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
H0046	001	0	1	04	01	H0046_001_0	6	1	111111111111111111111101111100001111111111111111	Group 1	1	20	20	1	2			2	
H0084	001	0	1	04	01	H0084_001_0	9	9	000000000000011110000001100000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
H0084	001	0	1	04	01	H0084_001_0	9	7	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	8	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	6	001000000000000000000000000000000000000000000000	$50 Copay	2				1	50.00	50.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	5	000000001001000000010000000000000000000000000000	$25 Copay - Individual	2				1	25.00	25.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	4	010001110110100000001000001000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	3	000000001001000000010000000000000000000000000000	$10 Copay - Group	2				1	10.00	10.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	2	000010000000000000000000000000000000000000010100	$10 Copay	2				1	10.00	10.00	2	
H0084	001	0	1	04	01	H0084_001_0	9	1	000100000100000000000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
H0104	002	0	1	04	01	H0104_002_0	8	1	011111111111111111111001111100001111111111111101	1	1	30	30	2	2			2	
H0104	002	0	1	04	01	H0104_002_0	8	2	000000000000000000000100000000000000000000000000	2	2				1	150.00	150.00	2	
H0104	002	0	1	04	01	H0104_002_0	8	3	100000000000000000000000000000000000000000000010	3	2				1	0.00	0.00	2	
H0104	004	0	1	04	01	H0104_004_0	7	1	011111111111111111111001111100001111111111101101	1	1	30	30	2	2			2	
H0104	004	0	1	04	01	H0104_004_0	7	2	000000000000000000000100000000000000000000000000	2	2				1	150.00	150.00	2	
H0104	004	0	1	04	01	H0104_004_0	7	3	100000000000000000000000000000000000000000010010	3	2				1	0.00	0.00	2	
H0104	006	0	1	04	01	H0104_006_0	5	1	011111111111111111111001111100001111111111101101	1	1	10	10	2	2			2	
H0104	006	0	1	04	01	H0104_006_0	5	2	000000000000000000000100000000000000000000000000	2	2				1	50.00	50.00	2	
H0104	006	0	1	04	01	H0104_006_0	5	3	000000000000000000000000000000000000000000010010	3	2				1	0.00	0.00	2	
H0104	008	0	1	04	01	H0104_008_0	6	2	000000000000000000000100000000000000000000000000	2	2				1	0.00	0.00	2	
H0104	008	0	1	04	01	H0104_008_0	6	3	100000000000000000000000000000000000000000010010	3	2				1	0.00	0.00	2	
H0104	008	0	1	04	01	H0104_008_0	6	1	011111111111111111111001111100001111111111101101	1	1	30	30	2	2			2	
H0104	801	0	1	04	01	H0104_801_0	4	1	010011110110101111111101111100001110111111101101	1	1	20	20	2	2			2	
H0104	801	0	1	04	01	H0104_801_0	4	3	001000001001000000000000000000000000000000000000	3	1	50	50	2	2			2	
H0104	801	0	1	04	01	H0104_801_0	4	2	100100000000010000000010000011110001000000010010	2	1	0	20	2	2			2	
H0104	802	0	1	04	01	H0104_802_0	5	3	001000001001000000000000000000000000000000000000	3	1	50	50	2	2			2	
H0104	802	0	1	04	01	H0104_802_0	5	2	100100000000010000000010000011110001000000010010	2	1	0	20	2	2			2	
H0104	802	0	1	04	01	H0104_802_0	5	1	010011110110101111111101111100001110111111101101	1	1	20	20	2	2			2	
H0104	804	0	1	04	01	H0104_804_0	5	1	010011110110101111111101111100001110111111101101	1	1	20	20	2	2			2	
H0104	804	0	1	04	01	H0104_804_0	5	2	100100000000010000000010000011110001000000010010	2	1	0	20	2	2			2	
H0104	804	0	1	04	01	H0104_804_0	5	3	001000001001000000000000000000000000000000000000	3	1	50	50	2	2			2	
H0248	001	0	1	04	01	H0248_001_0	6	1	111111111111111111111000000110000111111111101101		1	25	25	6	2			2	
H0248	001	0	1	04	01	H0248_001_0	6	2	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H0248	001	0	1	04	01	H0248_001_0	6	3	000000000000000000000000010000000000000000000000		1	20	20	6	2			2	
H0248	001	0	1	04	01	H0248_001_0	6	4	000000000000000000000010000000001000000000011000		1	50	50	6	2			2	
H0248	001	0	1	04	01	H0248_001_0	6	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0248	001	0	1	04	01	H0248_001_0	6	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H0248	001	0	1	04	01	H0248_001_0	6	7	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H0248	001	0	1	04	01	H0248_001_0	6	8	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H0248	801	0	1	04	01	H0248_801_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0248	801	0	1	04	01	H0248_801_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0248	801	0	1	04	01	H0248_801_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0248	802	0	1	04	01	H0248_802_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0248	802	0	1	04	01	H0248_802_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0248	802	0	1	04	01	H0248_802_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0248	803	0	1	04	01	H0248_803_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0248	803	0	1	04	01	H0248_803_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0248	803	0	1	04	01	H0248_803_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0248	804	0	1	04	01	H0248_804_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0248	804	0	1	04	01	H0248_804_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0248	804	0	1	04	01	