1	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	814	0	1	04	01	H3335_814_0	1	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	815	0	1	04	01	H3335_815_0	1	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	815	0	1	04	01	H3335_815_0	1	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	815	0	1	04	01	H3335_815_0	1	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	816	0	1	04	01	H3335_816_0	1	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	816	0	1	04	01	H3335_816_0	1	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	816	0	1	04	01	H3335_816_0	1	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	817	0	1	04	01	H3335_817_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	817	0	1	04	01	H3335_817_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	817	0	1	04	01	H3335_817_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	818	0	1	04	01	H3335_818_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	818	0	1	04	01	H3335_818_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3335	818	0	1	04	01	H3335_818_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	819	0	1	04	01	H3335_819_0	2	1	01100111101101011111110111110000011111111100101		1	20	20	2	2			2	
H3335	819	0	1	04	01	H3335_819_0	2	3	00001000000000100000000000000000000000000000000		2				2			2	
H3335	819	0	1	04	01	H3335_819_0	2	2	00010000010010000000000000000000000000000000000		1	50	50	2	2			2	
H3340	001	0	1	04	01	H3340_001_0	7	3	00010000010010000001000000000000000000000000000	$20 copayment group	2				1	20.00	20.00	2	
H3340	001	0	1	04	01	H3340_001_0	7	2	00100011101001000000100000000000000000000000000	$10 copayment group	2				1	10.00	10.00	2	
H3340	001	0	1	04	01	H3340_001_0	7	1	11001000000000000110010111100000111111111101111	zero copayment group	2				2			2	
H3340	002	0	1	04	01	H3340_002_0	6	2	00000000100000000000000000000000000000000000000	$10 copayment group	2				1	10.00	10.00	2	
H3340	002	0	1	04	01	H3340_002_0	6	1	11001000000000000110010111100000111111111101111	zero copayment group	2				2			2	
H3340	002	0	1	04	01	H3340_002_0	6	3	00110011011011000001100000000000000000000000000	$20 copayment group	2				1	20.00	20.00	2	
H3342	001	0	1	04	01	H3342_001_0	5	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	001	0	1	04	01	H3342_001_0	5	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	4	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	4	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	003	0	1	04	01	H3342_003_0	4	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	003	0	1	04	01	H3342_003_0	4	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	004	0	1	04	01	H3342_004_0	4	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	004	0	1	04	01	H3342_004_0	4	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	006	0	1	04	01	H3342_006_0	3	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	006	0	1	04	01	H3342_006_0	3	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	007	0	1	04	01	H3342_007_0	3	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	007	0	1	04	01	H3342_007_0	3	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	008	0	1	04	01	H3342_008_0	3	2	00111100101100111110111000110000011111111101000	20% coinsurance	1	20	20	2	2			2	
H3342	008	0	1	04	01	H3342_008_0	3	1	11000011010011000001000111000000100000000000001	50% coinsurance	1	50	50	2	2			2	
H3342	801	0	1	04	01	H3342_801_0	1	1	11111111111111111111111111110000111111111101111		1	20	20	2	2			2	
H3342	802	0	1	04	01	H3342_802_0	1	1	11111111111111111111111111110000111111111101111		1	20	20	2	2			2	
H3342	803	0	1	04	01	H3342_803_0	1	1	11111111111111111111111111110000111111111101111		1	20	20	2	2			2	
H3342	804	0	1	04	01	H3342_804_0	1	1	11111111111111111111111111110000111111111101111		1	20	20	2	2			2	
H3344	001	0	1	04	01	H3344_001_0	9	5	00000000000000000000000000000000000000000000110		2				2			2	
H3344	001	0	1	04	01	H3344_001_0	9	3	00000100100000000000000000000000000000000000100		2				1	30.00	30.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	2	00000000010010000001000000000000000000000000000		1	50	50	1	2			2	
H3344	001	0	1	04	01	H3344_001_0	9	4	00000001000001000000100000000000000000000000000		2				1	25.00	25.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	1	00100000001000111110000001110000110111111100001		1	20	20	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	1	00100000001000111110000001110000110111111100001		1	20	20	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	2	00000000010010000001000000000000000000000000000		1	50	50	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	4	00000101100001000000100000000000000000000000100		2				1	25.00	25.00	2	
H3344	003	0	1	04	01	H3344_003_0	8	5	00000000000000000000000000000000000000000000110		2				2			2	
H3344	003	0	1	04	01	H3344_003_0	8	6	00000000000000000000000000000000000000000010000		1	50	50	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	3	00000100100000000000000000000000000000000000100		2				1	25.00	25.00	2	
H3344	801	0	1	04	01	H3344_801_0	7	1	01001010000000001110000010000000000000000101000		1	30	40	1	2			2	
H3344	801	0	1	04	01	H3344_801_0	7	2	00100101101001111110100001110000110111111100101		1	30	30	1	2			2	
H3344	801	0	1	04	01	H3344_801_0	7	3	00010000000000000000000100000000000000000000000		1	50	60	1	2			2	
H3344	801	0	1	04	01	H3344_801_0	7	4	00000000010010000001000000000000000000000000000		1	50	50	1	2			2	
H3344	801	0	1	04	01	H3344_801_0	7	5	00000000000000000000000000000000000000000000110		2				2			2	
H3344	802	0	1	04	01	H3344_802_0	4	5	00000000000000000000000000000000000000000000110		2				2			2	
H3344	802	0	1	04	01	H3344_802_0	4	4	00000000010010000001000000000000000000000000000		1	50	50	1	2			2	
H3344	802	0	1	04	01	H3344_802_0	4	2	00100101101001111110100001110000110111111100101		1	30	30	1	2			2	
H3344	802	0	1	04	01	H3344_802_0	4	1	01001010000000001110000010000000000000000101000		1	30	40	1	2			2	
H3344	802	0	1	04	01	H3344_802_0	4	3	00010000000000000000000100000000000000000000000		1	40	50	1	2			2	
H3345	001	1	1	04	01	H3345_001_1	11	1	01001000000000010010100110000000000000000000000	Group 1 Base1	1	20	50	1	2			1	500.00
H3345	001	1	1	04	01	H3345_001_1	11	2	00110111111111101101010001110000111111111000111	Group 2  Base	1	20	20	1	2			1	500.00
H3345	001	2	1	04	01	H3345_001_2	11	1	01001000000000010010100110000000000000000000000	Group 1 Base1	1	20	50	1	2			1	500.00
H3345	001	2	1	04	01	H3345_001_2	11	2	00110111111111101101010001110000111111111000111	Group 2  Base	1	20	20	1	2			1	500.00
H3345	001	3	1	04	01	H3345_001_3	11	2	00110111111111101101010001110000111111111000111	Group 2  Base	1	20	20	1	2			1	500.00
H3345	001	3	1	04	01	H3345_001_3	11	1	01001000000000010010100110000000000000000000000	Group 1 Base1	1	20	50	1	2			1	500.00
H3345	801	5	1	04	01	H3345_801_5	7	1	01001000000000010010100110000000000000000000000	Group 1 Base1	1	20	50	1	2			1	500.00
H3345	801	5	1	04	01	H3345_801_5	7	2	00110111111111101101010001110000111111111000111	Group 2  Base	1	20	20	1	2			1	500.00
H3345	801	6	1	04	01	H3345_801_6	7	1	01001000000000010010100110000000000000000000000	Group 1 Base1	1	20	50	1	2			1	500.00
H3345	801	6	1	04	01	H3345_801_6	7	2	00110111111111101101010001110000111111111000111	Group 2  Base	1	20	20	1	2			1	500.00
H3345	801	7	1	04	01	H3345_801_7	8	1	01001000000000010010100110000000000000000000000	Group 1 Base1	1	20	50	1	2			1	500.00
H3345	801	7	1	04	01	H3345_801_7	8	2	00110111111111101101010001110000111111111000111	Group 2  Base	1	20	20	1	2			1	500.00
H3346	001	0	1	04	01	H3346_001_0	9	4	00000000000000000000010000000000000000000000000		2				1	35.00	35.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	5	00000000000000000000000000000000110111110000000		2				2			2	
H3346	001	0	1	04	01	H3346_001_0	9	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H3346	001	0	1	04	01	H3346_001_0	9	2	00000110101000001000000000000000001000000000101		2				1	25.00	25.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	1	01001001000101100110100111100000000000000000000		1	20	20	2	2			2	
H3346	002	0	1	04	01	H3346_002_0	6	1	01001001000101100100100111100000000000000000000		1	20	20	2	2			2	
H3346	002	0	1	04	01	H3346_002_0	6	2	00000110101000001000000000000000001000000000101		2				1	25.00	25.00	2	
H3346	002	0	1	04	01	H3346_002_0	6	5	00000000000000000000000000000000110111110000000		2				2			2	
H3346	002	0	1	04	01	H3346_002_0	6	4	00000000000000000000010000000000000000000000000		2				1	35.00	35.00	2	
H3346	002	0	1	04	01	H3346_002_0	6	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H3346	801	0	1	04	01	H3346_801_0	8	1	01001001000101100110100111100000000000000000000		1	20	20	2	2			2	
H3346	801	0	1	04	01	H3346_801_0	8	2	00000110101000001000000000000000001000000000101		2				1	25.00	25.00	2	
H3346	801	0	1	04	01	H3346_801_0	8	4	00000000000000000000010000000000000000000000000		2				1	35.00	35.00	2	
H3346	801	0	1	04	01	H3346_801_0	8	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H3346	801	0	1	04	01	H3346_801_0	8	5	00000000000000000000000000000000110111110000000		2				2			2	
H3346	802	0	1	04	01	H3346_802_0	12	4	00000000000000000000010000000000000000000000000		2				1	35.00	35.00	2	
H3346	802	0	1	04	01	H3346_802_0	12	5	00000000000000000000000000000000110111110000000		2				2			2	
H3346	802	0	1	04	01	H3346_802_0	12	1	01001001000101100110100111100000000000000000000		1	20	20	2	2			2	
H3346	802	0	1	04	01	H3346_802_0	12	3	00000000010010000001000000000000000000000000000		1	50	50	2	2			2	
H3346	802	0	1	04	01	H3346_802_0	12	2	00000110101000001000000000000000010000000000101		2				1	25.00	25.00	2	
H3404	001	0	1	04	01	H3404_001_0	1	1	01111111111111111111100111110000011111111101111	Group 1	1	20	20	6	2			2	
H3404	001	0	1	04	01	H3404_001_0	1	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3404	002	0	1	04	01	H3404_002_0	3	1	01111111111111111111100111110000011111111101111	Medicare Covered Services	1	20	20	6	2			2	
H3404	002	0	1	04	01	H3404_002_0	3	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H3404	801	0	1	04	01	H3404_801_0	2	1	11111111111111111111110111110000111111111101111	Group 1	1	20	20	6	2			2	
H3404	803	0	1	04	01	H3404_803_0	2	1	11111111111111111111110111110000111111111101111	Group 1	1	20	20	6	2			2	
H3404	805	0	1	04	01	H3404_805_0	2	1	11111111111111111111110111110000111111111101111	Group 1	1	20	20	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	8	00000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	7	00000000000000000000000000000000000000000010000		1	50	80	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	6	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3405	001	0	1	04	01	H3405_001_0	4	4	00000000000000000000000000100000000000000000000		2				1	0.00	75.00	2	
H3405	001	0	1	04	01	H3405_001_0	4	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3405	001	0	1	04	01	H3405_001_0	4	1	01111111111011111111100000010000011111111000101		1	30	30	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	2	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H3405	801	0	1	04	01	H3405_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3405	801	0	1	04	01	H3405_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3405	801	0	1	04	01	H3405_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3405	801	0	1	04	01	H3405_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3405	802	0	1	04	01	H3405_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3405	802	0	1	04	01	H3405_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3405	802	0	1	04	01	H3405_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3405	802	0	1	04	01	H3405_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3405	803	0	1	04	01	H3405_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3405	803	0	1	04	01	H3405_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3405	803	0	1	04	01	H3405_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3405	803	0	1	04	01	H3405_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3405	804	0	1	04	01	H3405_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3405	804	0	1	04	01	H3405_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3405	804	0	1	04	01	H3405_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3405	804	0	1	04	01	H3405_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3619	001	0	1	04	01	H3619_001_0	3	1	01111111111011111111100110010000011111111001101		1	30	30	6	2			2	
H3619	001	0	1	04	01	H3619_001_0	3	2	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
H3619	001	0	1	04	01	H3619_001_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	001	0	1	04	01	H3619_001_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	90.00	2	
H3619	001	0	1	04	01	H3619_001_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	004	0	1	04	01	H3619_004_0	4	1	01111111111011111111100111010000011111111101101		1	20	20	6	2			2	
H3619	004	0	1	04	01	H3619_004_0	4	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	004	0	1	04	01	H3619_004_0	4	4	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	004	0	1	04	01	H3619_004_0	4	3	00000000000000000000000000100000000000000000000		2				1	0.00	90.00	2	
H3619	005	0	1	04	01	H3619_005_0	3	1	01111111111011111111100111010000011111111101101		1	20	20	6	2			2	
H3619	005	0	1	04	01	H3619_005_0	3	3	00000000000000000000000000100000000000000000000		2				1	0.00	90.00	2	
H3619	005	0	1	04	01	H3619_005_0	3	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	005	0	1	04	01	H3619_005_0	3	4	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	006	0	1	04	01	H3619_006_0	3	1	01111111111011111111100110010000011111111001101		1	30	30	6	2			2	
H3619	006	0	1	04	01	H3619_006_0	3	2	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
H3619	006	0	1	04	01	H3619_006_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	006	0	1	04	01	H3619_006_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	90.00	2	
H3619	006	0	1	04	01	H3619_006_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	801	0	1	04	01	H3619_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	801	0	1	04	01	H3619_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3619	801	0	1	04	01	H3619_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3619	801	0	1	04	01	H3619_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3619	804	0	1	04	01	H3619_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	804	0	1	04	01	H3619_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3619	804	0	1	04	01	H3619_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3619	804	0	1	04	01	H3619_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3619	806	0	1	04	01	H3619_806_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3619	806	0	1	04	01	H3619_806_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	806	0	1	04	01	H3619_806_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3619	806	0	1	04	01	H3619_806_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3619	807	0	1	04	01	H3619_807_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H3619	807	0	1	04	01	H3619_807_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H3619	807	0	1	04	01	H3619_807_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H3619	807	0	1	04	01	H3619_807_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H3620	001	0	1	04	01	H3620_001_0	4	3	00000000000000000110000000000000000000000000000	OON Ambulatory Surgical Center Services	2				1	225.00	225.00	2	
H3620	001	0	1	04	01	H3620_001_0	4	2	00000000001111111000000111000000011111110000000		1	20	20	2	2			2	
H3620	001	0	1	04	01	H3620_001_0	4	1	01000000000000000000000000000000000000000000000	OON SNF	2				1	0.00	100.00	2	
H3620	001	0	1	04	01	H3620_001_0	4	4	00011000000000000000100000110000100000001100000		2				2			2	
H3620	801	0	1	04	01	H3620_801_0	3	3	00000000000000000010000000000000000000000000000	OON Ambulatory Surgical Center Services	2				1	225.00	225.00	2	
H3620	801	0	1	04	01	H3620_801_0	3	2	00100111111111111001010111000000011111110000000		1	20	20	2	2			2	
H3620	801	0	1	04	01	H3620_801_0	3	1	01000000000000000000000000000000000000000000000	OON SNF	2				1	0.00	100.00	2	
H3620	801	0	1	04	01	H3620_801_0	3	4	00011000000000000000100000110000100000001100000		2				2			2	
H3620	802	0	1	04	01	H3620_802_0	4	2	00100111111111111001010111000000011111110000000		1	20	20	2	2			2	
H3620	802	0	1	04	01	H3620_802_0	4	3	00000000000000000010000000000000000000000000000	OON Ambulatory Surgical Center Services	2				1	225.00	225.00	2	
H3620	802	0	1	04	01	H3620_802_0	4	4	00011000000000000000100000110000100000001100000		2				2			2	
H3620	802	0	1	04	01	H3620_802_0	4	1	01000000000000000000000000000000000000000000000	OON SNF	2				1	0.00	100.00	2	
H3620	803	0	1	04	01	H3620_803_0	3	2	00100111111111111001010111000000011111110000000		1	20	20	2	2			2	
H3620	803	0	1	04	01	H3620_803_0	3	3	00000000000000000010000000000000000000000000000	OON Ambulatory Surgical Center Services	2				1	225.00	225.00	2	
H3620	803	0	1	04	01	H3620_803_0	3	4	00011000000000000000100000110000100000001100000		2				2			2	
H3620	803	0	1	04	01	H3620_803_0	3	1	01000000000000000000000000000000000000000000000	OON SNF	2				1	0.00	100.00	2	
H3620	804	0	1	04	01	H3620_804_0	4	1	01000000000000000000000000000000000000000000000	OON SNF	2				1	0.00	100.00	2	
H3620	804	0	1	04	01	H3620_804_0	4	4	00011000000000000000100000110000100000001100000		2				2			2	
H3620	804	0	1	04	01	H3620_804_0	4	2	00100111111111111001010111000000011111110000000		1	20	20	2	2			2	
H3620	804	0	1	04	01	H3620_804_0	4	3	00000000000000000010000000000000000000000000000	OON Ambulatory Surgical Center Services	2				1	225.00	225.00	2	
H3624	001	0	1	04	01	H3624_001_0	4	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
H3624	001	0	1	04	01	H3624_001_0	4	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
H3624	002	0	1	04	01	H3624_002_0	4	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
H3624	002	0	1	04	01	H3624_002_0	4	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
H3624	801	0	1	04	01	H3624_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H3624	801	0	1	04	01	H3624_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H3624	802	0	1	04	01	H3624_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H3624	802	0	1	04	01	H3624_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H3709	001	0	1	04	01	H3709_001_0	5	1	01111111111111111111100111110000011111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	003	0	1	04	01	H3709_003_0	4	1	01111111111111111111100111110000011111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	801	0	1	04	01	H3709_801_0	5	1	01111111111111111111100111110000011111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	802	0	1	04	01	H3709_802_0	4	1	01111111111111111111100111110000011111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	803	0	1	04	01	H3709_803_0	5	1	01111111111111111111100111110000011111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	804	0	1	04	01	H3709_804_0	4	1	01111111111111111111100111110000011111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3812	001	0	1	04	01	H3812_001_0	5	1	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3812	001	0	1	04	01	H3812_001_0	5	2	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H3812	001	0	1	04	01	H3812_001_0	5	3	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H3812	001	0	1	04	01	H3812_001_0	5	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3812	001	0	1	04	01	H3812_001_0	5	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H3812	001	0	1	04	01	H3812_001_0	5	9	00000000000000000000000000010000100000000000000		2				2			2	
H3812	001	0	1	04	01	H3812_001_0	5	8	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H3812	001	0	1	04	01	H3812_001_0	5	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3812	001	0	1	04	01	H3812_001_0	5	5	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	9	00000000000000000000000000010000100000000000000		2				2			2	
H3812	003	0	1	04	01	H3812_003_0	7	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	6	00000010101100000000000000000000000000000001101		2				1	25.00	25.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	5	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	3	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H3812	003	0	1	04	01	H3812_003_0	7	2	00101001000001000110100111100000010111111100010		1	30	30	6	2			2	
H3812	003	0	1	04	01	H3812_003_0	7	1	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H3812	004	0	1	04	01	H3812_004_0	5	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H3812	004	0	1	04	01	H3812_004_0	5	2	10000000000000000000000000000000000000000000010		2				2			2	
H3812	005	0	1	04	01	H3812_005_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H3812	005	0	1	04	01	H3812_005_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H3812	801	0	1	04	01	H3812_801_0	4	1	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3812	801	0	1	04	01	H3812_801_0	4	2	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H3812	801	0	1	04	01	H3812_801_0	4	5	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H3812	801	0	1	04	01	H3812_801_0	4	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3812	801	0	1	04	01	H3812_801_0	4	3	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H3812	801	0	1	04	01	H3812_801_0	4	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
H3812	801	0	1	04	01	H3812_801_0	4	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3812	801	0	1	04	01	H3812_801_0	4	8	00000000000000000000000000010000100000000000000		2				2			2	