H0248_804_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	7	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0317	001	0	1	04	01	H0317_001_0	6	8	000011010111000000000000000000000111111111111101		1	20	20	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	9	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H0317	001	0	1	04	01	H0317_001_0	6	1	011000000000000001100000000000000000000000000000		1	15	15	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	10	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	11	000000101000111110011000000100000000011111000000		1	15	20	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	2	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H0317	001	0	1	04	01	H0317_001_0	6	3	000000000000000000000000010000000000000000000000		1	20	50	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	4	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	5	000000000000000000000001100000001000000000000000		1	50	50	6	2			2	
H0317	001	0	1	04	01	H0317_001_0	6	6	000100000000000000000000000000000000000000000000		1	40	40	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	4	000000000000000000000001100000001000000000011000		1	50	50	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	3	000000000000000000000000010000000000000000000000		1	20	50	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	2	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H0317	002	0	1	04	01	H0317_002_0	7	1	011011111111111111111000000100000111111111101101		1	20	20	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0317	002	0	1	04	01	H0317_002_0	7	6	000100000000000000000000000000000000000000000000		1	40	40	6	2			2	
H0317	002	0	1	04	01	H0317_002_0	7	7	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H0317	004	0	1	04	01	H0317_004_0	8	4	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H0317	004	0	1	04	01	H0317_004_0	8	3	000000000000000000000000010000000000000000000000		1	20	50	6	2			2	
H0317	004	0	1	04	01	H0317_004_0	8	2	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H0317	004	0	1	04	01	H0317_004_0	8	1	011111111111111111111000000100000111111111001101		1	25	25	6	2			2	
H0317	004	0	1	04	01	H0317_004_0	8	5	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H0317	004	0	1	04	01	H0317_004_0	8	8	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H0317	004	0	1	04	01	H0317_004_0	8	7	000000000000000000000100000000000000000000000000		1	100	100	6	2			2	
H0317	004	0	1	04	01	H0317_004_0	8	6	000000000000000000000000000000000000000000100000		1	20	25	6	2			2	
H0317	801	0	1	04	01	H0317_801_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0317	801	0	1	04	01	H0317_801_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0317	801	0	1	04	01	H0317_801_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0317	802	0	1	04	01	H0317_802_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0317	802	0	1	04	01	H0317_802_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0317	802	0	1	04	01	H0317_802_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0317	803	0	1	04	01	H0317_803_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0317	803	0	1	04	01	H0317_803_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0317	803	0	1	04	01	H0317_803_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0317	804	0	1	04	01	H0317_804_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0317	804	0	1	04	01	H0317_804_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0317	804	0	1	04	01	H0317_804_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0319	001	0	1	04	01	H0319_001_0	5	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0319	001	0	1	04	01	H0319_001_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	10.00	2	
H0319	001	0	1	04	01	H0319_001_0	5	3	100000000000000000000000001000000000000000000010	Group 3	2				1	0.00	0.00	2	
H0319	001	0	1	04	01	H0319_001_0	5	4	000000000000000000000000000000001000000000000000	Group 4	1	0	30	6	2			2	
H0319	002	0	1	04	01	H0319_002_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H0319	002	0	1	04	01	H0319_002_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H0319	002	0	1	04	01	H0319_002_0	5	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0319	002	0	1	04	01	H0319_002_0	5	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H0319	002	0	1	04	01	H0319_002_0	5	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H0319	004	0	1	04	01	H0319_004_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H0319	004	0	1	04	01	H0319_004_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H0319	004	0	1	04	01	H0319_004_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H0319	004	0	1	04	01	H0319_004_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H0319	004	0	1	04	01	H0319_004_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0319	005	0	1	04	01	H0319_005_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0319	005	0	1	04	01	H0319_005_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H0319	005	0	1	04	01	H0319_005_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H0319	005	0	1	04	01	H0319_005_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H0319	005	0	1	04	01	H0319_005_0	3	4	000000000000000000000000000000010000000000000010	Group 4	2				1	0.00	0.00	2	