H3813	001	0	1	04	01	H3813_001_0	8	1	00000000000000000110000000000000000000000000000	$400 Outpatient Facility	1	10	10	2	1	400.00	400.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	2	00010000010010000000000000000000000000000000000	$25 Group/$35 Indivdual Sessions	2				1	25.00	35.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	3	00000111001101000000100000000000000000110000001	$20 copayment	2				1	20.00	20.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	4	00000000000000001000000011000000000000001000000	$10 copayment	2				1	10.00	10.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	9	00000000000000000000010000000000000000000000000	$50	2				1	50.00	50.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	8	01000000000000000000000000000000000000000000000	$0 - $50 copayment	2				1	0.00	50.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	7	00000000000000100000000000000000000000000000000	0-10% with $100 maximum copayment	1	0	10	2	1	0.00	100.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	6	00000000100000010000000000000000000000000000000	$35 copayment	2				1	35.00	35.00	2	
H3813	001	0	1	04	01	H3813_001_0	8	5	00000000000000000000000100100000010000000101000	10% Coinsurance	1	10	10	2	2			2	
H3813	002	0	1	04	01	H3813_002_0	7	7	00000000000000100000000000000000000000000000000	0-10% with $100 maximum copayment	1	0	10	2	1	0.00	100.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	8	01000000000000000000000000000000000000000000000	$0 - $50 copayment	2				1	0.00	50.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	9	00000000000000000000010000000000000000000000000	$50	2				1	50.00	50.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	1	00000000000000000110000000000000000000000000000	$400 Outpatient Facility	1	10	10	2	1	400.00	400.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	2	00010000010010000000000000000000000000000000000	$25 Group/$35 Indivdual Sessions	2				1	25.00	35.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	3	00000111001101000000100000000000000000110000001	$20 copayment	2				1	20.00	20.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	4	00000000000000001000000011000000000000001000000	$10 copayment	2				1	10.00	10.00	2	
H3813	002	0	1	04	01	H3813_002_0	7	5	00000000000000000000000100100000010000000101000	10% Coinsurance	1	10	10	2	2			2	
H3813	002	0	1	04	01	H3813_002_0	7	6	00000000100000010000000000000000000000000000000	$35 copayment	2				1	35.00	35.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	6	00000000100000010000000000000000000000000000000	$35 copayment	2				1	35.00	35.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	5	00000000000000000000000100100000010000000101000	10% Coinsurance	1	10	10	2	2			2	
H3813	003	0	1	04	01	H3813_003_0	8	4	00000000000000001000000011000000000000001000000	$10 copayment	2				1	10.00	10.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	3	00000111001101000000100000000000000000110000001	$20 copayment	2				1	20.00	20.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	9	00000000000000000000010000000000000000000000000	$50	2				1	50.00	50.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	1	00000000000000000110000000000000000000000000000	$400 Outpatient Facility	1	10	10	2	1	400.00	400.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	7	00000000000000100000000000000000000000000000000	0-10% with $100 maximum copayment	1	0	10	2	1	0.00	100.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	8	01000000000000000000000000000000000000000000000	$0 - $50 copayment	2				1	0.00	50.00	2	
H3813	003	0	1	04	01	H3813_003_0	8	2	00010000010010000000000000000000000000000000000	$25 Group/$35 Indivdual Sessions	2				1	25.00	35.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	6	00000000100000010000000000000000000000000000000	$35 copayment	2				1	35.00	35.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	5	00000000000000000000000100100000010000000101000	10% Coinsurance	1	10	10	2	2			2	
H3813	801	0	1	04	01	H3813_801_0	4	4	00000000000000001000000011000000000000001000000	$10 copayment	2				1	10.00	10.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	3	00000111001101000000100000000000000000110000001	$20 copayment	2				1	20.00	20.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	2	00010000010010000000000000000000000000000000000	$25 Group/$35 Indivdual Sessions	2				1	25.00	35.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	1	00000000000000000110000000000000000000000000000	$400 Outpatient Facility	1	10	10	2	1	400.00	400.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	7	00000000000000100000000000000000000000000000000	0-10% with $100 maximum copayment	1	0	10	2	1	0.00	100.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	9	00000000000000000000010000000000000000000000000	$50	2				1	50.00	50.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	8	01000000000000000000000000000000000000000000000	$0 - $50 copayment	2				1	0.00	50.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	1	00000000000000000110000000000000000000000000000	$400 Outpatient Facility	1	10	10	2	1	400.00	400.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	2	00010000010010000000000000000000000000000000000	$25 Group/$35 Indivdual Sessions	2				1	25.00	35.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	3	00000111001101000000100000000000000000110000001	$20 copayment	2				1	20.00	20.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	4	00000000000000001000000011000000000000001000000	$10 copayment	2				1	10.00	10.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	5	00000000000000000000000100100000010000000101000	10% Coinsurance	1	10	10	2	2			2	
H3813	802	0	1	04	01	H3813_802_0	4	6	00000000100000010000000000000000000000000000000	$35 copayment	2				1	35.00	35.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	7	00000000000000100000000000000000000000000000000	0-10% with $100 maximum copayment	1	0	10	2	1	0.00	100.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	9	00000000000000000000010000000000000000000000000	$50	2				1	50.00	50.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	8	01000000000000000000000000000000000000000000000	$0 - $50 copayment	2				1	0.00	50.00	2	
H3817	001	0	1	04	01	H3817_001_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H3817	001	0	1	04	01	H3817_001_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3817	002	0	1	04	01	H3817_002_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H3817	002	0	1	04	01	H3817_002_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3817	003	0	1	04	01	H3817_003_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H3817	003	0	1	04	01	H3817_003_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H3912	001	0	1	04	01	H3912_001_0	4	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H3912	001	0	1	04	01	H3912_001_0	4	2	00000000000000000000000000000000000000000000010		2				2			2	
H3912	004	0	1	04	01	H3912_004_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H3912	004	0	1	04	01	H3912_004_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H3912	005	0	1	04	01	H3912_005_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H3912	005	0	1	04	01	H3912_005_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H3912	006	0	1	04	01	H3912_006_0	4	2	10000000000000000000000000000000000000000000010	Group 2	2				2			2	
H3912	006	0	1	04	01	H3912_006_0	4	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	001	0	1	04	01	H3916_001_0	5	4	00000000000000000000000000000000011111111000000		2				2			2	
H3916	001	0	1	04	01	H3916_001_0	5	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	001	0	1	04	01	H3916_001_0	5	9	10000000000000000000000000000000000000000000010		2				2			2	
H3916	001	0	1	04	01	H3916_001_0	5	1	01111111111111111111100000110000001100000001101		1	20	20	1	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	8	00000000000000000000000000000000000000000010000		1	50	50	2	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	6	00000000000000000000000000000000000000000100000		1	20	20	1	1	10.00	93.00	2	
H3916	001	0	1	04	01	H3916_001_0	5	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	001	0	1	04	01	H3916_001_0	5	2	00000000000000000000011000000000000000000000000		1	20	20	1	1	25.00	25.00	2	
H3916	002	0	1	04	01	H3916_002_0	5	9	10000000000000000000000000000000000000000000010		2				2			2	
H3916	002	0	1	04	01	H3916_002_0	5	8	00000000000000000000000000000000000000000010000		1	50	50	2	2			2	
H3916	002	0	1	04	01	H3916_002_0	5	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	002	0	1	04	01	H3916_002_0	5	6	00000000000000000000000000000000000000000100000		1	20	20	1	1	10.00	93.00	2	
H3916	002	0	1	04	01	H3916_002_0	5	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	002	0	1	04	01	H3916_002_0	5	4	00000000000000000000000000000000011111111000000		2				2			2	
H3916	002	0	1	04	01	H3916_002_0	5	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	002	0	1	04	01	H3916_002_0	5	2	00000000000000000000011000000000000000000000000		1	20	20	1	1	25.00	25.00	2	
H3916	002	0	1	04	01	H3916_002_0	5	1	01111111111111111111100000110000001100000001101		1	20	20	1	2			2	
H3916	003	0	1	04	01	H3916_003_0	5	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	003	0	1	04	01	H3916_003_0	5	6	00000000000000000000000000000000000000000100000		1	20	20	1	1	10.00	93.00	2	
H3916	003	0	1	04	01	H3916_003_0	5	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	003	0	1	04	01	H3916_003_0	5	8	00000000000000000000000000000000000000000010000		1	50	50	2	2			2	
H3916	003	0	1	04	01	H3916_003_0	5	1	01111111111111111111100000110000001100000001101		1	20	20	1	2			2	
H3916	003	0	1	04	01	H3916_003_0	5	4	00000000000000000000000000000000011111111000000		2				2			2	
H3916	003	0	1	04	01	H3916_003_0	5	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	003	0	1	04	01	H3916_003_0	5	2	00000000000000000000011000000000000000000000000		1	20	20	1	1	25.00	25.00	2	
H3916	003	0	1	04	01	H3916_003_0	5	9	10000000000000000000000000000000000000000000010		2				2			2	
H3916	005	0	1	04	01	H3916_005_0	5	1	01111111111111111111100000110000001100000001101		1	20	20	1	2			2	
H3916	005	0	1	04	01	H3916_005_0	5	2	00000000000000000000011000000000000000000000000		1	20	20	1	1	25.00	25.00	2	
H3916	005	0	1	04	01	H3916_005_0	5	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	005	0	1	04	01	H3916_005_0	5	4	00000000000000000000000000000000010001111000000		2				2			2	
H3916	005	0	1	04	01	H3916_005_0	5	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	005	0	1	04	01	H3916_005_0	5	9	10000000000000000000000000000000000000000000010		2				2			2	
H3916	005	0	1	04	01	H3916_005_0	5	8	00000000000000000000000000000000000000000010000		1	50	50	2	2			2	
H3916	005	0	1	04	01	H3916_005_0	5	6	00000000000000000000000000000000000000000100000		1	20	20	1	1	8.00	150.00	2	
H3916	005	0	1	04	01	H3916_005_0	5	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	012	0	1	04	01	H3916_012_0	4	1	01111111111111111111100000110000001100000001101		1	30	30	1	2			2	
H3916	012	0	1	04	01	H3916_012_0	4	2	00000000000000000000011000000000000000000000000		1	30	30	1	1	25.00	25.00	2	
H3916	012	0	1	04	01	H3916_012_0	4	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	012	0	1	04	01	H3916_012_0	4	4	00000000000000000000000000000000010001111000000		2				2			2	
H3916	012	0	1	04	01	H3916_012_0	4	8	10000000000000000000000000000000000000000000010		2				2			2	
H3916	012	0	1	04	01	H3916_012_0	4	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	012	0	1	04	01	H3916_012_0	4	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	012	0	1	04	01	H3916_012_0	4	6	00000000000000000000000000000000000000000100000		1	30	30	1	1	10.00	77.50	2	
H3916	015	0	1	04	01	H3916_015_0	5	1	01111111111111111111100000110000001100000001101		1	20	20	1	2			2	
H3916	015	0	1	04	01	H3916_015_0	5	2	00000000000000000000011000000000000000000000000		1	20	20	1	1	25.00	25.00	2	
H3916	015	0	1	04	01	H3916_015_0	5	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	015	0	1	04	01	H3916_015_0	5	4	00000000000000000000000000000000010001111000000		2				2			2	
H3916	015	0	1	04	01	H3916_015_0	5	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	015	0	1	04	01	H3916_015_0	5	8	10000000000000000000000000000000000000000000010		2				2			2	
H3916	015	0	1	04	01	H3916_015_0	5	6	00000000000000000000000000000000000000000100000		1	20	20	1	1	10.00	93.00	2	
H3916	015	0	1	04	01	H3916_015_0	5	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	018	0	1	04	01	H3916_018_0	5	5	00000000000000000000000000000000100000000000000		1	50	50	2	2			1	250.00
H3916	018	0	1	04	01	H3916_018_0	5	4	00000000000000000000000000000000010001111000000		2				2			2	
H3916	018	0	1	04	01	H3916_018_0	5	8	10000000000000000000000000000000000000000000010		2				2			2	
H3916	018	0	1	04	01	H3916_018_0	5	7	00000000000000000000000000000100000000000000000	Urgent Care	2				1	25.00	50.00	2	
H3916	018	0	1	04	01	H3916_018_0	5	6	00000000000000000000000000000000000000000100000		1	30	30	1	1	10.00	93.00	2	
H3916	018	0	1	04	01	H3916_018_0	5	1	01111111111111111111100000110000001100000001101		1	30	30	1	2			2	
H3916	018	0	1	04	01	H3916_018_0	5	2	00000000000000000000011000000000000000000000000		1	30	30	1	1	50.00	50.00	2	
H3916	018	0	1	04	01	H3916_018_0	5	3	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	019	0	1	04	01	H3916_019_0	5	6	10000000000000000000000000000000000000000000010		2				2			2	
H3916	019	0	1	04	01	H3916_019_0	5	5	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	019	0	1	04	01	H3916_019_0	5	4	00000000000000000000000000000000010111111000000		2				2			2	
H3916	019	0	1	04	01	H3916_019_0	5	3	00000000000000000000000000000000100000000000000		1	50	50	1	2			1	250.00
H3916	019	0	1	04	01	H3916_019_0	5	2	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	019	0	1	04	01	H3916_019_0	5	1	01111111111111111111111000110000001100000001101		1	30	30	1	2			2	
H3916	019	0	1	04	01	H3916_019_0	5	7	00000000000000000000000000000000000000000100000		1	30	30	1	1	10.00	93.00	2	
H3916	020	0	1	04	01	H3916_020_0	5	5	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	020	0	1	04	01	H3916_020_0	5	4	00000000000000000000000000000000010111111000000		2				2			2	
H3916	020	0	1	04	01	H3916_020_0	5	3	00000000000000000000000000000000100000000000000		1	50	50	1	2			1	250.00
H3916	020	0	1	04	01	H3916_020_0	5	2	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	020	0	1	04	01	H3916_020_0	5	1	01111111111111111111111000110000001100000001101		1	30	30	1	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	6	10000000000000000000000000000000000000000000010		2				2			2	
H3916	020	0	1	04	01	H3916_020_0	5	7	00000000000000000000000000000000000000000100000		1	30	30	1	1	10.00	93.00	2	
H3916	021	0	1	04	01	H3916_021_0	5	2	00000000000000000000000111000000000000000000000		1	50	50	1	2			1	500.00
H3916	021	0	1	04	01	H3916_021_0	5	1	01111111111111111111111000110000001100000001101		1	30	30	1	2			2	
H3916	021	0	1	04	01	H3916_021_0	5	3	00000000000000000000000000000000100000000000000		1	50	50	1	2			1	250.00
H3916	021	0	1	04	01	H3916_021_0	5	4	00000000000000000000000000000000010111111000000		2				2			2	
H3916	021	0	1	04	01	H3916_021_0	5	5	00000000000000000000000000000100000000000000000	Urgent Care	2				1	15.00	50.00	2	
H3916	021	0	1	04	01	H3916_021_0	5	6	10000000000000000000000000000000000000000000010		2				2			2	
H3916	021	0	1	04	01	H3916_021_0	5	7	00000000000000000000000000000000000000000100000		1	30	30	1	1	10.00	93.00	2	
H3916	801	0	1	04	01	H3916_801_0	5	2	00000000000000000000000100000000000000000000000		2				2			2	
H3916	801	0	1	04	01	H3916_801_0	5	1	01111111111111111111111011110100111111111100100		1	20	20	1	2			2	
H3916	801	0	1	04	01	H3916_801_0	5	3	00000000000000000000000000000000000000000000010		2				2			2	
H3916	802	0	1	04	01	H3916_802_0	6	1	01111111111111111111111011110100111111111100100		1	20	20	1	2			2	
H3916	802	0	1	04	01	H3916_802_0	6	2	00000000000000000000000100000000000000000000000		2				2			2	
H3916	802	0	1	04	01	H3916_802_0	6	3	00000000000000000000000000000000000000000000010		2				2			2	
H3916	803	0	1	04	01	H3916_803_0	5	1	01111111111111111111111011110100111111111100100		1	20	20	1	2			2	
H3916	803	0	1	04	01	H3916_803_0	5	2	00000000000000000000000100000000000000000000000		2				2			2	
H3916	803	0	1	04	01	H3916_803_0	5	3	00000000000000000000000000000000000000000000010		2				2			2	
H3916	804	0	1	04	01	H3916_804_0	6	1	01111111111111111111111011110100111111111100100		1	20	20	1	2			2	
H3916	804	0	1	04	01	H3916_804_0	6	2	00000000000000000000000100000000000000000000000		2				2			2	
H3916	804	0	1	04	01	H3916_804_0	6	3	00000000000000000000000000000000000000000000010		2				2			2	
H3921	001	0	1	04	01	H3921_001_0	8	5	00000000000000000000000000010000100000000000000		2				2			2	
H3921	001	0	1	04	01	H3921_001_0	8	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3921	001	0	1	04	01	H3921_001_0	8	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3921	001	0	1	04	01	H3921_001_0	8	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H3921	001	0	1	04	01	H3921_001_0	8	1	01101111101101000110100111100000011111111101111		1	30	30	6	2			2	
H3921	001	0	1	04	01	H3921_001_0	8	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3921	003	0	1	04	01	H3921_003_0	9	1	01101111101101000110100111100000011111111101111		1	30	30	6	2			2	
H3921	003	0	1	04	01	H3921_003_0	9	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H3921	003	0	1	04	01	H3921_003_0	9	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3921	003	0	1	04	01	H3921_003_0	9	5	00000000000000000000000000010000100000000000000		2				2			2	
H3921	003	0	1	04	01	H3921_003_0	9	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3921	003	0	1	04	01	H3921_003_0	9	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3921	005	0	1	04	01	H3921_005_0	5	1	01101111101101000110100111100000011111111101111		1	30	30	6	2			2	
H3921	005	0	1	04	01	H3921_005_0	5	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H3921	005	0	1	04	01	H3921_005_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3921	005	0	1	04	01	H3921_005_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3921	005	0	1	04	01	H3921_005_0	5	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3921	005	0	1	04	01	H3921_005_0	5	5	00000000000000000000000000010000100000000000010		2				2			2	
H3921	006	0	1	04	01	H3921_006_0	5	1	01101111101101000110100111100000011111111101111		1	30	30	6	2			2	
H3921	006	0	1	04	01	H3921_006_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H3921	006	0	1	04	01	H3921_006_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H3921	006	0	1	04	01	H3921_006_0	5	5	00000000000000000000000000010000100000000000000		2				2			2	
H3921	006	0	1	04	01	H3921_006_0	5	6	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H3921	006	0	1	04	01	H3921_006_0	5	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H3921	801	0	1	04	01	H3921_801_0	5	2	00000000000000111000000000000000000000000000000	Group Two	1	0	30	6	1	0.00	20.00	2	
H3921	801	0	1	04	01	H3921_801_0	5	3	00010000000000000000000000000000000000000000000	Group Three	2				1	75.00	75.00	2	
H3921	801	0	1	04	01	H3921_801_0	5	4	00000000000000000000010000000000000000000000000	Group Four	2				1	175.00	175.00	2	
H3921	801	0	1	04	01	H3921_801_0	5	5	00000000010010000001000000000000000000000000000	Group Five	2				1	35.00	45.00	2	
H3921	801	0	1	04	01	H3921_801_0	5	6	00000000000000000000000000010000100000000000000	Group Six	2				2			2	
H3921	801	0	1	04	01	H3921_801_0	5	1	01101111101101000110100111100000011111111101111	Group One	1	30	30	6	2			2	
H3924	001	0	1	04	01	H3924_001_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	002	0	1	04	01	H3924_002_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	003	0	1	04	01	H3924_003_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	004	0	1	04	01	H3924_004_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	005	0	1	04	01	H3924_005_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	006	0	1	04	01	H3924_006_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	007	0	1	04	01	H3924_007_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	008	0	1	04	01	H3924_008_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	009	0	1	04	01	H3924_009_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	010	0	1	04	01	H3924_010_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	011	0	1	04	01	H3924_011_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	012	0	1	04	01	H3924_012_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	013	0	1	04	01	H3924_013_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	014	0	1	04	01	H3924_014_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	015	0	1	04	01	H3924_015_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	016	0	1	04	01	H3924_016_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	017	0	1	04	01	H3924_017_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	018	0	1	04	01	H3924_018_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	019	0	1	04	01	H3924_019_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	020	0	1	04	01	H3924_020_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	021	0	1	04	01	H3924_021_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	022	0	1	04	01	H3924_022_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	023	0	1	04	01	H3924_023_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	024	0	1	04	01	H3924_024_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	025	0	1	04	01	H3924_025_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	026	0	1	04	01	H3924_026_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	027	0	1	04	01	H3924_027_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	028	0	1	04	01	H3924_028_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	029	0	1	04	01	H3924_029_0	6	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	030	0	1	04	01	H3924_030_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	031	0	1	04	01	H3924_031_0	5	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H3924	032	0	1	04	01	H3924_032_0	4	1	01111111111111111111100111110000111111111101111	OON	1	20	20	1	2			2	
H4005	001	0	1	04	01	H4005_001_0	3	1	01001000001100100110110111010000011111110111101		1	20	20	2	2			2	
H4005	001	0	1	04	01	H4005_001_0	3	4	00000101000010000000000000100000100000000000000		2				2			2	
H4005	001	0	1	04	01	H4005_001_0	3	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4005	001	0	1	04	01	H4005_001_0	3	2	00100011011001011001000000000000000000001000000		1	25	25	3	2			2	
H4005	003	0	1	04	01	H4005_003_0	5	4	00000101000010000000000000100000100000000000000		2				2			2	
H4005	003	0	1	04	01	H4005_003_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4005	003	0	1	04	01	H4005_003_0	5	2	00100011011001011001000000000000000000001000000		1	25	25	3	2			2	
H4005	003	0	1	04	01	H4005_003_0	5	1	01001000001100100110110111010000011111110111101		1	20	20	2	2			2	
H4005	004	0	1	04	01	H4005_004_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4005	004	0	1	04	01	H4005_004_0	5	4	00000101000010000000000000100000100000000000000		2				2			2	
H4005	004	0	1	04	01	H4005_004_0	5	2	00100011011001011001000000000000000000001000000		1	25	25	3	2			2	
H4005	004	0	1	04	01	H4005_004_0	5	1	01001000001100100110110111010000011111110111101		1	20	20	2	2			2	
H4005	801	0	1	04	01	H4005_801_0	2	1	01001100101100100110110111010000011111110111101		1	20	20	2	2			2	
H4005	801	0	1	04	01	H4005_801_0	2	4	00000101000010000000000000100000100000000000000		2				2			2	
H4005	801	0	1	04	01	H4005_801_0	2	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4005	801	0	1	04	01	H4005_801_0	2	2	00100011011011011001000000000000000000001000000		1	25	25	3	2			2	
H4005	802	0	1	04	01	H4005_802_0	3	4	00000101000010000000000000100000100000000000000		2				2			2	
H4005	802	0	1	04	01	H4005_802_0	3	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4005	802	0	1	04	01	H4005_802_0	3	2	00100011011011011001000000000000000000001000000		1	25	25	3	2			2	
H4005	802	0	1	04	01	H4005_802_0	3	1	01001100101100100110110111010000011111110111101		1	20	20	2	2			2	
H4005	804	0	1	04	01	H4005_804_0	3	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4005	804	0	1	04	01	H4005_804_0	3	4	00000101000010000000000000100000100000000000000		2				2			2	
H4005	804	0	1	04	01	H4005_804_0	3	1	01001100101100100110110111010000011111110111101		1	20	20	2	2			2	
H4005	804	0	1	04	01	H4005_804_0	3	2	00100011011011011001000000000000000000001000000		1	25	25	3	2			2	
H4011	001	0	1	04	01	H4011_001_0	6	1	01000000000000000000000000000000000000000000000		2				2			1	200.00
H4011	001	0	1	04	01	H4011_001_0	6	2	00111111101101111111110111100000011111111110101		1	20	20	1	2			2	
H4011	001	0	1	04	01	H4011_001_0	6	3	00000000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	003	0	1	04	01	H4011_003_0	6	2	00111111101101111111110111100000011111111110101		1	20	20	1	2			2	
H4011	003	0	1	04	01	H4011_003_0	6	1	01000000000000000000000000000000000000000000000		2				2			1	200.00
H4011	003	0	1	04	01	H4011_003_0	6	3	00000000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	004	0	1	04	01	H4011_004_0	6	1	01000000000000000000000000000000000000000000000		2				2			1	200.00
H4011	004	0	1	04	01	H4011_004_0	6	2	00111111101101111111110111100000011111111110101		1	20	20	1	2			2	
H4011	004	0	1	04	01	H4011_004_0	6	3	00000000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	008	0	1	04	01	H4011_008_0	6	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility	2				2			1	200.00
H4011	008	0	1	04	01	H4011_008_0	6	2	00111111101101111111110111100000011111111110101		1	20	20	1	2			2	
H4011	008	0	1	04	01	H4011_008_0	6	3	00000000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	801	0	1	04	01	H4011_801_0	8	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	801	0	1	04	01	H4011_801_0	8	1	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H4011	801	0	1	04	01	H4011_801_0	8	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	802	0	1	04	01	H4011_802_0	3	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	802	0	1	04	01	H4011_802_0	3	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	802	0	1	04	01	H4011_802_0	3	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	803	0	1	04	01	H4011_803_0	3	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	803	0	1	04	01	H4011_803_0	3	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	803	0	1	04	01	H4011_803_0	3	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	804	0	1	04	01	H4011_804_0	3	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	804	0	1	04	01	H4011_804_0	3	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	804	0	1	04	01	H4011_804_0	3	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	805	0	1	04	01	H4011_805_0	8	1	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H4011	805	0	1	04	01	H4011_805_0	8	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	805	0	1	04	01	H4011_805_0	8	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	806	0	1	04	01	H4011_806_0	3	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	806	0	1	04	01	H4011_806_0	3	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	806	0	1	04	01	H4011_806_0	3	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	807	0	1	04	01	H4011_807_0	3	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	807	0	1	04	01	H4011_807_0	3	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	807	0	1	04	01	H4011_807_0	3	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	808	0	1	04	01	H4011_808_0	3	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	808	0	1	04	01	H4011_808_0	3	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	808	0	1	04	01	H4011_808_0	3	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	809	0	1	04	01	H4011_809_0	10	1	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H4011	809	0	1	04	01	H4011_809_0	10	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	809	0	1	04	01	H4011_809_0	10	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	810	0	1	04	01	H4011_810_0	5	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	810	0	1	04	01	H4011_810_0	5	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	810	0	1	04	01	H4011_810_0	5	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	811	0	1	04	01	H4011_811_0	5	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	811	0	1	04	01	H4011_811_0	5	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	811	0	1	04	01	H4011_811_0	5	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4011	812	0	1	04	01	H4011_812_0	5	1	01000000000000000000000000000000000000000000000		2				1	119.50	119.50	2	
H4011	812	0	1	04	01	H4011_812_0	5	2	00101111101101111011110111110000011111111100101		1	20	20	1	2			2	
H4011	812	0	1	04	01	H4011_812_0	5	3	00010000010010000000000000000000000000000000000		1	50	50	1	2			2	
H4206	001	0	1	04	01	H4206_001_0	6	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	001	0	1	04	01	H4206_001_0	6	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	001	0	1	04	01	H4206_001_0	6	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	001	0	1	04	01	H4206_001_0	6	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	002	0	1	04	01	H4206_002_0	5	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	002	0	1	04	01	H4206_002_0	5	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	002	0	1	04	01	H4206_002_0	5	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	002	0	1	04	01	H4206_002_0	5	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	005	0	1	04	01	H4206_005_0	6	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	005	0	1	04	01	H4206_005_0	6	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	005	0	1	04	01	H4206_005_0	6	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	005	0	1	04	01	H4206_005_0	6	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	006	0	1	04	01	H4206_006_0	5	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	006	0	1	04	01	H4206_006_0	5	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	006	0	1	04	01	H4206_006_0	5	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	006	0	1	04	01	H4206_006_0	5	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	007	0	1	04	01	H4206_007_0	6	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	007	0	1	04	01	H4206_007_0	6	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	007	0	1	04	01	H4206_007_0	6	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	007	0	1	04	01	H4206_007_0	6	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	008	0	1	04	01	H4206_008_0	5	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	008	0	1	04	01	H4206_008_0	5	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	008	0	1	04	01	H4206_008_0	5	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	008	0	1	04	01	H4206_008_0	5	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	009	0	1	04	01	H4206_009_0	6	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	009	0	1	04	01	H4206_009_0	6	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	009	0	1	04	01	H4206_009_0	6	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	009	0	1	04	01	H4206_009_0	6	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	010	0	1	04	01	H4206_010_0	6	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
H4206	010	0	1	04	01	H4206_010_0	6	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4206	010	0	1	04	01	H4206_010_0	6	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H4206	010	0	1	04	01	H4206_010_0	6	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4206	025	0	1	04	01	H4206_025_0	6	1	01111111111111111111110111110000111111111101111	Group 1	1	20	20	1	2			2	
H4207	001	0	1	04	01	H4207_001_0	8	1	01111101100101111110100000110000111111101101000		1	20	20	1	2			2	
H4207	001	0	1	04	01	H4207_001_0	8	5	00000000000000000000000000000000000000000010000		2				2			2	
H4207	001	0	1	04	01	H4207_001_0	8	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4207	001	0	1	04	01	H4207_001_0	8	3	00000000000000000000000000000000000000000000111		1	30	30	2	2			2	
H4207	001	0	1	04	01	H4207_001_0	8	2	00000010011010000001000111000000000000000000000		1	50	50	1	2			2	
H4207	002	0	1	04	01	H4207_002_0	8	3	00000000000000000000000000000000000000000000111	Group 3	1	30	30	2	2			2	
H4207	002	0	1	04	01	H4207_002_0	8	4	00000000000000000000010000000000000000000000000	Group 4	2				1	75.00	75.00	2	
H4207	002	0	1	04	01	H4207_002_0	8	2	00000010011010000001000111000000000000000000000	Group 2	1	50	50	1	2			2	
H4207	002	0	1	04	01	H4207_002_0	8	1	01111101100101111110100000110000111111111101000	Group 1	1	20	20	1	2			2	
H4207	002	0	1	04	01	H4207_002_0	8	5	00000000000000000000000000000000000000000010000	Group 5	2				2			2	
H4207	003	0	1	04	01	H4207_003_0	8	4	00000000000000000000010000000000000000000000000	Group 4	2				1	50.00	50.00	2	
H4207	003	0	1	04	01	H4207_003_0	8	5	00000000000000000000000000000000000000000010000	Group 5	2				2			2	
H4207	003	0	1	04	01	H4207_003_0	8	1	01111101100101111110100000110000111111111101000	Group 1	1	20	20	1	2			2	
H4207	003	0	1	04	01	H4207_003_0	8	2	00000010011010000001000111000000000000000000000	Group 2	1	50	50	1	2			2	
H4207	003	0	1	04	01	H4207_003_0	8	3	00000000000000000000000000000000000000000000111	Group 3	1	30	30	2	2			2	
H4207	004	0	1	04	01	H4207_004_0	8	1	01111101100101111110100000110000111111101101000		1	20	20	1	2			2	
H4207	004	0	1	04	01	H4207_004_0	8	2	00000010011010000001000111000000000000000000000		1	50	50	1	2			2	
H4207	004	0	1	04	01	H4207_004_0	8	3	00000000000000000000000000000000000000000000111		1	30	30	2	2			2	
H4207	004	0	1	04	01	H4207_004_0	8	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4207	004	0	1	04	01	H4207_004_0	8	5	00000000000000000000000000000000000000000010000		2				2			2	
H4207	005	0	1	04	01	H4207_005_0	9	1	01111101100101111110100000110000111111111101000	Group 1	1	20	20	1	2			2	
H4207	005	0	1	04	01	H4207_005_0	9	2	00000010011010000001000111000000000000000000000	Group 2	1	50	50	1	2			2	
H4207	005	0	1	04	01	H4207_005_0	9	5	00000000000000000000000000000000000000000010000	Group 5	2				2			2	
H4207	005	0	1	04	01	H4207_005_0	9	4	00000000000000000000010000000000000000000000000	Group 4	2				1	50.00	50.00	2	
H4207	005	0	1	04	01	H4207_005_0	9	3	00000000000000000000000000000000000000000000111	Group 3	1	30	30	2	2			2	
H4209	001	0	1	04	01	H4209_001_0	5	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	001	0	1	04	01	H4209_001_0	5	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	001	0	1	04	01	H4209_001_0	5	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	002	0	1	04	01	H4209_002_0	5	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	002	0	1	04	01	H4209_002_0	5	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	002	0	1	04	01	H4209_002_0	5	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	003	0	1	04	01	H4209_003_0	5	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	003	0	1	04	01	H4209_003_0	5	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	1	01111111111111111111100001110000111111111101001	Group 1	1	20	20	1	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	4	00000000000000000000000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	005	0	1	04	01	H4209_005_0	5	4	00000000000000000000000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4209	005	0	1	04	01	H4209_005_0	5	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	005	0	1	04	01	H4209_005_0	5	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	005	0	1	04	01	H4209_005_0	5	1	01111111111111111111100001110000111111111101001	Group 1	1	20	20	1	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	4	00000000000000000000000110000000000000000000000	Group 4	1	30	30	1	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	1	01111111111111111111100001110000111111111101001	Group 1	1	20	20	1	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	006	0	1	04	01	H4209_006_0	5	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	809	0	1	04	01	H4209_809_0	4	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	809	0	1	04	01	H4209_809_0	4	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	809	0	1	04	01	H4209_809_0	4	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	810	0	1	04	01	H4209_810_0	4	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	810	0	1	04	01	H4209_810_0	4	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	810	0	1	04	01	H4209_810_0	4	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	811	0	1	04	01	H4209_811_0	3	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4209	811	0	1	04	01	H4209_811_0	3	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	811	0	1	04	01	H4209_811_0	3	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	812	0	1	04	01	H4209_812_0	3	2	00000000000000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
H4209	812	0	1	04	01	H4209_812_0	3	1	01111111111111111111100111110000111111111101001	Group 1	1	30	30	1	2			2	
H4209	812	0	1	04	01	H4209_812_0	3	3	00000000000000000000000000000000000000000000110	Group 3	2				2			2	
H4408	001	0	1	04	01	H4408_001_0	3	1	01111111111011111111100000010000011111111001101		1	30	30	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	3	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4408	001	0	1	04	01	H4408_001_0	3	3	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	3	4	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	3	5	00000000000000000000000000100000000000000000000		2				1	0.00	90.00	2	
H4408	001	0	1	04	01	H4408_001_0	3	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4408	001	0	1	04	01	H4408_001_0	3	7	00000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	3	1	01111111111011111111100000010000011111111001101		1	30	30	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	3	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4408	002	0	1	04	01	H4408_002_0	3	3	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	3	4	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	3	5	00000000000000000000000000100000000000000000000		2				1	0.00	90.00	2	
H4408	002	0	1	04	01	H4408_002_0	3	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4408	002	0	1	04	01	H4408_002_0	3	7	00000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4408	801	0	1	04	01	H4408_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4408	801	0	1	04	01	H4408_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4408	801	0	1	04	01	H4408_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4408	801	0	1	04	01	H4408_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4408	803	0	1	04	01	H4408_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4408	803	0	1	04	01	H4408_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4408	803	0	1	04	01	H4408_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4408	803	0	1	04	01	H4408_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4408	804	0	1	04	01	H4408_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4408	804	0	1	04	01	H4408_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4408	804	0	1	04	01	H4408_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4408	804	0	1	04	01	H4408_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4408	805	0	1	04	01	H4408_805_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4408	805	0	1	04	01	H4408_805_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4408	805	0	1	04	01	H4408_805_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4408	805	0	1	04	01	H4408_805_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4520	001	0	1	04	01	H4520_001_0	3	6	00000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H4520	001	0	1	04	01	H4520_001_0	3	2	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H4520	001	0	1	04	01	H4520_001_0	3	1	00111111111011111111100111010000011111111100101		1	20	20	6	2			2	
H4520	001	0	1	04	01	H4520_001_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	75.00	2	
H4520	001	0	1	04	01	H4520_001_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	001	0	1	04	01	H4520_001_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	002	0	1	04	01	H4520_002_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	002	0	1	04	01	H4520_002_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	100.00	2	
H4520	002	0	1	04	01	H4520_002_0	3	1	01111111111011111111100111010000011111111100101		1	20	20	6	2			2	
H4520	002	0	1	04	01	H4520_002_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	002	0	1	04	01	H4520_002_0	3	2	00000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	3	1	00111111111011111111100000010000011111111101101		1	20	20	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	3	2	01000000000000000000000000000000000000000000000		1	15	15	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H4520	003	0	1	04	01	H4520_003_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	003	0	1	04	01	H4520_003_0	3	6	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	3	7	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	005	0	1	04	01	H4520_005_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	3	6	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H4520	005	0	1	04	01	H4520_005_0	3	2	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H4520	005	0	1	04	01	H4520_005_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	005	0	1	04	01	H4520_005_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H4520	005	0	1	04	01	H4520_005_0	3	1	01111111111011111111100000010000011111111101101		1	15	15	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	3	9	00000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	3	8	00000001000001111001000000010000000001111100000		1	15	20	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	3	7	00000110111010000000000000000000011110000000101		1	15	15	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	006	0	1	04	01	H4520_006_0	3	6	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H4520	006	0	1	04	01	H4520_006_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	006	0	1	04	01	H4520_006_0	3	2	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	3	1	01111000000000000110100000000000000000000000000		1	20	20	6	2			2	
H4520	801	0	1	04	01	H4520_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4520	801	0	1	04	01	H4520_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4520	801	0	1	04	01	H4520_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4520	801	0	1	04	01	H4520_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	804	0	1	04	01	H4520_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	804	0	1	04	01	H4520_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4520	804	0	1	04	01	H4520_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4520	804	0	1	04	01	H4520_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4520	805	0	1	04	01	H4520_805_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4520	805	0	1	04	01	H4520_805_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4520	805	0	1	04	01	H4520_805_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4520	805	0	1	04	01	H4520_805_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	1	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	7	2	01000000000000000000000000000000000000000000000		2				1	175.00	175.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	3	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	7	4	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	8	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	7	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	6	00000010101100000000000000000000000000000001100		2				1	35.00	35.00	2	