H0319	006	0	1	04	01	H0319_006_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H0319	006	0	1	04	01	H0319_006_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H0319	006	0	1	04	01	H0319_006_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H0319	006	0	1	04	01	H0319_006_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H0319	006	0	1	04	01	H0319_006_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0322	002	0	1	04	01	H0322_002_0	6	5	100000000000000000000000000000000000000000000000		2				1	0.00	0.00	2	
H0322	002	0	1	04	01	H0322_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H0322	002	0	1	04	01	H0322_002_0	6	3	000000000000000000000000000000001000000000010010	Tier 3	2				2			2	
H0322	002	0	1	04	01	H0322_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H0322	002	0	1	04	01	H0322_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0322	006	0	1	04	01	H0322_006_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H0322	006	0	1	04	01	H0322_006_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0322	006	0	1	04	01	H0322_006_0	6	3	000000000000000000000000000000001000000000010010	Tier 3	2				2			2	
H0322	006	0	1	04	01	H0322_006_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H0322	006	0	1	04	01	H0322_006_0	6	5	100000000000000000000000000000000000000000000000	Tier 5	2				1	0.00	0.00	2	
H0322	801	0	1	04	01	H0322_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0322	801	0	1	04	01	H0322_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0322	801	0	1	04	01	H0322_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0322	802	0	1	04	01	H0322_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0322	802	0	1	04	01	H0322_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0322	802	0	1	04	01	H0322_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0322	804	0	1	04	01	H0322_804_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0322	804	0	1	04	01	H0322_804_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0322	804	0	1	04	01	H0322_804_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0370	001	0	1	04	01	H0370_001_0	11	1	011111111111111111111000011100001111111111101101	OON	1	20	20	2	2			2	
H0370	001	0	1	04	01	H0370_001_0	11	5	000000000000000000000000000000000000000000000010	Allowance Items	1	0	0	2	1	0.00	0.00	2	
H0370	001	0	1	04	01	H0370_001_0	11	4	000000000000000000000000000000000000000000010000	Preventive Dental	1	50	50	2	2			2	
H0370	001	0	1	04	01	H0370_001_0	11	3	000000000000000000000001100000000000000000000000	DME/Pros	1	30	30	2	2			2	
H0370	001	0	1	04	01	H0370_001_0	11	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H0370	002	0	1	04	01	H0370_002_0	12	1	011111111111111111111001111100001111111111100101	OON	1	10	10	2	2			2	
H0370	002	0	1	04	01	H0370_002_0	12	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H0370	002	0	1	04	01	H0370_002_0	12	3	000000000000000000000000000000000000000000001000	Comp Dental	1	0	50	2	2			1	25.00
H0370	002	0	1	04	01	H0370_002_0	12	4	100000000000000000000000000000000000000000010010	Allowance Items	1	0	0	2	1	0.00	0.00	2	
H0370	801	0	1	04	01	H0370_801_0	10	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H0370	801	0	1	04	01	H0370_801_0	10	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H0370	802	0	1	04	01	H0370_802_0	10	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H0370	802	0	1	04	01	H0370_802_0	10	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H0370	803	0	1	04	01	H0370_803_0	10	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H0370	803	0	1	04	01	H0370_803_0	10	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H0620	002	0	1	04	01	H0620_002_0	5	2	000010000000000000000000000000001000000000001000	Group 2	1	0	20	6	2			2	
H0620	002	0	1	04	01	H0620_002_0	5	1	011101111111111111111111110101100111111111100101	Group 1	1	20	20	6	2			2	
H0620	002	0	1	04	01	H0620_002_0	5	3	100000000000000000000000001000000000000000010010	Group 3	2				1	0.00	0.00	2	
H0623	001	0	1	04	01	H0623_001_0	6	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H0623	001	0	1	04	01	H0623_001_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0623	001	0	1	04	01	H0623_001_0	6	4	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H0623	001	0	1	04	01	H0623_001_0	6	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H0623	001	0	1	04	01	H0623_001_0	6	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H0623	001	0	1	04	01	H0623_001_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	005	0	1	04	01	H0623_005_0	5	7	000000000000000000000001000000000000000000000000		1	40	40	3	2			2	
H0623	005	0	1	04	01	H0623_005_0	5	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H0623	005	0	1	04	01	H0623_005_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	005	0	1	04	01	H0623_005_0	5	4	011111111111111111111000100100000111111111001101		1	30	30	6	2			2	