H4522	001	0	1	04	01	H4522_001_0	7	9	00000000000000000000000000010000000000000000000		2				2			2	
H4522	005	0	1	04	01	H4522_005_0	4	7	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4522	005	0	1	04	01	H4522_005_0	4	8	00000000000000000000000000010000000000000000000		2				2			2	
H4522	005	0	1	04	01	H4522_005_0	4	9	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H4522	005	0	1	04	01	H4522_005_0	4	1	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H4522	005	0	1	04	01	H4522_005_0	4	2	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H4522	005	0	1	04	01	H4522_005_0	4	3	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H4522	005	0	1	04	01	H4522_005_0	4	4	00000000000000111000000000000000000000000000000		1	40	40	6	1	20.00	20.00	2	
H4522	005	0	1	04	01	H4522_005_0	4	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H4522	005	0	1	04	01	H4522_005_0	4	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H4522	007	0	1	04	01	H4522_007_0	5	2	10000000000000000000000000000000000000000000010		2				2			2	
H4522	007	0	1	04	01	H4522_007_0	5	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H4522	801	0	1	04	01	H4522_801_0	5	1	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H4522	801	0	1	04	01	H4522_801_0	5	2	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H4522	801	0	1	04	01	H4522_801_0	5	3	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H4522	801	0	1	04	01	H4522_801_0	5	4	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
H4522	801	0	1	04	01	H4522_801_0	5	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H4522	801	0	1	04	01	H4522_801_0	5	6	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H4522	801	0	1	04	01	H4522_801_0	5	7	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H4522	801	0	1	04	01	H4522_801_0	5	8	00000000000000000000000000010000000000000000000		2				2			2	
H4524	001	0	1	04	01	H4524_001_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H4524	001	0	1	04	01	H4524_001_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	002	0	1	04	01	H4524_002_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	002	0	1	04	01	H4524_002_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H4524	801	0	1	04	01	H4524_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H4524	801	0	1	04	01	H4524_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H4524	802	0	1	04	01	H4524_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H4524	802	0	1	04	01	H4524_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H4531	001	0	1	04	01	H4531_001_0	4	2	00000000000000000000000000000000000000000000101	OON:  $50 copayment	2				1	50.00	50.00	2	
H4531	001	0	1	04	01	H4531_001_0	4	1	01111111111111111111100110110000011111110100000	OON:  20% coinsurance	1	20	20	1	2			2	
H4531	802	0	1	04	01	H4531_802_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H4531	803	0	1	04	01	H4531_803_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H4531	804	0	1	04	01	H4531_804_0	2	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H4531	805	0	1	04	01	H4531_805_0	3	1	01111111111111111111100110110000011111110100000	OON:  20% Coinsurance	1	20	20	1	2			2	
H4605	001	0	1	04	01	H4605_001_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H4605	001	0	1	04	01	H4605_001_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H4605	002	0	1	04	01	H4605_002_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H4605	002	0	1	04	01	H4605_002_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H4605	004	0	1	04	01	H4605_004_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H4605	004	0	1	04	01	H4605_004_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H4606	001	0	1	04	01	H4606_001_0	5	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4606	001	0	1	04	01	H4606_001_0	5	5	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H4606	001	0	1	04	01	H4606_001_0	5	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	001	0	1	04	01	H4606_001_0	5	2	01000000000000000000000000000000000000000000000		1	20	20	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	5	3	00000000000000000000000001000000000000000100000		1	20	40	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	5	1	00111111111011111111100110010000011111111001101		1	40	40	6	2			2	
H4606	003	0	1	04	01	H4606_003_0	6	1	00111111111011111111100110010000011111111001101		1	40	40	6	2			2	
H4606	003	0	1	04	01	H4606_003_0	6	5	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H4606	003	0	1	04	01	H4606_003_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	003	0	1	04	01	H4606_003_0	6	3	00000000000000000000000001000000000000000100000		1	20	40	6	2			2	
H4606	003	0	1	04	01	H4606_003_0	6	2	01000000000000000000000000000000000000000000000		1	20	20	6	2			2	
H4606	003	0	1	04	01	H4606_003_0	6	6	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4606	004	0	1	04	01	H4606_004_0	4	9	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4606	004	0	1	04	01	H4606_004_0	4	8	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H4606	004	0	1	04	01	H4606_004_0	4	7	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	004	0	1	04	01	H4606_004_0	4	6	00000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	4	5	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	4	4	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	4	2	00000110111010000000000000000000011110000000101		1	25	25	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	4	3	00000001000001111001000000010000000001111100000		1	20	25	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	4	1	01111000000000000110100000000000000000000000000		1	20	20	6	2			2	
H4606	801	0	1	04	01	H4606_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4606	801	0	1	04	01	H4606_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4606	801	0	1	04	01	H4606_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	801	0	1	04	01	H4606_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4606	802	0	1	04	01	H4606_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	802	0	1	04	01	H4606_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4606	802	0	1	04	01	H4606_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4606	802	0	1	04	01	H4606_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	804	0	1	04	01	H4606_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H4606	804	0	1	04	01	H4606_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H4606	804	0	1	04	01	H4606_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H4606	804	0	1	04	01	H4606_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H4908	001	0	1	04	01	H4908_001_0	3	7	00000000000000110000000000000000000000000000000	Diagnostic Tests/Rad Therapy	2				1	15.00	100.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	6	00000000000000000000000000000000110111110000000	Preventive	2				2			2	
H4908	001	0	1	04	01	H4908_001_0	3	5	00000000000000000000000110000000000000000100110	DME and Rx	1	20	20	1	2			2	
H4908	001	0	1	04	01	H4908_001_0	3	4	00000000000000000000010000000000000000000000000	Ambulance and Emergency	2				1	50.00	50.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	3	00000000000000000110000000000000000000000000000	OP Surgery	2				1	250.00	250.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	2	00001111111111001001000001000000001000001000000	OP Professional	2				1	15.00	15.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	1	01000000000000000000000000000000000000000000000	SNF	2				1	150.00	150.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	6	00000000000000000000000000000000110111110000000	Preventive	2				2			2	
H4908	002	0	1	04	01	H4908_002_0	5	7	00000000000000110000000000000000000000000000000	Diagnostic Tests/Rad Therapy	2				1	15.00	100.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	5	00000000000000000000000110000000000000000100110	DME and Rx	1	20	20	1	2			2	
H4908	002	0	1	04	01	H4908_002_0	5	4	00000000000000000000010000000000000000000000000	Ambulance and Emergency	2				1	50.00	50.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	3	00000000000000000110000000000000000000000000000	OP Surgery	2				1	250.00	250.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	2	00001111111111001001000001000000001000001000000	OP Professional	2				1	15.00	15.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	1	01000000000000000000000000000000000000000000000	SNF	2				1	150.00	150.00	2	
H4908	003	0	1	04	01	H4908_003_0	3	2	00001000000000000000000000000000110111111000000		2				2			2	
H4908	003	0	1	04	01	H4908_003_0	3	1	01000000000000000000000000000000000000000000000		2				1	1000.00	1000.00	2	
H4908	003	0	1	04	01	H4908_003_0	3	6	00000000000000110000000000000000000000000000000		2				1	15.00	150.00	2	
H4908	003	0	1	04	01	H4908_003_0	3	5	00000001000001000000100110000000000000000100110		1	20	20	1	2			2	
H4908	003	0	1	04	01	H4908_003_0	3	4	00000000000000000110000000000000000000000000000		2				1	250.00	250.00	2	
H4908	003	0	1	04	01	H4908_003_0	3	8	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H4908	003	0	1	04	01	H4908_003_0	3	7	00000000000000001000000000000000000000000000000		2				1	15.00	15.00	2	
H4908	003	0	1	04	01	H4908_003_0	3	3	00001110111110000001000001000000001000000000000		2				1	20.00	20.00	2	
H4908	004	0	1	04	01	H4908_004_0	4	7	00000000000000110000000000000000000000000000000	Diagnostic Tests/Rad Therapy	2				1	15.00	150.00	2	
H4908	004	0	1	04	01	H4908_004_0	4	8	00000000000000001000000000000000000000000000000	X-rays	2				1	15.00	15.00	2	
H4908	004	0	1	04	01	H4908_004_0	4	5	00000001000001000000100110000000000000000100110	DME and Rx	1	20	20	1	2			2	
H4908	004	0	1	04	01	H4908_004_0	4	6	00000000000000000000000000000000110111110000000	Preventive	2				2			2	
H4908	004	0	1	04	01	H4908_004_0	4	4	00000000000000000000010000000000000000000000000	Ambulance and Emergency	2				1	50.00	50.00	2	
H4908	004	0	1	04	01	H4908_004_0	4	3	00000000000000000110000000000000000000000000000	ASC	2				1	250.00	250.00	2	
H4908	004	0	1	04	01	H4908_004_0	4	2	00001110111110000001000001000000001000000000000		2				1	20.00	20.00	2	
H4908	004	0	1	04	01	H4908_004_0	4	1	01000000000000000000000000000000000000000000000	SNF	2				1	1000.00	1000.00	2	
H4908	801	0	1	04	01	H4908_801_0	1	3	00000000000000000000000000110000111111111111111		2				2			2	
H4908	801	0	1	04	01	H4908_801_0	1	2	00011111111111111111111111000000000000000000000		1	24	24	1	2			2	
H4908	801	0	1	04	01	H4908_801_0	1	1	01100000000000000000000000000000000000000000000		1	15	15	1	2			2	
H4908	802	0	1	04	01	H4908_802_0	2	2	00011111111111111111111111000000000000000000000		1	24	24	1	2			2	
H4908	802	0	1	04	01	H4908_802_0	2	1	01100000000000000000000000000000000000000000000		1	15	15	1	2			2	
H4908	802	0	1	04	01	H4908_802_0	2	3	00000000000000000000000000110000111111111111111		2				2			2	
H4909	001	0	1	04	01	H4909_001_0	7	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H4909	001	0	1	04	01	H4909_001_0	7	7	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H4909	001	0	1	04	01	H4909_001_0	7	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	40.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	7	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	25.00	25.00	2	
H4909	001	0	1	04	01	H4909_001_0	7	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
H4909	001	0	1	04	01	H4909_001_0	7	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
H4909	001	0	1	04	01	H4909_001_0	7	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
H4909	001	0	1	04	01	H4909_001_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	7	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	7	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	7	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
H4909	004	0	1	04	01	H4909_004_0	7	6	00110011111011000001000000000000000000000000101	Specialist	2				1	35.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	7	5	00000100000000000000000000000000001000000000000	PCP	2				1	20.00	20.00	2	
H4909	004	0	1	04	01	H4909_004_0	7	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
H4909	004	0	1	04	01	H4909_004_0	7	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H4909	801	0	1	04	01	H4909_801_0	5	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
H4909	801	0	1	04	01	H4909_801_0	5	7	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H4909	801	0	1	04	01	H4909_801_0	5	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	40.00	40.00	2	
H4909	801	0	1	04	01	H4909_801_0	5	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	25.00	25.00	2	
H4909	801	0	1	04	01	H4909_801_0	5	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
H4909	801	0	1	04	01	H4909_801_0	5	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
H4909	801	0	1	04	01	H4909_801_0	5	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H4909	801	0	1	04	01	H4909_801_0	5	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H4909	803	0	1	04	01	H4909_803_0	2	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
H4909	803	0	1	04	01	H4909_803_0	2	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
H4909	803	0	1	04	01	H4909_803_0	2	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	25.00	25.00	2	
H4909	803	0	1	04	01	H4909_803_0	2	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	40.00	40.00	2	
H4909	803	0	1	04	01	H4909_803_0	2	7	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H4909	803	0	1	04	01	H4909_803_0	2	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H4909	803	0	1	04	01	H4909_803_0	2	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
H4909	803	0	1	04	01	H4909_803_0	2	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H4911	002	0	1	04	01	H4911_002_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H4911	002	0	1	04	01	H4911_002_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4911	003	0	1	04	01	H4911_003_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H4911	003	0	1	04	01	H4911_003_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4911	004	0	1	04	01	H4911_004_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H4911	004	0	1	04	01	H4911_004_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4911	801	0	1	04	01	H4911_801_0	3	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H4911	801	0	1	04	01	H4911_801_0	3	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H4911	802	0	1	04	01	H4911_802_0	5	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H4911	802	0	1	04	01	H4911_802_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H5009	002	0	1	04	01	H5009_002_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H5009	002	0	1	04	01	H5009_002_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5009	004	0	1	04	01	H5009_004_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H5009	004	0	1	04	01	H5009_004_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H5010	002	0	1	04	01	H5010_002_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H5010	004	0	1	04	01	H5010_004_0	4	1	01111111111111111111100111110000001111111101101		1	20	20	3	2			2	
H5010	004	0	1	04	01	H5010_004_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5106	013	0	1	04	01	H5106_013_0	6	1	01111111111111111111100111010000011111111101111	OON OVERALL	1	30	30	2	2			2	
H5106	013	0	1	04	01	H5106_013_0	6	2	00000000000000000000000000000000000000000000100	OON PAYS AS INN ROUTINE VISION EXAM	2				1	20.00	20.00	2	
H5106	014	0	1	04	01	H5106_014_0	13	1	01111111111111111111100000010000011111110101111	OON OVERALL	1	30	30	2	2			2	
H5106	014	0	1	04	01	H5106_014_0	13	2	00000000000000000000000111000000000000001000000	OON HIGHER BENEFIT	1	20	20	2	2			2	
H5106	014	0	1	04	01	H5106_014_0	13	3	00000000000000000000000000000000000000000000100	OON PAYS AS INN - ROUTINE VISION EXAM	2				1	15.00	15.00	2	
H5106	015	0	1	04	01	H5106_015_0	6	1	01111111111111111111100111010000011111111101111	OON OVERALL	1	30	30	2	2			2	
H5106	015	0	1	04	01	H5106_015_0	6	2	00000000000000000000000000000000000000000000100	OON PAYS AS INN ROUTINE VISION EXAM	2				1	20.00	20.00	2	
H5106	016	0	1	04	01	H5106_016_0	12	1	01111111111111111111100000010000011111110101111	OON OVERALL	1	30	30	2	2			2	
H5106	016	0	1	04	01	H5106_016_0	12	2	00000000000000000000000111000000000000001000000	OON HIGHER BENEFIT	1	20	20	2	2			2	
H5106	016	0	1	04	01	H5106_016_0	12	3	00000000000000000000000000000000000000000000100	OON PAYS AS INN - ROUTINE VISION EXAMS	2				1	15.00	15.00	2	
H5106	017	0	1	04	01	H5106_017_0	5	1	01111111111111111111100111010000011111111101111	OON OVERALL	1	30	30	2	2			2	
H5106	017	0	1	04	01	H5106_017_0	5	2	00000000000000000000000000000000000000000000100	OON PAYS AS INN ROUTINE VISION EXAM	2				1	20.00	20.00	2	
H5106	018	0	1	04	01	H5106_018_0	5	1	01111111111111111111100111010000011111111101111	OON OVERALL	1	30	30	2	2			2	
H5106	018	0	1	04	01	H5106_018_0	5	2	00000000000000000000000000000000000000000000100	OON PAYS AS INN ROUTINE VISION EXAM	2				1	20.00	20.00	2	
H5106	805	0	1	04	01	H5106_805_0	4	1	01111111111111111111100111010000011111111101111		1	30	30	2	2			2	
H5106	806	0	1	04	01	H5106_806_0	4	1	01111111111111111111100111010000011111111101111		1	30	30	2	2			2	
H5106	807	0	1	04	01	H5106_807_0	5	1	01111111111111111111100111010000011111111101111		1	30	30	2	2			2	
H5106	808	0	1	04	01	H5106_808_0	5	1	01111111111111111111100111010000011111111101111		1	30	30	2	2			2	
H5214	003	0	1	04	01	H5214_003_0	3	7	00000000000000000000000001000000000000000000000		1	20	40	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	3	6	00000000000000000000000110000000000000000000000		1	40	40	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	3	5	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5214	003	0	1	04	01	H5214_003_0	3	1	01111111111011111111100000010000011111111001101		1	25	25	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	3	2	00000000000000000000000000000000000000000100000		1	20	25	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	3	3	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5214	003	0	1	04	01	H5214_003_0	3	4	00000000000000000000000000100000000000000000000		2				1	0.00	75.00	2	
H5214	801	0	1	04	01	H5214_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5214	801	0	1	04	01	H5214_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5214	801	0	1	04	01	H5214_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5214	801	0	1	04	01	H5214_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5214	803	0	1	04	01	H5214_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5214	803	0	1	04	01	H5214_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5214	803	0	1	04	01	H5214_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5214	803	0	1	04	01	H5214_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5214	805	0	1	04	01	H5214_805_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5214	805	0	1	04	01	H5214_805_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5214	805	0	1	04	01	H5214_805_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5214	805	0	1	04	01	H5214_805_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5215	001	0	1	04	01	H5215_001_0	7	3	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	1	01000000000000000000000000000000000000000000000		2				1	50.00	50.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	2	00101011111111000001000001100000000000000000111		2				1	15.00	15.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	9	00000000000000000000000000010000010000000000000		2				1	0.00	0.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	8	00000000000000001000000000000000000000000000000	CAT, PET, MRI, MRI and NUC Services	2				1	10.00	100.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	7	00000000000000010000000000000000000000000000000		1	10	10	1	2			2	
H5215	001	0	1	04	01	H5215_001_0	7	6	00000000000000000110000000000000000000000000000		2				1	75.00	75.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	5	00010100000000000000100000000000001111110001000		2				1	10.00	10.00	2	
H5215	001	0	1	04	01	H5215_001_0	7	4	00000000000000000000000110000000000000000100000		1	20	20	1	2			2	
H5215	002	0	1	04	01	H5215_002_0	9	1	01000000000000000000000000000000000000000000000		2				1	50.00	50.00	2	
H5215	002	0	1	04	01	H5215_002_0	9	2	00101011111111000001000001100000000000000000111		2				1	15.00	15.00	2	
H5215	002	0	1	04	01	H5215_002_0	9	8	00000000000000001000000000000000000000000000000	CAT, PET, MRI, MRI and NUC Services	2				1	10.00	100.00	2	
H5215	002	0	1	04	01	H5215_002_0	9	7	00000000000000010000000000000000000000000000000		1	10	10	1	2			2	
H5215	002	0	1	04	01	H5215_002_0	9	9	00000000000000000000000000010000010000000000000		2				1	0.00	0.00	2	
H5215	002	0	1	04	01	H5215_002_0	9	5	00010100000000000000100000000000001111110001000		2				1	10.00	10.00	2	
H5215	002	0	1	04	01	H5215_002_0	9	4	00000000000000000000000110000000000000000100000		1	20	20	1	2			2	
H5215	002	0	1	04	01	H5215_002_0	9	3	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5215	002	0	1	04	01	H5215_002_0	9	6	00000000000000000110000000000000000000000000000		2				1	75.00	75.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	3	00110011111111010001100000100000001111111000110		2				1	10.00	10.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	4	00000000000000000000000111000000000000000100000		1	10	10	1	2			2	