H0623	005	0	1	04	01	H0623_005_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H0623	005	0	1	04	01	H0623_005_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0623	005	0	1	04	01	H0623_005_0	5	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H0623	006	0	1	04	01	H0623_006_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0623	006	0	1	04	01	H0623_006_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H0623	006	0	1	04	01	H0623_006_0	5	4	011111111111111111111000100100000111111111001101		1	30	30	6	2			2	
H0623	006	0	1	04	01	H0623_006_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	006	0	1	04	01	H0623_006_0	5	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H0623	006	0	1	04	01	H0623_006_0	5	7	000000000000000000000001000000000000000000000000		1	40	40	3	2			2	
H0623	006	0	1	04	01	H0623_006_0	5	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H0623	007	0	1	04	01	H0623_007_0	5	7	000000000000000000000001000000000000000000000000		1	40	40	3	2			2	
H0623	007	0	1	04	01	H0623_007_0	5	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H0623	007	0	1	04	01	H0623_007_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	007	0	1	04	01	H0623_007_0	5	4	011111111111111111111000100100000111111111001101		1	30	30	6	2			2	
H0623	007	0	1	04	01	H0623_007_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H0623	007	0	1	04	01	H0623_007_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0623	007	0	1	04	01	H0623_007_0	5	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H0623	008	0	1	04	01	H0623_008_0	5	7	000000000000000000000001000000000000000000000000		1	40	40	3	2			2	
H0623	008	0	1	04	01	H0623_008_0	5	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H0623	008	0	1	04	01	H0623_008_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	008	0	1	04	01	H0623_008_0	5	4	011111111111111111111000100100000111111111001101		1	30	30	6	2			2	
H0623	008	0	1	04	01	H0623_008_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H0623	008	0	1	04	01	H0623_008_0	5	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H0623	008	0	1	04	01	H0623_008_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0623	009	0	1	04	01	H0623_009_0	5	1	000000000000000000000000110000000000000000100000		1	20	40	6	2			2	
H0623	009	0	1	04	01	H0623_009_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H0623	009	0	1	04	01	H0623_009_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H0623	009	0	1	04	01	H0623_009_0	5	4	011111111111111111111000100100000111111111001101		1	30	30	6	2			2	
H0623	009	0	1	04	01	H0623_009_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H0623	009	0	1	04	01	H0623_009_0	5	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H0623	009	0	1	04	01	H0623_009_0	5	7	000000000000000000000001000000000000000000000000		1	40	40	3	2			2	
H0623	801	0	1	04	01	H0623_801_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0623	801	0	1	04	01	H0623_801_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0623	801	0	1	04	01	H0623_801_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0623	802	0	1	04	01	H0623_802_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0623	802	0	1	04	01	H0623_802_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0623	802	0	1	04	01	H0623_802_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0623	803	0	1	04	01	H0623_803_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0623	803	0	1	04	01	H0623_803_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0623	803	0	1	04	01	H0623_803_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0623	804	0	1	04	01	H0623_804_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H0623	804	0	1	04	01	H0623_804_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H0623	804	0	1	04	01	H0623_804_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H0710	001	0	1	04	01	H0710_001_0	6	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H0710	001	0	1	04	01	H0710_001_0	6	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H0710	001	0	1	04	01	H0710_001_0	6	3	000000000000000000000000000000000000000000000010	Group 3	2				1	0.00	0.00	2	
H0710	001	0	1	04	01	H0710_001_0	6	4	000000000000000000000000001000000000000000000000	Group 4	1	20	20	6	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H0710	003	0	1	04	01	H0710_003_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H0710	003	0	1	04	01	H0710_003_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H0768	001	0	1	04	01	H0768_001_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H0768	001	0	1	04	01	H0768_001_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H0768	001	0	1	04	01	H0768_001_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H0768	001	0	1	04	01	H0768_001_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H0768	001	0	1	04	01	H0768_001_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0768	002	0	1	04	01	H0768_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H0768	002	0	1	04	01	H0768_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0768	002	0	1	04	01	H0768_002_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H0768	002	0	1	04	01	H0768_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	15.00	15.00	2	
H0768	002	0	1	04	01	H0768_002_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H0768	801	0	1	04	01	H0768_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0768	801	0	1	04	01	H0768_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0768	801	0	1	04	01	H0768_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0768	802	0	1	04	01	H0768_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0768	802	0	1	04	01	H0768_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0768	802	0	1	04	01	H0768_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0902	002	0	1	04	01	H0902_002_0	9	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H0902	002	0	1	04	01	H0902_002_0	9	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H0902	002	0	1	04	01	H0902_002_0	9	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H0902	002	0	1	04	01	H0902_002_0	9	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H0902	002	0	1	04	01	H0902_002_0	9	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H0902	801	0	1	04	01	H0902_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0902	801	0	1	04	01	H0902_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0902	801	0	1	04	01	H0902_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0902	802	0	1	04	01	H0902_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0902	802	0	1	04	01	H0902_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0902	802	0	1	04	01	H0902_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0902	804	0	1	04	01	H0902_804_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H0902	804	0	1	04	01	H0902_804_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H0902	804	0	1	04	01	H0902_804_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H0967	001	0	1	04	01	H0967_001_0	8	3	000000000000000000000000000000000000000000011000	Dental Services	1	50	50	6	2			2	
H0967	001	0	1	04	01	H0967_001_0	8	2	000000000000000000000000000001000000000000000000	Over the Counter Package	2				1	15.00	15.00	2	
H0967	001	0	1	04	01	H0967_001_0	8	1	011111111111111111111101111100000111111111100000		1	20	20	6	2			2	
H0967	001	0	1	04	01	H0967_001_0	8	4	000000000000000000000000000000000000000000000110	Vision Services	1	50	50	6	2			2	
H0967	001	0	1	04	01	H0967_001_0	8	5	100000000000000000000000000000000000000000000001	Hearing Services	1	50	50	6	2			2	
H0967	001	0	1	04	01	H0967_001_0	8	6	000000000000000000000000000000001000000000000000	Health Education/Wellness Programs	2				1	0.00	0.00	2	
H1108	001	0	1	04	01	H1108_001_0	4	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	3	000000000000000000000000000000000000000000000010	Group 3	2				1	0.00	0.00	2	
H1108	001	0	1	04	01	H1108_001_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	4	000000000000000000000000001000000000000000000000	Group 4	1	20	20	6	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1108	006	0	1	04	01	H1108_006_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1108	006	0	1	04	01	H1108_006_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H1108	006	0	1	04	01	H1108_006_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1108	006	0	1	04	01	H1108_006_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1108	006	0	1	04	01	H1108_006_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1108	007	0	1	04	01	H1108_007_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	0	30	6	1	0.00	7.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	10.00	10.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	3	000100000000001101100001110001000001111111100000	Group 3	1	30	30	2	2			2	
H1108	007	0	1	04	01	H1108_007_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	11	000000000000000000000000000000000000000000000010	Group 11	1	30	50	6	2			2	
H1108	007	0	1	04	01	H1108_007_0	5	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1108	007	0	1	04	01	H1108_007_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H1108	007	0	1	04	01	H1108_007_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
H1108	801	0	1	04	01	H1108_801_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	0	30	2	1	0.00	7.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H1108	801	0	1	04	01	H1108_801_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	35.00	35.00	2	
H1108	801	0	1	04	01	H1108_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	35.00	35.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
H1108	802	0	1	04	01	H1108_802_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1108	802	0	1	04	01	H1108_802_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H1108	802	0	1	04	01	H1108_802_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	35.00	35.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
H1108	803	0	1	04	01	H1108_803_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1108	803	0	1	04	01	H1108_803_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H1108	803	0	1	04	01	H1108_803_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
H1108	804	0	1	04	01	H1108_804_0	3	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H1108	804	0	1	04	01	H1108_804_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	1	010011110110100000001000000000000010000000001101	Group 1	2				1	35.00	35.00	2	