H5215	005	0	1	04	01	H5215_005_0	10	5	00000000000000000110000000000000000000000000000		2				1	75.00	75.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	6	00000100000000100000000000000000000000000001000		2				1	5.00	5.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	7	00001000000000000000000000000000000000000000000		2				1	15.00	15.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	8	00000000000000000000000000000000110000000000000		2				1	0.00	0.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	1	01000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5215	005	0	1	04	01	H5215_005_0	10	2	00000000000000001000000000000000000000000000000		2				1	10.00	25.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	1	01000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	2	00000000000000001000000000000000000000000000000		2				1	10.00	25.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	3	00110011111111010001100000100000001111111000111		2				1	10.00	10.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	4	00000000000000000000000111000000000000000100000		1	10	10	1	2			2	
H5215	006	0	1	04	01	H5215_006_0	11	5	00000000000000000110000000000000000000000000000		2				1	75.00	75.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	6	00000100000000100000000000000000000000000001000		2				1	5.00	5.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	7	00001000000000000000000000000000000000000000000		2				1	15.00	15.00	2	
H5215	006	0	1	04	01	H5215_006_0	11	8	00000000000000000000000000000000110000000000000		2				1	0.00	0.00	2	
H5215	801	0	1	04	01	H5215_801_0	2	1	01111111101101111110110111110000111111111101111		1	20	20	1	2			2	
H5215	801	0	1	04	01	H5215_801_0	2	2	00000000010010000001000000000000000000000000000		1	50	50	1	2			2	
H5215	804	0	1	04	01	H5215_804_0	2	1	01111111111111111111110111110000111111111101111		1	20	20	1	2			2	
H5215	805	0	1	04	01	H5215_805_0	2	1	01111111101101111110110111110000111111111101111		1	20	20	1	2			2	
H5215	805	0	1	04	01	H5215_805_0	2	2	00000000010010000001000000000000000000000000000		1	50	50	1	2			2	
H5216	001	0	1	04	01	H5216_001_0	6	7	00000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	6	8	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5216	001	0	1	04	01	H5216_001_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
H5216	001	0	1	04	01	H5216_001_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	6	4	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5216	001	0	1	04	01	H5216_001_0	6	3	00000001000001111001000000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
H5216	001	0	1	04	01	H5216_001_0	6	2	00000110111010000000000000000000011110000000101		2				1	35.00	35.00	2	
H5216	001	0	1	04	01	H5216_001_0	6	1	01111000000000000110100110000000000000000000000		1	30	30	6	2			2	
H5216	801	0	1	04	01	H5216_801_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5216	801	0	1	04	01	H5216_801_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5216	801	0	1	04	01	H5216_801_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5216	801	0	1	04	01	H5216_801_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5216	803	0	1	04	01	H5216_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5216	803	0	1	04	01	H5216_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5216	803	0	1	04	01	H5216_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5216	803	0	1	04	01	H5216_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5216	804	0	1	04	01	H5216_804_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5216	804	0	1	04	01	H5216_804_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5216	804	0	1	04	01	H5216_804_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5216	804	0	1	04	01	H5216_804_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5301	002	0	1	38	05	H5301_002_0	4	1	00000000000000000000000000100000000000000000000	Non-contracted OON Renal Care Cost Share	1	35	35	6	2			2	
H5301	003	0	1	38	05	H5301_003_0	3	1	00000000100000000000000000100000000000000000000	Non-contracted OON Renal Care Cost Share	1	35	35	6	2			2	
H5415	039	0	1	04	01	H5415_039_0	4	1	01111000000000000110000111000000000000000100000		1	20	20	6	2			2	
H5415	039	0	1	04	01	H5415_039_0	4	5	00000000000000000000100000000000000000000000000		1	10	10	6	2			2	
H5415	039	0	1	04	01	H5415_039_0	4	2	00000110111010000000000000000000011110000000101		2				1	35.00	35.00	2	
H5415	039	0	1	04	01	H5415_039_0	4	3	00000001000001111001000000010000000001111000000		1	20	20	6	1	35.00	35.00	2	
H5415	039	0	1	04	01	H5415_039_0	4	4	00000000000000000000000000100000000000000000000		1	10	10	6	1	0.00	0.00	2	
H5415	039	0	1	04	01	H5415_039_0	4	8	00000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5415	039	0	1	04	01	H5415_039_0	4	7	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5415	039	0	1	04	01	H5415_039_0	4	6	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
H5415	801	0	1	04	01	H5415_801_0	2	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5415	801	0	1	04	01	H5415_801_0	2	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5415	801	0	1	04	01	H5415_801_0	2	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5415	801	0	1	04	01	H5415_801_0	2	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5415	803	0	1	04	01	H5415_803_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5415	803	0	1	04	01	H5415_803_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5415	803	0	1	04	01	H5415_803_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5415	803	0	1	04	01	H5415_803_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	2	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	2	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	2	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	2	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5415	805	0	1	04	01	H5415_805_0	1	1	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5415	805	0	1	04	01	H5415_805_0	1	2	01001000100000000100000000000000000000000000000		1	40	40	6	2			2	
H5415	805	0	1	04	01	H5415_805_0	1	3	00000100000000000000000000000000000000000000000		1	20	20	6	2			2	
H5415	805	0	1	04	01	H5415_805_0	1	4	00000000000000000000000100000000000000000000000		1	50	50	6	2			2	
H5417	001	0	1	04	01	H5417_001_0	6	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H5417	001	0	1	04	01	H5417_001_0	6	2	00000000000000000000000000000000000000000000010	Group 2	2				2			2	
H5417	005	0	1	04	01	H5417_005_0	5	1	01111111111111111111111111110000011111111101101	Group 1	1	30	30	6	2			2	
H5417	005	0	1	04	01	H5417_005_0	5	2	10000000000000000000000000000000000000000011010	Group 2	2				2			2	
H5417	006	0	1	04	01	H5417_006_0	9	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
H5417	006	0	1	04	01	H5417_006_0	9	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5417	006	0	1	04	01	H5417_006_0	9	3	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5417	006	0	1	04	01	H5417_006_0	9	2	00101001000001000110100111100000010111111110010		1	30	30	6	2			2	
H5417	006	0	1	04	01	H5417_006_0	9	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5417	006	0	1	04	01	H5417_006_0	9	8	01000000000000000000000000000000000000000000000		2				1	150.00	150.00	2	
H5417	006	0	1	04	01	H5417_006_0	9	7	00000000000000000000000000010000100000000000000		2				2			2	
H5417	006	0	1	04	01	H5417_006_0	9	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5418	001	0	1	04	01	H5418_001_0	9	1	01000000000000000000000000000000000000000000000	SNF	2				1	0.00	125.00	2	
H5418	001	0	1	04	01	H5418_001_0	9	2	00111111111111111111110111110000011111111101011	Outpatient Services	1	20	20	2	2			1	110.00
H5424	001	0	1	04	01	H5424_001_0	7	2	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H5424	001	0	1	04	01	H5424_001_0	7	10	00000000000000000000000000010000100000000000000		2				2			2	
H5424	001	0	1	04	01	H5424_001_0	7	1	01000000000000000000000000000000000000000000000		2				1	125.00	125.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	3	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	9	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	8	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	6	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	5	00000000000000101000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H5424	001	0	1	04	01	H5424_001_0	7	4	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	1	00101001000001010110100111100000010111111100010		1	30	30	6	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	2	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	3	01010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	7	00000000000000000000000000010000100000000000000		2				2			2	
H5424	003	0	1	04	01	H5424_003_0	4	6	00000010101100000000000000000000000000000001101		2				1	25.00	25.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	5	00000100000000000000000000000000001000000000000		2				1	15.00	15.00	2	
H5424	005	0	1	04	01	H5424_005_0	4	2	10000000000000000000000000000000000000000000010		2				2			2	
H5424	005	0	1	04	01	H5424_005_0	4	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
H5424	801	0	1	04	01	H5424_801_0	3	6	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5424	801	0	1	04	01	H5424_801_0	3	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5424	801	0	1	04	01	H5424_801_0	3	8	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H5424	801	0	1	04	01	H5424_801_0	3	9	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H5424	801	0	1	04	01	H5424_801_0	3	1	01000000000000000000000000000000000000000000000		2				1	130.00	130.00	2	
H5424	801	0	1	04	01	H5424_801_0	3	10	00000000000000000000000000010000100000000000000		2				2			2	
H5424	801	0	1	04	01	H5424_801_0	3	2	00101001000001000110100000000000010111111000010		1	40	40	6	2			2	
H5424	801	0	1	04	01	H5424_801_0	3	3	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5424	801	0	1	04	01	H5424_801_0	3	4	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
H5424	801	0	1	04	01	H5424_801_0	3	5	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
H5429	001	0	1	04	01	H5429_001_0	6	2	00000000000000000100000000000000000000000000000	Out of Network Service 02	1	25	25	3	2			2	
H5429	001	0	1	04	01	H5429_001_0	6	1	01111111111111111011110111010000111111111100110	Out of Network Service	1	20	20	2	2			2	
H5429	005	0	1	04	01	H5429_005_0	6	1	01111111111111111011110111010000111111111100110	Out of Network Service	1	20	20	2	2			2	
H5429	005	0	1	04	01	H5429_005_0	6	2	00000000000000000100000000000000000000000000000	Out of Network Service 02	1	25	25	3	2			2	
H5429	007	0	1	04	01	H5429_007_0	6	1	01111111111111111011110111010000111111111100110	Out of Network Service	1	20	20	2	2			2	
H5429	007	0	1	04	01	H5429_007_0	6	2	00000000000000000100000000000000000000000000000	Out of Network Service 02	1	25	25	3	2			2	
H5429	011	0	1	04	01	H5429_011_0	6	2	00000000000000000100000000000000000000000000000	Out of Network Service 02	1	25	25	3	2			2	
H5429	011	0	1	04	01	H5429_011_0	6	1	01111111111111111011110111010000111111111100110	Out of Network Service	1	20	20	2	2			2	
H5429	015	0	1	04	01	H5429_015_0	6	1	01111111111111111011110111010000111111111100110	Out of Network Service	1	20	20	2	2			2	
H5429	015	0	1	04	01	H5429_015_0	6	2	00000000000000000100000000000000000000000000000	Out of Network Service 02	1	25	25	3	2			2	
H5429	020	0	1	04	01	H5429_020_0	6	2	00000000000000000100000000000000000000000000000	Out of Network Service 02	1	25	25	3	2			2	
H5429	020	0	1	04	01	H5429_020_0	6	1	01111111111111111011110111010000111111111100110	Out of Network Service	1	20	20	2	2			2	
H5434	001	0	1	04	01	H5434_001_0	3	4	00000000000000000000010000000000000000000000000	$100 copayment	2				1	100.00	100.00	2	
H5434	001	0	1	04	01	H5434_001_0	3	1	01101111101101111110100111010111011111111001111	30%	1	30	30	2	2			2	
H5434	001	0	1	04	01	H5434_001_0	3	3	00000000000000000000000000100000000000000000000	0 copayment	2				2			2	
H5434	001	0	1	04	01	H5434_001_0	3	2	00000000010010000001000000000000000000000000000	50%	1	50	50	2	2			2	
H5434	002	0	1	04	01	H5434_002_0	3	4	00000000000000000000010000000000000000000000000	$100 copayment	2				1	100.00	100.00	2	
H5434	002	0	1	04	01	H5434_002_0	3	2	00000000010010000001000000000000000000000000000	50%	1	50	50	2	2			2	
H5434	002	0	1	04	01	H5434_002_0	3	1	01101111101101111110100111010111011111111001111	30%	1	30	30	2	2			2	
H5434	002	0	1	04	01	H5434_002_0	3	3	00000000000000000000000000100000000000000000000	0 copayment	2				2			2	
H5434	801	0	1	04	01	H5434_801_0	5	2	01000000000000000000000000000000000000000000000	18	1	18	18	3	2			2	
H5434	801	0	1	04	01	H5434_801_0	5	3	00001000000000000000000000000000000000000000000	0 coinsurance	2				2			2	
H5434	801	0	1	04	01	H5434_801_0	5	1	10110111111111111111111111111111111111111111111	24%	1	24	24	3	2			2	
H5434	802	0	1	04	01	H5434_802_0	5	2	01000000000000000000000000000000000000000000000	18	1	18	18	3	2			2	
H5434	802	0	1	04	01	H5434_802_0	5	3	00001000000000000000000000000000000000000000000	0 coinsurance	2				2			2	
H5434	802	0	1	04	01	H5434_802_0	5	1	10110111111111111111111111111111111111111111111	24%	1	24	24	3	2			2	
H5436	001	0	1	04	01	H5436_001_0	9	1	01011111101101111110100110110000111111111001111	Group 1	1	20	20	3	2			2	
H5436	001	0	1	04	01	H5436_001_0	9	2	00000000010010000001000000000000000000000000000	Group 2	1	10	10	3	2			2	
H5436	001	0	1	04	01	H5436_001_0	9	5	00100000000000000000000000000000000000000000000	Group 5	2				1	25.00	25.00	2	
H5436	001	0	1	04	01	H5436_001_0	9	4	00000000000000000000000001000000000000000100000	Group 4	2				1	20.00	50.00	2	
H5436	001	0	1	04	01	H5436_001_0	9	3	00000000000000000000010000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H5436	002	0	1	04	01	H5436_002_0	9	5	00100000000000000000000000000000000000000000000	Group 5	2				1	25.00	25.00	2	
H5436	002	0	1	04	01	H5436_002_0	9	2	00000000010010000001000000000000000000000000000	Group 2	1	10	10	3	2			2	
H5436	002	0	1	04	01	H5436_002_0	9	1	01011111101101111110100110110000111111111001111	Group 1	1	20	20	3	2			2	
H5436	002	0	1	04	01	H5436_002_0	9	4	00000000000000000000000001000000000000000100000	Group 4	2				1	20.00	50.00	2	
H5436	002	0	1	04	01	H5436_002_0	9	3	00000000000000000000010000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H5437	001	0	1	04	01	H5437_001_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5437	001	0	1	04	01	H5437_001_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	801	0	1	04	01	H5437_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5437	801	0	1	04	01	H5437_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5437	802	0	1	04	01	H5437_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5437	802	0	1	04	01	H5437_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	1	01000100100100111110000111100000001111111101101		1	10	10	6	2			2	
H5439	001	0	1	04	01	H5439_001_0	6	2	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	4	00000010010010000001000000000000000000000000000		2				1	50.00	50.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	5	00011000000000000000000000010000110000000000010		2				2			2	
H5439	001	0	1	04	01	H5439_001_0	6	3	00100001001001000000100000000000000000000000000		2				1	35.00	35.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	7	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	9	00000000000000000000000000010000100000000000000		2				2			2	
H5500	001	0	1	04	01	H5500_001_0	5	1	01000000000000000000000000000000000000000000000		2				1	185.00	185.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	2	00101001000001000110100111100000010111111100010		1	30	30	6	2			2	
H5500	001	0	1	04	01	H5500_001_0	5	3	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5500	001	0	1	04	01	H5500_001_0	5	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5501	001	0	1	04	01	H5501_001_0	7	1	01111111111111111111110111110100011111111100000	Non-Participating Providers medical	1	20	20	1	2			2	
H5501	001	0	1	04	01	H5501_001_0	7	2	00000000000000000000000000000000000000000011000	Non-Participating Providers dental	2				1	0.00	1000.00	2	
H5507	001	0	1	04	01	H5507_001_0	5	6	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5507	001	0	1	04	01	H5507_001_0	5	4	00000000000000000000000000010000000000000000000		2				2			2	
H5507	001	0	1	04	01	H5507_001_0	5	1	01101111101101000110100111100000011111111101111		1	30	30	2	2			2	
H5507	001	0	1	04	01	H5507_001_0	5	3	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5507	001	0	1	04	01	H5507_001_0	5	5	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5507	001	0	1	04	01	H5507_001_0	5	2	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5508	001	0	1	04	01	H5508_001_0	5	3	00000000010000000000000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5508	001	0	1	04	01	H5508_001_0	5	2	00000000000000000000000000000000011111110100000	Group 2	2				2			2	
H5508	001	0	1	04	01	H5508_001_0	5	1	01111111101111111111110111110000000000001011111	Group 1	1	20	20	1	2			2	
H5508	002	0	1	04	01	H5508_002_0	2	3	00000000010000000000000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5508	002	0	1	04	01	H5508_002_0	2	1	01111111101111111111110111110000000000001011111	Group 1	1	20	20	1	2			2	
H5508	002	0	1	04	01	H5508_002_0	2	2	00000000000000000000000000000000011111110100000	Group 2	2				2			2	
H5509	001	0	1	04	01	H5509_001_0	5	1	11111111111111111111100111110000111111111111111		1	20	20	2	2			2	
H5509	001	0	1	04	01	H5509_001_0	5	2	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
H5509	003	0	1	04	01	H5509_003_0	6	1	11111111111111111111100111110000111111111111111		1	20	20	2	2			2	
H5509	003	0	1	04	01	H5509_003_0	6	2	00000000000000000000010000000000000000000000000		2				1	150.00	150.00	2	
H5509	801	0	1	04	01	H5509_801_0	3	1	01000000000000000000000000000000000000000000000		1	18	18	2	2			2	
H5509	801	0	1	04	01	H5509_801_0	3	2	00111111111111111111110111110000111111111101000		1	24	24	2	2			2	
H5509	802	0	1	04	01	H5509_802_0	2	1	01000000000000000000000000000000000000000000000		1	18	18	2	2			2	
H5509	802	0	1	04	01	H5509_802_0	2	2	00111111111111111111110111110000111111111101000		1	24	24	2	2			2	
H5509	803	0	1	04	01	H5509_803_0	3	1	01000000000000000000000000000000000000000000000		1	18	18	2	2			2	
H5509	803	0	1	04	01	H5509_803_0	3	2	00111111111111111111110111110000111111111101000		1	24	24	2	2			2	
H5509	804	0	1	04	01	H5509_804_0	2	1	01000000000000000000000000000000000000000000000		1	18	18	2	2			2	
H5509	804	0	1	04	01	H5509_804_0	2	2	00111111111111111111110111110000111111111101000		1	24	24	2	2			2	
H5509	805	0	1	04	01	H5509_805_0	3	1	01000000000000000000000000000000000000000000000		1	18	18	2	2			2	
H5509	805	0	1	04	01	H5509_805_0	3	2	00111111111111111111110111110000111111111101000		1	24	24	2	2			2	
H5509	806	0	1	04	01	H5509_806_0	3	1	01000000000000000000000000000000000000000000000		1	18	18	2	2			2	
H5509	806	0	1	04	01	H5509_806_0	3	2	00111111111111111111110111110000111111111101000		1	24	24	2	2			2	
H5510	002	0	1	04	01	H5510_002_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H5510	002	0	1	04	01	H5510_002_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	003	0	1	04	01	H5510_003_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5510	003	0	1	04	01	H5510_003_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	005	0	1	04	01	H5510_005_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5510	005	0	1	04	01	H5510_005_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	006	0	1	04	01	H5510_006_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H5510	006	0	1	04	01	H5510_006_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	801	0	1	04	01	H5510_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5510	801	0	1	04	01	H5510_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5510	802	0	1	04	01	H5510_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5510	802	0	1	04	01	H5510_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5512	001	0	1	04	01	H5512_001_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	001	0	1	04	01	H5512_001_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5512	002	0	1	04	01	H5512_002_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5512	002	0	1	04	01	H5512_002_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	005	0	1	04	01	H5512_005_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5512	005	0	1	04	01	H5512_005_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	006	0	1	04	01	H5512_006_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	006	0	1	04	01	H5512_006_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5512	008	0	1	04	01	H5512_008_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5512	008	0	1	04	01	H5512_008_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	009	0	1	04	01	H5512_009_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H5512	009	0	1	04	01	H5512_009_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	801	0	1	04	01	H5512_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5512	801	0	1	04	01	H5512_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5512	802	0	1	04	01	H5512_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5512	802	0	1	04	01	H5512_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	7	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	9	00000000000000000000000000010000100000000000000		2				2			2	
H5516	001	0	1	04	01	H5516_001_0	6	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	3	00000000000000101000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	2	00101001000001000110100111100000010111111100010		1	30	30	6	2			2	
H5516	001	0	1	04	01	H5516_001_0	6	1	01000000000000000000000000000000000000000000000		2				1	185.00	185.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