H1108	804	0	1	04	01	H1108_804_0	3	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	35	35	6	2			2	
H1110	001	0	1	04	01	H1110_001_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H1110	003	0	1	04	01	H1110_003_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	35	35	6	2			2	
H1110	003	0	1	04	01	H1110_003_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H1110	003	0	1	04	01	H1110_003_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H1110	003	0	1	04	01	H1110_003_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H1110	003	0	1	04	01	H1110_003_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H1110	801	0	1	04	01	H1110_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H1110	801	0	1	04	01	H1110_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H1110	801	0	1	04	01	H1110_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H1110	802	0	1	04	01	H1110_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H1110	802	0	1	04	01	H1110_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H1110	802	0	1	04	01	H1110_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H1302	001	0	1	04	01	H1302_001_0	13	1	000000000000000000000100001000000000000000000000	OON - 10% Coinsurance Group	1	10	10	2	2			2	
H1302	001	0	1	04	01	H1302_001_0	13	2	011111111111111111111001110100001111111111101101	OON - 25% Coinsurance Group	1	25	25	2	2			2	
H1302	001	0	1	04	01	H1302_001_0	13	3	000000000000000000000000000000000000000000000010	OON - Eyewear	2				1	50.00	50.00	2	
H1302	004	0	1	04	01	H1302_004_0	13	1	000000000000000000000100001000000000000000000000	OON - 10% Coinsurance Group	1	10	10	2	2			2	
H1302	004	0	1	04	01	H1302_004_0	13	2	011111111111111111111001110100001111111111101101	OON - 25% Coinsurance Group	1	25	25	2	2			2	
H1302	004	0	1	04	01	H1302_004_0	13	3	000000000000000000000000000000000000000000000010	OON - Eye Wear	2				1	50.00	50.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	11	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	10	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	9	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	8	000000000000010000000000000000000000000000000000	Group 7	1	30	30	6	1	7.00	7.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	6	000000001001000000010000000000000000000000000000	Group 6	2				1	35.00	45.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	5	000000000000000000000000000000000000000000000010	Group 5	1	30	50	6	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	3	000100000000001101100001110001000001111111100000	Group 3	1	30	30	6	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	12	100000000000000000000000000000000000000000000000	Group 11	1	50	50	6	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
H1303	003	0	1	04	01	H1303_003_0	3	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	3	000100000000001101100001110001000001111111100000	Group 3	1	30	30	6	2			2	
H1303	003	0	1	04	01	H1303_003_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1303	003	0	1	04	01	H1303_003_0	3	11	100000000000000000000000000000000000000000000000		1	50	50	6	2			2	
H1303	003	0	1	04	01	H1303_003_0	3	10	000000000000000000000000000000000000000000000010	Group 10	1	30	50	6	2			2	
H1303	003	0	1	04	01	H1303_003_0	3	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H1303	004	0	1	04	01	H1303_004_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1303	004	0	1	04	01	H1303_004_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1303	006	0	1	04	01	H1303_006_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H1303	006	0	1	04	01	H1303_006_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1303	006	0	1	04	01	H1303_006_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1303	006	0	1	04	01	H1303_006_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1303	006	0	1	04	01	H1303_006_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1303	801	0	1	04	01	H1303_801_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H1303	801	0	1	04	01	H1303_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1303	801	0	1	04	01	H1303_801_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H1303	801	0	1	04	01	H1303_801_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H1303	803	0	1	04	01	H1303_803_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H1303	803	0	1	04	01	H1303_803_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1303	803	0	1	04	01	H1303_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1303	803	0	1	04	01	H1303_803_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H1303	803	0	1	04	01	H1303_803_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H1303	803	0	1	04	01	H1303_803_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H1303	803	0	1	04	01	H1303_803_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1303	803	0	1	04	01	H1303_803_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H1303	803	0	1	04	01	H1303_803_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1303	803	0	1	04	01	H1303_803_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1304	001	0	1	04	01	H1304_001_0	6	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H1304	001	0	1	04	01	H1304_001_0	6	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H1304	001	0	1	04	01	H1304_001_0	6	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H1304	001	0	1	04	01	H1304_001_0	6	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H1304	001	0	1	04	01	H1304_001_0	6	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H1304	001	0	1	04	01	H1304_001_0	6	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H1304	001	0	1	04	01	H1304_001_0	6	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H1304	002	0	1	04	01	H1304_002_0	7	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H1304	002	0	1	04	01	H1304_002_0	7	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H1304	002	0	1	04	01	H1304_002_0	7	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H1304	002	0	1	04	01	H1304_002_0	7	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H1304	002	0	1	04	01	H1304_002_0	7	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H1304	002	0	1	04	01	H1304_002_0	7	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H1304	002	0	1	04	01	H1304_002_0	7	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H1304	004	0	1	04	01	H1304_004_0	7	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H1304	004	0	1	04	01	H1304_004_0	7	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H1304	004	0	1	04	01	H1304_004_0	7	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H1304	004	0	1	04	01	H1304_004_0	7	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H1304	004	0	1	04	01	H1304_004_0	7	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H1304	004	0	1	04	01	H1304_004_0	7	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H1304	004	0	1	04	01	H1304_004_0	7	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	3	000000000000000000100000000000000000000000000000	$500	2				1	500.00	500.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	4	000000000000000000000000001000000000000000100000	20% coinsurance	1	20	20	2	2			2	
H1304	006	0	1	04	01	H1304_006_0	6	5	000100000000001110000001100000000000000000000000	40% coinsurance	1	40	40	2	2			2	
H1304	006	0	1	04	01	H1304_006_0	6	6	011000000000000000001000010100000101111111000000	$0 copay	2				1	0.00	0.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	7	000000000000000000000000000000000000000000000010	$0 copay	2				1	0.00	0.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	8	000000000000010000000000000000000000000000000000	0to 40% coinsurance	1	0	40	2	2			2	
H1304	006	0	1	04	01	H1304_006_0	6	9	000000000000000000000000000000001000000000000000	$0 cost sharing	2				1	0.00	0.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	1	000011111111100000010000000000000010000000001101	$35.00 copay	2				1	35.00	35.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	10	000000000000000001000000000000000000000000000000	$0 to $500	2				1	0.00	500.00	2	
H1304	006	0	1	04	01	H1304_006_0	6	2	000000000000000000000100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H1317	001	0	1	04	01	H1317_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H1317	001	0	1	04	01	H1317_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H1317	002	0	1	04	01	H1317_002_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H1317	002	0	1	04	01	H1317_002_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H1317	003	0	1	04	01	H1317_003_0	7	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	9	000000000010000000000000000000000000000000000000	Other Health Care	2				1	25.00	25.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	8	000000000000011110000001100000000000000000000000	Diagnostic and DME	1	30	30	3	2			2	
H1317	003	0	1	04	01	H1317_003_0	7	7	000000000000000000000000000000000000000011000000	Diabetes Monitoring, Nutrition Therapy	2				1	10.00	10.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	6	000100001001000001100000000000000000000000000000	OP Mental Health, HHC, OP Surgery	1	30	30	3	2			2	
H1317	003	0	1	04	01	H1317_003_0	7	5	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	95.00	95.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	4	000011110100100000001000000000000000000000000000	Physician Services and Rehab Therapies	2				1	35.00	35.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	3	000000000000000000010000000000000000000000000000	Outpatient Substance Abuse	1	50	50	3	2			2	