H5516	001	0	1	04	01	H5516_001_0	6	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5517	001	0	1	04	01	H5517_001_0	3	2	00010000010010000001000000000000100000000000000	Health Wellness Programs	1	50	50	1	2			2	
H5517	001	0	1	04	01	H5517_001_0	3	1	01101111101101111110110111110000011111111101101	OON Services	1	20	20	1	2			2	
H5517	802	0	1	04	01	H5517_802_0	4	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5517	802	0	1	04	01	H5517_802_0	4	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	21	21	1	2			2	
H5517	804	0	1	04	01	H5517_804_0	3	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	21	21	1	2			2	
H5517	804	0	1	04	01	H5517_804_0	3	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5517	805	0	1	04	01	H5517_805_0	3	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	21	21	1	2			2	
H5517	805	0	1	04	01	H5517_805_0	3	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5517	806	0	1	04	01	H5517_806_0	4	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5517	806	0	1	04	01	H5517_806_0	4	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	21	21	1	2			2	
H5520	001	0	1	04	01	H5520_001_0	8	2	00000100100000101000000000000000000000000000101		2				1	20.00	20.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	10	00000010000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	9	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	8	00000000000000000000000001000000000000000000000		2				1	30.00	30.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	7	00000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	001	0	1	04	01	H5520_001_0	8	6	00001000000000000000000000000000100000000000000		2				2			2	
H5520	001	0	1	04	01	H5520_001_0	8	5	00000000000000011000000110100000000000000000000		2				1	30.00	900.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	4	00000000010010000001000000000000000000000000000		2				1	50.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	3	00100001001001000000100000000000000000000000000		2				1	35.00	35.00	2	
H5520	001	0	1	04	01	H5520_001_0	8	1	00000000000000000110000000000000000000000000000	Group 1	2				1	400.00	400.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	1	00000000000000000110000000000000000000000000000		2				1	400.00	400.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	8	00000000000000000000000001000000000000000000000		2				1	30.00	30.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	7	00000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	002	0	1	04	01	H5520_002_0	10	6	00001000000000000000000000000000100000000000000		2				2			2	
H5520	002	0	1	04	01	H5520_002_0	10	9	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	4	00000000010010000001000000000000000000000000000		2				1	50.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	3	00100001001001000000100000000000000000000000000		2				1	35.00	35.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	2	00000100100000101000000000000000000000000000101		2				1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	10	00000010000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	10	5	00000000000000011000000110000000000000000100000		2				1	30.00	900.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	2	00000010000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	10	00000000000000000000000000000100000000000000000	Urgent Care	2				1	25.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	1	00000000000000000110000000000000000000000000000		2				1	400.00	400.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	3	00100101101001000000100000000000000000000000101		2				1	35.00	35.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	9	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	8	00000000000000100000000001000000000000000000000		2				1	30.00	30.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	7	00000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	003	0	1	04	01	H5520_003_0	9	6	00001000000000000000000000000000100000000000000		2				2			2	
H5520	003	0	1	04	01	H5520_003_0	9	5	00000000000000011000000110100000000000000000000		2				1	30.00	900.00	2	
H5520	003	0	1	04	01	H5520_003_0	9	4	00000000010010000001000000000000000000000000000		2				1	50.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	1	00000000000000000110000000000000000000000000000		2				1	400.00	400.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	2	00000000000000000000010000000000000000000000000		2				1	25.00	25.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	9	00000010000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	8	00000000000000101000000001000000000000000000000		2				1	30.00	30.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	7	00000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	004	0	1	04	01	H5520_004_0	11	6	00001000000000000000000000000000100000000000000		2				2			2	
H5520	004	0	1	04	01	H5520_004_0	11	5	00000000000000011000000110000000000000000100000		2				1	30.00	900.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	4	00000000010010000001000000000000000000000000000		2				1	50.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	11	3	00100101101001000000100000000000000000000000101		2				1	35.00	35.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	1	00000000000000000000000111000000000000000000000		1	30	30	2	2			2	
H5520	005	0	1	04	01	H5520_005_0	10	3	00100000001000000000100000000000000000000000000		2				1	35.00	35.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	4	00000000010010000001000000000000000000000000000		2				1	40.00	40.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	5	00000000000000011000000000100000000000000100000		2				1	30.00	900.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	9	00000000000000000000010000000000000000000000000		2				1	150.00	150.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	7	00000000000000000000000000000000100000000000000		2				2			2	
H5520	005	0	1	04	01	H5520_005_0	10	8	00000100100000101000000000000000000000000000101		2				1	30.00	30.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	2	00000010000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	10	6	00001001000001000110000000000000000000000000010		1	40	40	2	2			2	
H5520	006	0	1	04	01	H5520_006_0	9	4	00000000010010000001000000000000000000000000000		2				1	40.00	40.00	2	
H5520	006	0	1	04	01	H5520_006_0	9	5	00000000000000011000000000100000000000000100000		2				1	30.00	900.00	2	
H5520	006	0	1	04	01	H5520_006_0	9	6	00001001000001000110000000000000000000000000010		1	40	40	2	2			2	
H5520	006	0	1	04	01	H5520_006_0	9	7	00000000000000000000000000000000100000000000000		2				2			2	
H5520	006	0	1	04	01	H5520_006_0	9	8	00000100100000101000000000000000000000000000101		2				1	30.00	30.00	2	
H5520	006	0	1	04	01	H5520_006_0	9	9	00000000000000000000010000000000000000000000000		2				1	150.00	150.00	2	
H5520	006	0	1	04	01	H5520_006_0	9	1	00000000000000000000000111000000000000000000000		1	30	30	2	2			2	
H5520	006	0	1	04	01	H5520_006_0	9	2	00000010000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	9	3	00100000001000000000100000000000000000000000000		2				1	35.00	35.00	2	
H5520	801	0	1	04	01	H5520_801_0	1	2	00110111101101011111110111110000011111111101111		1	20	20	2	2			2	
H5520	801	0	1	04	01	H5520_801_0	1	1	00001000000000100000000000000000000000000000000		2				2			2	
H5520	801	0	1	04	01	H5520_801_0	1	3	00000000010010000000000000000000000000000000000		1	50	50	2	2			2	
H5520	803	0	1	04	01	H5520_803_0	2	2	00110111101101011111110111110000011111111101111		1	20	20	2	2			2	
H5520	803	0	1	04	01	H5520_803_0	2	1	00001000000000100000000000000000000000000000000		2				2			2	
H5520	803	0	1	04	01	H5520_803_0	2	3	00000000010010000000000000000000000000000000000		1	50	50	2	2			2	
H5520	804	0	1	04	01	H5520_804_0	1	1	00001000000000100000000000000000000000000000000		2				2			2	
H5520	804	0	1	04	01	H5520_804_0	1	2	00110111101101011111110111110000011111111101111		1	20	20	2	2			2	
H5520	804	0	1	04	01	H5520_804_0	1	3	00000000010010000000000000000000000000000000000		1	50	50	2	2			2	
H5520	806	0	1	04	01	H5520_806_0	2	1	00001000000000100000000000000000000000000000000		2				2			2	
H5520	806	0	1	04	01	H5520_806_0	2	2	00110111101101011111110111110000011111111101111		1	20	20	2	2			2	
H5520	806	0	1	04	01	H5520_806_0	2	3	00000000010010000000000000000000000000000000000		1	50	50	2	2			2	
H5521	002	0	1	04	01	H5521_002_0	7	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5521	002	0	1	04	01	H5521_002_0	7	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	003	0	1	04	01	H5521_003_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H5521	003	0	1	04	01	H5521_003_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	005	0	1	04	01	H5521_005_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5521	005	0	1	04	01	H5521_005_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	006	0	1	04	01	H5521_006_0	6	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H5521	006	0	1	04	01	H5521_006_0	6	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	008	0	1	04	01	H5521_008_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5521	008	0	1	04	01	H5521_008_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	009	0	1	04	01	H5521_009_0	8	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
H5521	009	0	1	04	01	H5521_009_0	8	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	801	0	1	04	01	H5521_801_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5521	801	0	1	04	01	H5521_801_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5521	802	0	1	04	01	H5521_802_0	1	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5521	802	0	1	04	01	H5521_802_0	1	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5522	001	0	1	04	01	H5522_001_0	6	1	01101111101101111110111111110000011111111101101	OON Services	1	20	20	1	2			2	
H5522	001	0	1	04	01	H5522_001_0	6	2	00010000010010000001000000000000100000000000000	O/P MH and Health & Wellness	1	50	50	3	2			2	
H5522	002	0	1	04	01	H5522_002_0	6	1	01101111101101111110111111110000011111111101101	OON Services	1	20	20	1	2			2	
H5522	002	0	1	04	01	H5522_002_0	6	2	00010000010010000001000000000000100000000000000	O/P MH and Health & Wellness	1	50	50	3	2			2	
H5522	003	0	1	04	01	H5522_003_0	6	1	01101111101101111110111111110000011111111101101	OON Services	1	20	20	1	2			2	
H5522	003	0	1	04	01	H5522_003_0	6	2	00010000010010000001000000000000100000000000000	O/P MH and Health & Wellness	1	50	50	3	2			2	
H5522	802	0	1	04	01	H5522_802_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	19	19	1	2			2	
H5522	802	0	1	04	01	H5522_802_0	2	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5522	803	0	1	04	01	H5522_803_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	19	19	1	2			2	
H5522	803	0	1	04	01	H5522_803_0	2	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5522	805	0	1	04	01	H5522_805_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	19	19	1	2			2	
H5522	805	0	1	04	01	H5522_805_0	2	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5522	806	0	1	04	01	H5522_806_0	2	1	01000000000000000000000000000000000000000000000	Skilled Nursing Facility (SNF)	1	19	19	1	2			2	
H5522	806	0	1	04	01	H5522_806_0	2	2	10111111111111111111110111110000011111111101111	OON Services	1	24	24	1	2			2	
H5523	001	0	1	04	01	H5523_001_0	10	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5523	001	0	1	04	01	H5523_001_0	10	2	01101001000001000110000000000000000000000000000	Group 2	1	30	30	1	2			2	
H5523	001	0	1	04	01	H5523_001_0	10	1	00000110101100111000101111110000011111111100101	Group 1	1	30	30	1	2			2	
H5525	001	0	1	04	01	H5525_001_0	3	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	001	0	1	04	01	H5525_001_0	3	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	001	0	1	04	01	H5525_001_0	3	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	001	0	1	04	01	H5525_001_0	3	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	001	0	1	04	01	H5525_001_0	3	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	002	0	1	04	01	H5525_002_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	002	0	1	04	01	H5525_002_0	4	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	002	0	1	04	01	H5525_002_0	4	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	002	0	1	04	01	H5525_002_0	4	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	002	0	1	04	01	H5525_002_0	4	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	003	0	1	04	01	H5525_003_0	5	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	003	0	1	04	01	H5525_003_0	5	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	003	0	1	04	01	H5525_003_0	5	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	003	0	1	04	01	H5525_003_0	5	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	003	0	1	04	01	H5525_003_0	5	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	004	0	1	04	01	H5525_004_0	5	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	004	0	1	04	01	H5525_004_0	5	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	004	0	1	04	01	H5525_004_0	5	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	801	0	1	04	01	H5525_801_0	4	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	801	0	1	04	01	H5525_801_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	801	0	1	04	01	H5525_801_0	4	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	801	0	1	04	01	H5525_801_0	4	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	801	0	1	04	01	H5525_801_0	4	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	802	0	1	04	01	H5525_802_0	4	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	802	0	1	04	01	H5525_802_0	4	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	802	0	1	04	01	H5525_802_0	4	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	802	0	1	04	01	H5525_802_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	802	0	1	04	01	H5525_802_0	4	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	805	0	1	04	01	H5525_805_0	4	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	805	0	1	04	01	H5525_805_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	805	0	1	04	01	H5525_805_0	4	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	805	0	1	04	01	H5525_805_0	4	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	805	0	1	04	01	H5525_805_0	4	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5525	806	0	1	04	01	H5525_806_0	4	1	01100000000000000000000000000000000000000000000		2				1	0.00	120.00	2	
H5525	806	0	1	04	01	H5525_806_0	4	2	00000000000000000000010000000000000000000000000		2				1	50.00	50.00	2	
H5525	806	0	1	04	01	H5525_806_0	4	3	10011111111111111111100111110000010111111101111		1	20	20	1	2			2	
H5525	806	0	1	04	01	H5525_806_0	4	4	00000000000000000000000000000000100000000000000		1	50	50	2	2			2	
H5525	806	0	1	04	01	H5525_806_0	4	5	00000000000000000110000000000000000000000000000		1	20	30	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	6	1	01000000000000000110000000000000000000000100000	SNF/Ambulatory Surgery	1	20	20	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	6	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	001	0	1	04	01	H5526_001_0	6	3	00010000010010000001000000000000000000000000000	Psych	1	55	55	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	6	4	00101011101101111000101000100000010111111000111	Specialist Services	2				1	20.00	20.00	2	
H5526	001	0	1	04	01	H5526_001_0	6	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	001	0	1	04	01	H5526_001_0	6	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	30	30	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	6	7	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	20.00	20.00	2	
H5526	002	0	1	04	01	H5526_002_0	4	1	01000000000000000000000000000000000000000100000	SNF	1	20	20	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	4	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	002	0	1	04	01	H5526_002_0	4	3	00010000010010000001000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	4	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	25.00	25.00	2	
H5526	002	0	1	04	01	H5526_002_0	4	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	002	0	1	04	01	H5526_002_0	4	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	4	7	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	002	0	1	04	01	H5526_002_0	4	8	00000000000000000110000000000000000000000000000	Outpatient Surgery	2				1	75.00	75.00	2	
H5526	003	0	1	04	01	H5526_003_0	7	1	01000000000000000110000000000000000000000100000	SNF/Ambulatory Surgery	1	20	20	1	2			2	
H5526	003	0	1	04	01	H5526_003_0	7	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	003	0	1	04	01	H5526_003_0	7	3	00010000010010000001000000000000000000000000000	Psych	1	55	55	1	2			2	
H5526	003	0	1	04	01	H5526_003_0	7	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	20.00	20.00	2	
H5526	003	0	1	04	01	H5526_003_0	7	8	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	20.00	20.00	2	
H5526	003	0	1	04	01	H5526_003_0	7	7	00000000000000000000000000000000000000000011010	Dental/Eye Wear	2				2			2	
H5526	003	0	1	04	01	H5526_003_0	7	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	30	30	1	2			2	
H5526	003	0	1	04	01	H5526_003_0	7	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	004	0	1	04	01	H5526_004_0	6	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	20.00	20.00	2	
H5526	004	0	1	04	01	H5526_004_0	6	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	6	7	00000000000000000000000000000000000000000011010	Dental/Eye Wear	2				2			2	
H5526	004	0	1	04	01	H5526_004_0	6	8	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	004	0	1	04	01	H5526_004_0	6	9	00000000000000000110000000000000000000000000000	Outpatient Surgery	2				1	75.00	75.00	2	
H5526	004	0	1	04	01	H5526_004_0	6	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	004	0	1	04	01	H5526_004_0	6	3	00010000010010000001000000000000000000000000000	Psych	1	55	55	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	6	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	004	0	1	04	01	H5526_004_0	6	1	01000000000000000000000000000000000000000100000	SNF	1	20	20	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	6	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	007	0	1	04	01	H5526_007_0	6	3	00010000010010000001000000000000000000000000000	Psych	1	55	55	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	6	1	01000000000000000110000000000000000000000100000	SNF/Ambulatory Surgery	1	20	20	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	6	8	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	10.00	10.00	2	
H5526	007	0	1	04	01	H5526_007_0	6	7	00000000000000000000000000000000000000000011010	Dental/Eye Wear	2				2			2	
H5526	007	0	1	04	01	H5526_007_0	6	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	30	30	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	6	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	007	0	1	04	01	H5526_007_0	6	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	20.00	20.00	2	
H5526	008	0	1	04	01	H5526_008_0	6	7	00000000000000000000000000000000000000000011010	Dental/Eye Wear	2				2			2	
H5526	008	0	1	04	01	H5526_008_0	6	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	008	0	1	04	01	H5526_008_0	6	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	008	0	1	04	01	H5526_008_0	6	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	10.00	10.00	2	
H5526	008	0	1	04	01	H5526_008_0	6	3	00010000010010000001000000000000000000000000000	Psych	1	55	55	1	2			2	
H5526	008	0	1	04	01	H5526_008_0	6	2	00000000000000000110010000000000000000000000000	Ambulance/Outpatient Surgery	2				1	50.00	50.00	2	
H5526	008	0	1	04	01	H5526_008_0	6	1	01000000000000000000000000000000000000000100000	SNF/Part B Drugs	1	20	20	1	2			2	
H5526	008	0	1	04	01	H5526_008_0	6	8	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	10.00	10.00	2	
H5526	801	0	1	04	01	H5526_801_0	4	3	00010000010010000001000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	4	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	25.00	25.00	2	
H5526	801	0	1	04	01	H5526_801_0	4	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	801	0	1	04	01	H5526_801_0	4	8	00000000000000000110000000000000000000000000000	Outpatient Surgery	2				1	75.00	75.00	2	
H5526	801	0	1	04	01	H5526_801_0	4	7	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	801	0	1	04	01	H5526_801_0	4	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	4	1	01000000000000000000000000000000000000000100000	SNF	1	20	20	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	4	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	802	0	1	04	01	H5526_802_0	4	3	00010000010010000001000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	802	0	1	04	01	H5526_802_0	4	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	802	0	1	04	01	H5526_802_0	4	1	01000000000000000000000000000000000000000100000	SNF	1	20	20	1	2			2	
H5526	802	0	1	04	01	H5526_802_0	4	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	25.00	25.00	2	
H5526	802	0	1	04	01	H5526_802_0	4	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	802	0	1	04	01	H5526_802_0	4	8	00000000000000000110000000000000000000000000000	Outpatient Surgery	2				1	75.00	75.00	2	
H5526	802	0	1	04	01	H5526_802_0	4	7	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	802	0	1	04	01	H5526_802_0	4	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	5	1	01000000000000000000000000000000000000000100000	SNF	1	20	20	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	5	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	803	0	1	04	01	H5526_803_0	5	3	00010000010010000001000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	5	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	25.00	25.00	2	
H5526	803	0	1	04	01	H5526_803_0	5	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	803	0	1	04	01	H5526_803_0	5	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	5	7	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	803	0	1	04	01	H5526_803_0	5	8	00000000000000000110000000000000000000000000000	Outpatient Surgery	2				1	75.00	75.00	2	
H5526	804	0	1	04	01	H5526_804_0	5	1	01000000000000000000000000000000000000000100000	SNF	1	20	20	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	5	2	00000000000000000000010000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	804	0	1	04	01	H5526_804_0	5	3	00010000010010000001000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	5	8	00000000000000000110000000000000000000000000000	Outpatient Surgery	2				1	75.00	75.00	2	
H5526	804	0	1	04	01	H5526_804_0	5	5	00000000000000000000000000010000000000000000000	Outpatient Blood	2				2			2	
H5526	804	0	1	04	01	H5526_804_0	5	6	00000000000000000000000111000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	5	7	00000100000000000000000000000000001000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	804	0	1	04	01	H5526_804_0	5	4	00101011101101111000101000100000010111111000101	Specialist Services	2				1	25.00	25.00	2	
H5527	001	0	1	04	01	H5527_001_0	8	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5527	001	0	1	04	01	H5527_001_0	8	6	00000000000000000000000000010000100000000000000		2				2			2	
H5527	001	0	1	04	01	H5527_001_0	8	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5527	001	0	1	04	01	H5527_001_0	8	2	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5527	001	0	1	04	01	H5527_001_0	8	3	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5527	001	0	1	04	01	H5527_001_0	8	1	01101111101101000110100111100000011111111101111		1	30	30	6	2			2	
H5528	001	0	1	04	01	H5528_001_0	2	1	01000100100000111110010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	001	0	1	04	01	H5528_001_0	2	2	00110001010011000001100111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	001	0	1	04	01	H5528_001_0	2	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	001	0	1	04	01	H5528_001_0	2	4	10000000000000000000000000000000000000000000000	$500.00 maximum benefit coverage OON	2				2			2	
H5528	002	0	1	04	01	H5528_002_0	3	1	01000100100000111110010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	002	0	1	04	01	H5528_002_0	3	2	00110001010011000001100111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	002	0	1	04	01	H5528_002_0	3	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	1	01000100100000111110010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	003	0	1	04	01	H5528_003_0	4	2	00110001010011000001100111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	003	0	1	04	01	H5528_003_0	4	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	004	0	1	04	01	H5528_004_0	3	1	01000100100000111110010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	004	0	1	04	01	H5528_004_0	3	2	00110001010011000001100111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	004	0	1	04	01	H5528_004_0	3	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	004	0	1	04	01	H5528_004_0	3	4	10000000000000000000000000000000000000000000000	$500 maximum benefit coverage OON	2				2			2	
H5528	005	0	1	04	01	H5528_005_0	4	1	01000100100000111110010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	005	0	1	04	01	H5528_005_0	4	2	00110001010011000001100111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	005	0	1	04	01	H5528_005_0	4	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	005	0	1	04	01	H5528_005_0	4	4	10000000000000000000000000000000000000000000000	$500 maximum benefit coverage OON	2				2			2	
H5528	008	0	1	04	01	H5528_008_0	5	1	01000100100000111110010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	008	0	1	04	01	H5528_008_0	5	2	00110001010011000001100111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	008	0	1	04	01	H5528_008_0	5	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	008	0	1	04	01	H5528_008_0	5	4	10000000000000000000000000000000000000000000000	$500 maximum benefit coverage OON	2				2			2	
H5528	009	0	1	04	01	H5528_009_0	2	1	01000100100000000000010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	6	00000000000000000110000000000000000000000000000	Zero OON Group	2				2			2	
H5528	009	0	1	04	01	H5528_009_0	2	5	00000000000000111000000000000000000000000000000	OON Lab-xray	2				1	0.00	20.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	2	00010000010010000001000111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	7	00100001000001000000100000000000000000000000000	$10 copay OON Group	2				1	10.00	10.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	4	10000000000000000000000000000000000000000000000	$500 maximum benefit coverage OON	2				2			2	
H5528	010	0	1	04	01	H5528_010_0	5	5	00100001000001000000100000000000000000000000000	$20 copay OON group	2				1	20.00	20.00	2	
H5528	010	0	1	04	01	H5528_010_0	5	4	00000000000000111000000000000000000000000000000	OON Lab-xray	2				1	0.00	50.00	2	
H5528	010	0	1	04	01	H5528_010_0	5	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	010	0	1	04	01	H5528_010_0	5	2	00010000010010000001000111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	010	0	1	04	01	H5528_010_0	5	1	01000100100000000000010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	010	0	1	04	01	H5528_010_0	5	6	00000000000000000110000000000000000000000000000	$50 Copayment OON Group	2				1	50.00	50.00	2	
H5528	011	0	1	04	01	H5528_011_0	5	2	00010000010010000001000111000000000000000110110	50% Coinsurance OON	1	50	50	1	2			2	
H5528	011	0	1	04	01	H5528_011_0	5	3	00001010001000000000000000000000000000000000001	$40 Copayment OON	2				1	40.00	40.00	2	
H5528	011	0	1	04	01	H5528_011_0	5	4	00100001000001000000100000000000000000000000000	$20 copay  OON group	2				1	20.00	20.00	2	
H5528	011	0	1	04	01	H5528_011_0	5	5	00000000000000111000000000000000000000000000000	OON Lab-xray	2				1	0.00	50.00	2	
H5528	011	0	1	04	01	H5528_011_0	5	1	01000100100000000000010000000000011111111000000	25% Coinsurance OON	1	25	25	1	2			2	
H5528	011	0	1	04	01	H5528_011_0	5	6	00000000000000000110000000000000000000000000000	$50 Copayment OON Group	2				1	50.00	50.00	2	
H5528	012	0	1	04	01	H5528_012_0	6	2	00000000100000000000000000000000000000000000000	$10 copayment group	2				1	10.00	10.00	2	
H5528	012	0	1	04	01	H5528_012_0	6	3	00110001010011000001100000000000000000000000000	$20 copayment group	2				1	20.00	20.00	2	
H5528	012	0	1	04	01	H5528_012_0	6	4	00000010001000000000000000000000000000000000000	$15 copayment group	2				1	15.00	15.00	2	
H5528	012	0	1	04	01	H5528_012_0	6	1	11001000000000000110010111100000111111111101111	zero copayment group	2				2			2	
H5528	802	0	1	04	01	H5528_802_0	1	4	00010000010010000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	802	0	1	04	01	H5528_802_0	1	3	00100111101101111111110111000000011111111111111	20% Group	1	20	20	1	2			2	
H5528	802	0	1	04	01	H5528_802_0	1	1	01000000000000000000000000000000000000000000000	SNF copay	2				1	0.00	125.00	2	
H5528	802	0	1	04	01	H5528_802_0	1	2	00001000000000000000000000000000000000000000000	Home Health	2				2			2	
H5528	804	0	1	04	01	H5528_804_0	1	4	00010000010010000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	804	0	1	04	01	H5528_804_0	1	1	01000000000000000000000000000000000000000000000	SNF copay	2				1	0.00	125.00	2	
H5528	804	0	1	04	01	H5528_804_0	1	3	00100111101101111111110111000000011111111111111	20% Group	1	20	20	1	2			2	
H5528	804	0	1	04	01	H5528_804_0	1	2	00001000000000000000000000000000000000000000000	Home Health	2				2			2	
H5528	806	0	1	04	01	H5528_806_0	1	1	01000000000000000000000000000000000000000000000	SNF copay	2				1	0.00	125.00	2	
H5528	806	0	1	04	01	H5528_806_0	1	2	00001000000000000000000000000000000000000000000	Home Health	2				2			2	
H5528	806	0	1	04	01	H5528_806_0	1	3	00100111101101111111110111000000011111111111111	20% Group	1	20	20	1	2			2	
H5528	806	0	1	04	01	H5528_806_0	1	4	00010000010010000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	807	0	1	04	01	H5528_807_0	1	4	00010000010010000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	807	0	1	04	01	H5528_807_0	1	2	00001000000000000000000000000000000000000000000	Home Health	2				2			2	
H5528	807	0	1	04	01	H5528_807_0	1	1	01000000000000000000000000000000000000000000000	SNF copay	2				1	0.00	125.00	2	
H5528	807	0	1	04	01	H5528_807_0	1	3	00100111101101111111110111000000011111111111111	20% Group	1	20	20	1	2			2	
H5528	809	0	1	04	01	H5528_809_0	1	2	00001000000000000000000000000000000000000000000	Home Health	2				2			2	
H5528	809	0	1	04	01	H5528_809_0	1	3	00100111101101111111110111000000011111111111111	20% Group	1	20	20	1	2			2	
H5528	809	0	1	04	01	H5528_809_0	1	4	00010000010010000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	809	0	1	04	01	H5528_809_0	1	1	01000000000000000000000000000000000000000000000	SNF copay	2				1	0.00	125.00	2	
H5528	810	0	1	04	01	H5528_810_0	1	4	00010000010010000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	810	0	1	04	01	H5528_810_0	1	1	01000000000000000000000000000000000000000000000	SNF copay	2				1	0.00	125.00	2	
H5528	810	0	1	04	01	H5528_810_0	1	2	00001000000000000000000000000000000000000000000	Home Health	2				2			2	
H5528	810	0	1	04	01	H5528_810_0	1	3	00100111101101111111110111000000011111111111111	20% Group	1	20	20	1	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	5	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H5529	002	0	1	04	01	H5529_002_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5529	002	0	1	04	01	H5529_002_0	7	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H5529	002	0	1	04	01	H5529_002_0	7	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H5529	002	0	1	04	01	H5529_002_0	7	5	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
H5529	002	0	1	04	01	H5529_002_0	7	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5529	801	0	1	04	01	H5529_801_0	4	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H5529	801	0	1	04	01	H5529_801_0	4	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5529	801	0	1	04	01	H5529_801_0	4	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5529	801	0	1	04	01	H5529_801_0	4	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H5529	801	0	1	04	01	H5529_801_0	4	5	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H5530	001	0	1	04	01	H5530_001_0	7	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5530	001	0	1	04	01	H5530_001_0	7	5	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H5530	001	0	1	04	01	H5530_001_0	7	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	7	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5530	002	0	1	04	01	H5530_002_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5530	002	0	1	04	01	H5530_002_0	7	5	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
H5530	002	0	1	04	01	H5530_002_0	7	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H5530	002	0	1	04	01	H5530_002_0	7	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5530	002	0	1	04	01	H5530_002_0	7	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H5530	801	0	1	04	01	H5530_801_0	4	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
H5530	801	0	1	04	01	H5530_801_0	4	4	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5530	801	0	1	04	01	H5530_801_0	4	5	00000000000000000000010000000000000000000000000	Ambulance	2				1	75.00	75.00	2	
H5530	801	0	1	04	01	H5530_801_0	4	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5530	801	0	1	04	01	H5530_801_0	4	1	01110111111011011011000000000000001000101000101	20% Coinsurance OON	1	20	20	3	2			2	
H5531	001	0	1	04	01	H5531_001_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5531	001	0	1	04	01	H5531_001_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	002	0	1	04	01	H5531_002_0	5	1	01111111111111111111100111110000011111111100101	Tier 1	1	30	30	6	2			2	
H5531	002	0	1	04	01	H5531_002_0	5	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	801	0	1	04	01	H5531_801_0	2	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5531	801	0	1	04	01	H5531_801_0	2	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5531	802	0	1	04	01	H5531_802_0	2	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
H5531	802	0	1	04	01	H5531_802_0	2	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	7	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	6	00000000000000000000000000010000100000000000000		2				2			2	
H5532	001	0	1	04	01	H5532_001_0	5	5	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	3	00000010101100000000000000000000000000000001101		2				1	30.00	30.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	2	00101001000001000110100111000000010111111100010		1	30	30	2	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	1	01000000000000000000000000000000000000000000000		2				1	175.00	175.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	8	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	9	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
H5533	002	0	1	04	01	H5533_002_0	3	3	00000000000000000000000000000000010000000000000	0% Grouping	2				2			2	
H5533	002	0	1	04	01	H5533_002_0	3	2	10000000000000000000000110000000100000000010010	50% Grouping	1	50	50	1	2			2	
H5533	002	0	1	04	01	H5533_002_0	3	1	01111111111111111111110001110000001111111101101	20% Grouping	1	20	20	1	2			2	
H5533	801	0	1	04	01	H5533_801_0	4	1	01111111111111111111110111110000001111111101101	20% Grouping	1	20	20	1	2			2	
H5533	801	0	1	04	01	H5533_801_0	4	3	00000000000000000000000000000000010000000000000	0% Grouping	1	0	0	1	2			2	
H5533	801	0	1	04	01	H5533_801_0	4	2	10000000000000000000000000000000100000000010010	50% Grouping	1	50	50	1	2			2	
H5533	802	0	1	04	01	H5533_802_0	4	2	10000000000000000000000000000000100000000010010	50% Grouping	1	50	50	1	2			2	
H5533	802	0	1	04	01	H5533_802_0	4	3	00000000000000000000000000000000010000000000000	0% Grouping	1	0	0	1	2			2	
H5533	802	0	1	04	01	H5533_802_0	4	1	01111111111111111111110111110000001111111101101	20% Grouping	1	20	20	1	2			2	
H5533	803	0	1	04	01	H5533_803_0	4	1	01111111111111111111110111110000001111111101101	20% Grouping	1	20	20	1	2			2	
H5533	803	0	1	04	01	H5533_803_0	4	2	10000000000000000000000000000000100000000010010	50% Grouping	1	50	50	1	2			2	
H5533	803	0	1	04	01	H5533_803_0	4	3	00000000000000000000000000000000010000000000000	0% Grouping	1	0	0	1	2			2	
H5606	001	0	1	38	05	H5606_001_0	4	1	00000000000000000000000000100000000000000000000	Renal Dialysis	1	35	35	1	2			2	
H5839	001	0	1	09	04	H5839_001_0	8	1	00000000000000000100000000000000000000000000000	Outpatient Hospital	1	20	20	6	2			2	
H5909	001	0	1	38	05	H5909_001_0	3	1	00000000000000000000000000100000000000000000000	Non-contracted OON Renal Care Cost Share	1	35	35	6	2			2	
H5962	001	0	1	38	05	H5962_001_0	5	1	00000000000000000000000000100000000000000000000	Renal Dialysis	1	35	35	1	2			2	
R3175	001	0	1	31	11	R3175_001_0	5	1	01101001000001000110100000000000010111111000010		1	40	40	6	2			2	
R3175	001	0	1	31	11	R3175_001_0	5	2	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R3175	001	0	1	31	11	R3175_001_0	5	9	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R3175	001	0	1	31	11	R3175_001_0	5	8	00000000000000000000000000010000100000000000000		2				2			2	
R3175	001	0	1	31	11	R3175_001_0	5	7	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
R3175	001	0	1	31	11	R3175_001_0	5	6	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
R3175	001	0	1	31	11	R3175_001_0	5	5	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R3175	001	0	1	31	11	R3175_001_0	5	4	00000000000000111000000000000000000000000000000		1	0	40	6	1	0.00	20.00	2	
R3175	001	0	1	31	11	R3175_001_0	5	3	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
R3175	002	0	1	31	11	R3175_002_0	6	1	00101001000001010110100111100000010111111100010	Group One	1	30	30	6	2			2	
R3175	002	0	1	31	11	R3175_002_0	6	8	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R3175	002	0	1	31	11	R3175_002_0	6	7	00000000000000000000000000010000100000000000000	Group Seven	2				2			2	
R3175	002	0	1	31	11	R3175_002_0	6	6	00000010101100000000000000000000000000000001101	Group Six	2				1	35.00	35.00	2	
R3175	002	0	1	31	11	R3175_002_0	6	9	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R3175	002	0	1	31	11	R3175_002_0	6	4	00000000010010000001000000000000000000000000000	Group Four	2				1	35.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	6	3	01000000000000000000000000000000000000000000000	Group Three	2				1	125.00	125.00	2	
R3175	002	0	1	31	11	R3175_002_0	6	2	00000000000000101000000000000000000000000000000	Group Two	1	0	30	6	1	0.00	20.00	2	
R3175	002	0	1	31	11	R3175_002_0	6	5	00000100000000000000000000000000001000000000000	Group Five	2				1	20.00	20.00	2	
R3175	003	0	1	31	11	R3175_003_0	9	1	01111111111111111111111111110000111111111101101		1	30	30	6	2			2	
R3175	003	0	1	31	11	R3175_003_0	9	2	00000000000000000000000000000000000000000000011		2				2			2	
R3175	801	0	1	31	11	R3175_801_0	4	1	01101001000001010110100000000000010111111000010	Group One	1	40	40	6	2			2	
R3175	801	0	1	31	11	R3175_801_0	4	2	00000000000000101000000000000000000000000000000	Group Two	1	0	40	6	1	0.00	20.00	2	
R3175	801	0	1	31	11	R3175_801_0	4	9	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
R3175	801	0	1	31	11	R3175_801_0	4	8	00000000000000000000000000010000100000000000000		2				2			2	
R3175	801	0	1	31	11	R3175_801_0	4	7	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
R3175	801	0	1	31	11	R3175_801_0	4	6	00000000000000000000010000000000000000000000000	Group Six	2				1	175.00	175.00	2	
R3175	801	0	1	31	11	R3175_801_0	4	5	00000000010010000001000000000000000000000000000	Group Five	2				1	35.00	45.00	2	
R3175	801	0	1	31	11	R3175_801_0	4	4	00000010101100000000000000000000000000000001101	Group Four	2				1	35.00	35.00	2	
R3175	801	0	1	31	11	R3175_801_0	4	3	00010000000000000000000000000000000000000000000	Group Three	2				1	75.00	75.00	2	
R3175	802	0	1	31	11	R3175_802_0	6	1	01101001000001010110100000000000010111111000010	Group One	1	40	40	6	2			2	
R3175	802	0	1	31	11	R3175_802_0	6	8	00000000000000000000000000010000100000000000000		2				2			2	
R3175	802	0	1	31	11	R3175_802_0	6	7	00000000000000000000000111100000000000000100000		1	30	30	6	2			2	
R3175	802	0	1	31	11	R3175_802_0	6	6	00000000000000000000010000000000000000000000000	Group Six	2				1	175.00	175.00	2	
R3175	802	0	1	31	11	R3175_802_0	6	9	00000100000000000000000000000000001000000000000		2				1	25.00	25.00	2	
R3175	802	0	1	31	11	R3175_802_0	6	4	00000010101100000000000000000000000000000001101	Group Four	2				1	35.00	35.00	2	
R3175	802	0	1	31	11	R3175_802_0	6	3	00010000000000000000000000000000000000000000000	Group Three	2				1	75.00	75.00	2	
R3175	802	0	1	31	11	R3175_802_0	6	2	00000000000000101000000000000000000000000000000	Group Two	1	0	40	6	1	0.00	20.00	2	
R3175	802	0	1	31	11	R3175_802_0	6	5	00000000010010000001000000000000000000000000000	Group Five	2				1	35.00	45.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	3	00000000000000000000000000010000100000000000000		2				2			2	
R5287	001	0	1	31	11	R5287_001_0	9	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	5	01000000000000000000000000000000000000000000000		2				1	150.00	150.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	8	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5287	001	0	1	31	11	R5287_001_0	9	2	00101001000001000110100111100000010111111100010		1	30	30	6	2			2	
R5287	002	0	1	31	11	R5287_002_0	6	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5287	002	0	1	31	11	R5287_002_0	6	2	00101001000001000110100111100000010111111100010		1	30	30	6	2			2	
R5287	002	0	1	31	11	R5287_002_0	6	3	00000000000000000000000000010000100000000000000		2				2			2	
R5287	002	0	1	31	11	R5287_002_0	6	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5287	002	0	1	31	11	R5287_002_0	6	5	01000000000000000000000000000000000000000000000		2				1	150.00	150.00	2	
R5287	002	0	1	31	11	R5287_002_0	6	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
R5287	002	0	1	31	11	R5287_002_0	6	7	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5287	002	0	1	31	11	R5287_002_0	6	8	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5287	003	0	1	31	11	R5287_003_0	8	1	01111111111111111111111111110000011111111111101	Group 1	1	30	30	6	2			2	
R5287	003	0	1	31	11	R5287_003_0	8	2	00000000000000000000000000000000000000000000010	Group 2	2				2			2	
R5287	801	0	1	31	11	R5287_801_0	4	7	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	1	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	2	00101001000001000110100111100000010111111100010		1	30	30	2	2			2	
R5287	801	0	1	31	11	R5287_801_0	4	3	00000000000000000000000000010000100000000000000		2				2			2	
R5287	801	0	1	31	11	R5287_801_0	4	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	7	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	1	01000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	2	00101001000001000110100111100000010111111100010		1	30	30	2	2			2	
R5287	802	0	1	31	11	R5287_802_0	5	3	00000000000000000000000000010000100000000000000		2				2			2	
R5287	802	0	1	31	11	R5287_802_0	5	4	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	5	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	6	00000110101100000000000000000000001000000001101		2				1	40.00	40.00	2	
R5342	001	0	1	31	11	R5342_001_0	8	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5342	001	0	1	31	11	R5342_001_0	8	2	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
R5342	001	0	1	31	11	R5342_001_0	8	8	00000000000000000000000000010000100000000000000		2				2			2	
R5342	001	0	1	31	11	R5342_001_0	8	7	00000000000000110000000000000000000000000000000		1	0	30	2	1	0.00	20.00	2	
R5342	001	0	1	31	11	R5342_001_0	8	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
R5342	001	0	1	31	11	R5342_001_0	8	5	01101001000001000110100111100000010111111100010		1	30	30	6	2			2	
R5342	001	0	1	31	11	R5342_001_0	8	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5342	001	0	1	31	11	R5342_001_0	8	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5342	002	0	1	31	11	R5342_002_0	4	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5342	002	0	1	31	11	R5342_002_0	4	7	00000000000000000000000000010000100000000000000		2				2			2	
R5342	002	0	1	31	11	R5342_002_0	4	6	00000010101100000000000000000000000000000001101		2				1	35.00	35.00	2	
R5342	002	0	1	31	11	R5342_002_0	4	5	01101001000001000111000111100000010111111100010		1	30	30	6	2			2	
R5342	002	0	1	31	11	R5342_002_0	4	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5342	002	0	1	31	11	R5342_002_0	4	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5342	002	0	1	31	11	R5342_002_0	4	2	00000100000000000000000000000000001000000000000		2				1	20.00	20.00	2	
R5342	002	0	1	31	11	R5342_002_0	4	8	00000000000000110000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5342	003	0	1	31	11	R5342_003_0	7	1	01111111111111111111111111110000011111111101101		1	30	30	6	2			2	
R5342	003	0	1	31	11	R5342_003_0	7	2	10000000000000000000000000000000000000000000010		2				2			2	
R5342	801	0	1	31	11	R5342_801_0	4	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5342	801	0	1	31	11	R5342_801_0	4	2	00000100000000000000000000000000001000000000000		2				1	30.00	30.00	2	
R5342	801	0	1	31	11	R5342_801_0	4	8	00000000000000000000000000010000100000000000000		2				2			2	
R5342	801	0	1	31	11	R5342_801_0	4	7	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5342	801	0	1	31	11	R5342_801_0	4	6	00000010101100000000000000000000000000000001101		2				1	40.00	40.00	2	
R5342	801	0	1	31	11	R5342_801_0	4	5	01001001000001000110100111000000010111111100010		1	30	30	2	2			2	
R5342	801	0	1	31	11	R5342_801_0	4	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5342	801	0	1	31	11	R5342_801_0	4	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	1	00000000000000000000010000000000000000000000000		2				1	175.00	175.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	7	00000000000000111000000000000000000000000000000		1	0	30	6	1	0.00	20.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	6	00000010101100000000000000000000000000000001101		2				1	40.00	40.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	5	01001001000001000110100111000000010111111100010		1	30	30	2	2			2	
R5342	802	0	1	31	11	R5342_802_0	5	4	00000000010010000001000000000000000000000000000		2				1	35.00	45.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	3	00010000000000000000000000000000000000000000000		2				1	75.00	75.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	2	00000100000000000000000000000000001000000000000		2				1	30.00	30.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	8	00000000000000000000000000010000100000000000000		2				2			2	
R5553	001	0	1	31	11	R5553_001_0	9	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
R5553	001	0	1	31	11	R5553_001_0	9	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
R5553	001	0	1	31	11	R5553_001_0	9	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
R5553	001	0	1	31	11	R5553_001_0	9	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
R5553	002	0	1	31	11	R5553_002_0	7	2	00000010001000000000010000000000000000000000000	Group 2	2				1	50.00	50.00	2	
R5553	002	0	1	31	11	R5553_002_0	7	3	00010000010010000001000000000000000000000000000	Group 3	1	50	50	1	2			2	
R5553	002	0	1	31	11	R5553_002_0	7	1	01101101100101111010100001110000011111111101111	Group 1	1	20	20	1	2			2	
R5553	002	0	1	31	11	R5553_002_0	7	4	00000000000000000100000110000000000000000000000	Group 4	1	30	30	1	2			2	
R5566	003	0	1	31	11	R5566_003_0	2	1	01111111111111111111111111110000001111111101111		1	40	40	1	2			2	
R5566	003	0	1	31	11	R5566_003_0	2	2	10000000000000000000000000001111000000000010000		1	100	100	1	2			2	
R5566	003	0	1	31	11	R5566_003_0	2	3	00000000000000000000000000000000010000000000000		2				2			2	
R5566	005	0	1	31	11	R5566_005_0	2	1	01111111111111111111111111110000001111111101111		1	20	20	1	2			2	
R5566	005	0	1	31	11	R5566_005_0	2	3	00000000000000000000000000000000010000000000000		2				2			2	
R5566	005	0	1	31	11	R5566_005_0	2	2	10000000000000000000000000001111000000000010000		1	100	100	1	2			2	
R5566	006	0	1	31	11	R5566_006_0	2	1	01111111111111111111111111110000001111111101111		1	20	20	1	2			2	
R5566	006	0	1	31	11	R5566_006_0	2	2	10000000000000000000000000001111000000000010000		1	100	100	1	2			2	
R5566	006	0	1	31	11	R5566_006_0	2	3	00000000000000000000000000000000010000000000000		2				2			2	
R5566	008	0	1	31	11	R5566_008_0	2	2	10000000000000000000000000001111000000000010000		1	100	100	1	2			2	
R5566	008	0	1	31	11	R5566_008_0	2	1	01111111111111111111111111110000001111111101111		1	20	20	1	2			2	
R5566	008	0	1	31	11	R5566_008_0	2	3	00000000000000000000000000000000010000000000000		2				2			2	
R5566	801	0	1	31	11	R5566_801_0	3	1	01111111111111111111110111110000001001111101101		1	50	50	1	2			2	
R5566	801	0	1	31	11	R5566_801_0	3	2	10000000000000000000001000001111100000000010000		1	100	100	1	2			2	
R5566	801	0	1	31	11	R5566_801_0	3	3	00000000000000000000000000000000010110000000010		2				2			2	
R5566	802	0	1	31	11	R5566_802_0	1	2	10000000000000000000001000001111100000000010000		1	100	100	1	2			2	
R5566	802	0	1	31	11	R5566_802_0	1	1	01111111111111111111110111110000001001111101101		1	50	50	1	2			2	
R5566	802	0	1	31	11	R5566_802_0	1	3	00000000000000000000000000000000010110000000010		2				2			2	
R5566	803	0	1	31	11	R5566_803_0	2	1	01111111111111111111110111110000001001111101101		1	50	50	1	2			2	
R5566	803	0	1	31	11	R5566_803_0	2	2	10000000000000000000001000001111100000000010000		1	100	100	1	2			2	
R5566	803	0	1	31	11	R5566_803_0	2	3	00000000000000000000000000000000010110000000010		2				2			2	
R5566	804	0	1	31	11	R5566_804_0	1	1	01111111111111111111110111110000001001111101101		1	50	50	1	2			2	
R5566	804	0	1	31	11	R5566_804_0	1	2	10000000000000000000001000001111100000000010000		1	100	100	1	2			2	
R5566	804	0	1	31	11	R5566_804_0	1	3	00000000000000000000000000000000010110000000010		2				2			2	
R5566	805	0	1	31	11	R5566_805_0	2	1	01111111111111111111110111110000001001111101101		1	50	50	1	2			2	
R5566	805	0	1	31	11	R5566_805_0	2	2	10000000000000000000001000001111100000000010000		1	100	100	1	2			2	
R5566	805	0	1	31	11	R5566_805_0	2	3	00000000000000000000000000000000010110000000010		2				2			2	
R5566	806	0	1	31	11	R5566_806_0	2	1	01111111111111111111110111110000001001111101101		1	50	50	1	2			2	
R5566	806	0	1	31	11	R5566_806_0	2	2	10000000000000000000001000001111100000000010000		1	100	100	1	2			2	
R5566	806	0	1	31	11	R5566_806_0	2	3	00000000000000000000000000000000010110000000010		2				2			2	
R5595	001	0	1	31	11	R5595_001_0	3	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
R5595	001	0	1	31	11	R5595_001_0	3	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
R5595	003	0	1	31	11	R5595_003_0	4	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
R5595	003	0	1	31	11	R5595_003_0	4	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
R5595	003	0	1	31	11	R5595_003_0	4	3	00000000000000000000000000000000000000000011000	Tier 3	1	50	50	6	2			2	
R5595	004	0	1	31	11	R5595_004_0	4	1	01111111111111111111100111110000011111111100101	Tier 1	1	20	20	6	2			2	
R5595	004	0	1	31	11	R5595_004_0	4	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
R5595	005	0	1	31	11	R5595_005_0	5	1	01111111111111111111100111110000011111111100101	Teir 1	1	30	30	6	2			2	
R5595	005	0	1	31	11	R5595_005_0	5	2	00000000000000000000010000000000000000000000000	Tier two	2				1	100.00	100.00	2	
R5595	005	0	1	31	11	R5595_005_0	5	3	00000000000000000000000000000000000000000011000	Tier 3	1	50	50	6	2			2	
R5595	801	0	1	31	11	R5595_801_0	2	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
R5595	801	0	1	31	11	R5595_801_0	2	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
R5595	802	0	1	31	11	R5595_802_0	2	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
R5595	802	0	1	31	11	R5595_802_0	2	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
R5595	803	0	1	31	11	R5595_803_0	2	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
R5595	803	0	1	31	11	R5595_803_0	2	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
R5595	804	0	1	31	11	R5595_804_0	3	1	01111111111111111111100111110000011111111101101	Tier 1	1	30	30	6	2			2	
R5595	804	0	1	31	11	R5595_804_0	3	2	00000000000000000000010000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
R5674	001	0	1	31	11	R5674_001_0	9	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
R5674	001	0	1	31	11	R5674_001_0	9	2	01001011111111111111100000100000000001111001111	40% Group	1	40	40	2	2			2	
R5674	001	0	1	31	11	R5674_001_0	9	3	00000000000000000000000000000000010110000000000	20-40% Group	1	20	40	2	2			2	
R5674	001	0	1	31	11	R5674_001_0	9	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
R5674	001	0	1	31	11	R5674_001_0	9	5	00000000000000000000010000000000000000000000000	Ambulance Group	1	40	40	2	1	100.00	100.00	2	
R5674	001	0	1	31	11	R5674_001_0	9	6	00110000000000000000000000010000000000000000000	$0 Group	2				2			2	
R5674	801	0	1	31	11	R5674_801_0	7	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
R5674	802	0	1	31	11	R5674_802_0	5	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
R5674	802	0	1	31	11	R5674_802_0	5	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
R5674	802	0	1	31	11	R5674_802_0	5	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
R5674	802	0	1	31	11	R5674_802_0	5	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
R5674	803	0	1	31	11	R5674_803_0	6	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
R5674	803	0	1	31	11	R5674_803_0	6	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
R5674	803	0	1	31	11	R5674_803_0	6	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
R5674	803	0	1	31	11	R5674_803_0	6	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
R5674	804	0	1	31	11	R5674_804_0	5	3	00110000000000000000000000010000000000000000000	0% Group	1	0	0	2	2			2	
R5674	804	0	1	31	11	R5674_804_0	5	2	01001011111111111111110000100000010111111001111	40% Group	1	40	40	2	2			2	
R5674	804	0	1	31	11	R5674_804_0	5	1	00000100000000000000000000000000001000000100000	20% Group	1	20	20	2	2			2	
R5674	804	0	1	31	11	R5674_804_0	5	4	00000000000000000000000111000000000000000000000	50% Group	1	50	50	2	2			2	
R5826	001	0	1	31	11	R5826_001_0	6	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	001	0	1	31	11	R5826_001_0	6	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	001	0	1	31	11	R5826_001_0	6	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	001	0	1	31	11	R5826_001_0	6	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	001	0	1	31	11	R5826_001_0	6	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	001	0	1	31	11	R5826_001_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	001	0	1	31	11	R5826_001_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	001	0	1	31	11	R5826_001_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	002	0	1	31	11	R5826_002_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	002	0	1	31	11	R5826_002_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	002	0	1	31	11	R5826_002_0	6	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	003	0	1	31	11	R5826_003_0	6	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	003	0	1	31	11	R5826_003_0	6	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	003	0	1	31	11	R5826_003_0	6	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	003	0	1	31	11	R5826_003_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	003	0	1	31	11	R5826_003_0	6	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	003	0	1	31	11	R5826_003_0	6	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	003	0	1	31	11	R5826_003_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	003	0	1	31	11	R5826_003_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	004	0	1	31	11	R5826_004_0	6	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	004	0	1	31	11	R5826_004_0	6	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	004	0	1	31	11	R5826_004_0	6	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	004	0	1	31	11	R5826_004_0	6	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	004	0	1	31	11	R5826_004_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	004	0	1	31	11	R5826_004_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	004	0	1	31	11	R5826_004_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	004	0	1	31	11	R5826_004_0	6	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	005	0	1	31	11	R5826_005_0	5	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	005	0	1	31	11	R5826_005_0	5	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	005	0	1	31	11	R5826_005_0	5	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	005	0	1	31	11	R5826_005_0	5	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	005	0	1	31	11	R5826_005_0	5	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	005	0	1	31	11	R5826_005_0	5	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	005	0	1	31	11	R5826_005_0	5	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	005	0	1	31	11	R5826_005_0	5	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	006	0	1	31	11	R5826_006_0	5	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	006	0	1	31	11	R5826_006_0	5	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	006	0	1	31	11	R5826_006_0	5	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	006	0	1	31	11	R5826_006_0	5	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	006	0	1	31	11	R5826_006_0	5	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	006	0	1	31	11	R5826_006_0	5	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	006	0	1	31	11	R5826_006_0	5	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	006	0	1	31	11	R5826_006_0	5	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	007	0	1	31	11	R5826_007_0	5	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	007	0	1	31	11	R5826_007_0	5	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	007	0	1	31	11	R5826_007_0	5	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	007	0	1	31	11	R5826_007_0	5	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	007	0	1	31	11	R5826_007_0	5	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	007	0	1	31	11	R5826_007_0	5	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	007	0	1	31	11	R5826_007_0	5	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	007	0	1	31	11	R5826_007_0	5	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	008	0	1	31	11	R5826_008_0	6	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	008	0	1	31	11	R5826_008_0	6	2	00000110101010000000000000000000011110000000101		2				1	35.00	35.00	2	
R5826	008	0	1	31	11	R5826_008_0	6	8	00000000000000000000000000000000000000000000010		2				2			2	
R5826	008	0	1	31	11	R5826_008_0	6	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	008	0	1	31	11	R5826_008_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	008	0	1	31	11	R5826_008_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	008	0	1	31	11	R5826_008_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
R5826	008	0	1	31	11	R5826_008_0	6	3	00000001000001111001100000010000000001111000000		1	30	30	6	1	35.00	35.00	2	
R5826	009	0	1	31	11	R5826_009_0	6	1	01111000010000000110000110000000000000000000000		1	30	30	6	2			2	
R5826	009	0	1	31	11	R5826_009_0	6	7	00000000000000000000000000000000000000000011000		1	50	50	6	2			2	
R5826	009	0	1	31	11	R5826_009_0	6	6	00000000000000000000000000100000000000000000000		2				1	0.00	50.00	2	
R5826	009	0	1	31	11	R5826_009_0	6	5	00000000000000000000000001000000000000000100000		1	20	30	6	2			2	
R5826	009	0	1	31	11	R5826_009_0	6	4	00000000000000000000010000000000000000000000000		2				1	100.00	100.00	2	
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R5941	001	0	1	31	11	R5941_001_0	10	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	6	00110011111011000001000000000000000000000000111	OON Specialist	2				1	35.00	35.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	5	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	4	00000000000000100000000000000000000000000000000	c/d/t	1	0	20	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	1	01110111111011011011000000000000001000101000111	20% Coinsurance OON	1	20	20	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	6	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	003	0	1	31	11	R5941_003_0	10	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	10	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	10	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	10	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
R5941	003	0	1	31	11	R5941_003_0	10	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	003	0	1	31	11	R5941_003_0	10	6	00110011111011000001000000000000000000000000111	OON Specialist	2				1	35.00	35.00	2	
R5941	003	0	1	31	11	R5941_003_0	10	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	003	0	1	31	11	R5941_003_0	10	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	004	0	1	31	11	R5941_004_0	9	1	01110111111011011011000000000000001000101000111	20% Coinsurance OON	1	20	20	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	9	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	9	3	00000000000000100000000000000000000000000000000		1	0	20	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	9	4	00000000000000100000000000000000000000000000000	c/d/t	1	0	20	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	9	5	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	004	0	1	31	11	R5941_004_0	9	6	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	801	0	1	31	11	R5941_801_0	7	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	801	0	1	31	11	R5941_801_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	801	0	1	31	11	R5941_801_0	7	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	801	0	1	31	11	R5941_801_0	7	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	801	0	1	31	11	R5941_801_0	7	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	35.00	35.00	2	
R5941	801	0	1	31	11	R5941_801_0	7	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	801	0	1	31	11	R5941_801_0	7	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
R5941	801	0	1	31	11	R5941_801_0	7	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
R5941	802	0	1	31	11	R5941_802_0	7	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
R5941	802	0	1	31	11	R5941_802_0	7	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	802	0	1	31	11	R5941_802_0	7	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	802	0	1	31	11	R5941_802_0	7	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
R5941	802	0	1	31	11	R5941_802_0	7	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	802	0	1	31	11	R5941_802_0	7	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	35.00	35.00	2	
R5941	802	0	1	31	11	R5941_802_0	7	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	802	0	1	31	11	R5941_802_0	7	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	805	0	1	31	11	R5941_805_0	4	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
R5941	805	0	1	31	11	R5941_805_0	4	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	805	0	1	31	11	R5941_805_0	4	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	805	0	1	31	11	R5941_805_0	4	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
R5941	805	0	1	31	11	R5941_805_0	4	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R5941	805	0	1	31	11	R5941_805_0	4	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	805	0	1	31	11	R5941_805_0	4	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	35.00	35.00	2	
R5941	805	0	1	31	11	R5941_805_0	4	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	806	0	1	31	11	R5941_806_0	4	1	01000000000000011000000000000000000000101000000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	806	0	1	31	11	R5941_806_0	4	7	00000000000000000000010000000000000000000000000		2				1	75.00	75.00	2	
R5941	806	0	1	31	11	R5941_806_0	4	6	00110011111011000001000000000000000000000000101	OON Specialist	2				1	35.00	35.00	2	
R5941	806	0	1	31	11	R5941_806_0	4	2	00000000000000000000000111000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	806	0	1	31	11	R5941_806_0	4	3	00000000000000100000000000000000000000000000000	OON Labs	1	0	20	3	2			2	
R5941	806	0	1	31	11	R5941_806_0	4	4	00000000000000000010000000000000000000000000000	Outpatient Surgery	2				1	250.00	250.00	2	
R5941	806	0	1	31	11	R5941_806_0	4	5	00000100000000000000000000000000001000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	806	0	1	31	11	R5941_806_0	4	8	00000000000000000000000000100000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
R9943	001	0	1	31	11	R9943_001_0	8	1	01001111111111111011110111110000011111111100111	20% OON Coinsurance Group	1	20	20	1	2			2	
R9943	002	0	1	31	11	R9943_002_0	8	1	01001111111111111011110111110000011111111100111	20% OON Coinsurance Group	1	20	20	1	2			2	