H1317	003	0	1	04	01	H1317_003_0	7	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H1317	003	0	1	04	01	H1317_003_0	7	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H1317	003	0	1	04	01	H1317_003_0	7	12	000000000000000000000000000101001111111100000000	Preventative Services	2				1	0.00	0.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	13	000000000000000000000000000000000000000000000101	Vision / Hearing Exam	2				1	35.00	35.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H1317	003	0	1	04	01	H1317_003_0	7	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H1317	801	0	1	04	01	H1317_801_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H1317	801	0	1	04	01	H1317_801_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H1317	801	0	1	04	01	H1317_801_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H1317	802	0	1	04	01	H1317_802_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H1317	802	0	1	04	01	H1317_802_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H1317	802	0	1	04	01	H1317_802_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H1317	803	0	1	04	01	H1317_803_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H1317	803	0	1	04	01	H1317_803_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H1317	803	0	1	04	01	H1317_803_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H1355	001	0	1	04	01	H1355_001_0	2	1	011000001001000000011001110000000000000000000000	Group 1	1	30	30	2	2			2	
H1355	001	0	1	04	01	H1355_001_0	2	2	100111110110111111100100001100001111111111111111	Group 2	1	20	20	2	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H1356	001	0	1	04	01	H1356_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H1356	001	0	1	04	01	H1356_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H1356	002	0	1	04	01	H1356_002_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H1356	002	0	1	04	01	H1356_002_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H1356	003	0	1	04	01	H1356_003_0	6	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	9	000000000010000000000000000000000000000000000000	Other Health Care	2				1	25.00	25.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	8	000000000000011110000001100000000000000000000000	Diagnostic and DME	1	30	30	3	2			2	
H1356	003	0	1	04	01	H1356_003_0	6	7	000000000000000000000000000000000000000011000000	Diabetes Monitoring, Nutrition Therapy	2				1	10.00	10.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	6	000100001001000001100000000000000000000000000000	OP Mental Health, HHC, OP Surgery	1	30	30	3	2			2	
H1356	003	0	1	04	01	H1356_003_0	6	5	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	95.00	95.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	4	000011110100100000001000000000000000000000000000	Physician Services and Rehab Therapies	2				1	35.00	35.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	3	000000000000000000010000000000000000000000000000	Outpatient Substance Abuse	1	50	50	3	2			2	
H1356	003	0	1	04	01	H1356_003_0	6	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H1356	003	0	1	04	01	H1356_003_0	6	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H1356	003	0	1	04	01	H1356_003_0	6	12	000000000000000000000000000101001111111100000000	Preventative Services	2				1	0.00	0.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	13	000000000000000000000000000000000000000000000101	Vision / Hearing Exam	2				1	35.00	35.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H1356	003	0	1	04	01	H1356_003_0	6	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H1356	801	0	1	04	01	H1356_801_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H1356	801	0	1	04	01	H1356_801_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H1356	801	0	1	04	01	H1356_801_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H1356	802	0	1	04	01	H1356_802_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H1356	802	0	1	04	01	H1356_802_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H1356	802	0	1	04	01	H1356_802_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H1356	803	0	1	04	01	H1356_803_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H1356	803	0	1	04	01	H1356_803_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H1356	803	0	1	04	01	H1356_803_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H1417	001	0	1	04	01	H1417_001_0	5	1	000000000000000000000000000100001100111111100010	Wellness	2				1	0.00	0.00	2	
H1417	001	0	1	04	01	H1417_001_0	5	2	000100000000000000000000000000000000000000000000	Home Health	2				1	10.00	10.00	2	
H1417	001	0	1	04	01	H1417_001_0	5	3	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H1417	001	0	1	04	01	H1417_001_0	5	7	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	10.00	10.00	2	
H1417	001	0	1	04	01	H1417_001_0	5	5	011011111111111111011000000000000011000000001101	Office Visits - Therapy	2				1	30.00	30.00	2	
H1417	001	0	1	04	01	H1417_001_0	5	6	000000000000000000100000000000000000000000000000	ASC	2				1	200.00	200.00	2	
H1417	001	0	1	04	01	H1417_001_0	5	4	000000000000000000000001110000000000000000000000	DME	1	20	20	1	2			2	
H1417	002	0	1	04	01	H1417_002_0	7	5	011011111111111111011000000000000011000000001101	Office Visits - Therapy	2				1	30.00	30.00	2	
H1417	002	0	1	04	01	H1417_002_0	7	6	000000000000000000100000000000000000000000000000	ASC	2				1	200.00	200.00	2	
H1417	002	0	1	04	01	H1417_002_0	7	7	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	10.00	10.00	2	
H1417	002	0	1	04	01	H1417_002_0	7	1	000000000000000000000000000100001100111111100010	Wellness	2				1	0.00	0.00	2	
H1417	002	0	1	04	01	H1417_002_0	7	2	000100000000000000000000000000000000000000000000	Home Health	2				1	10.00	10.00	2	
H1417	002	0	1	04	01	H1417_002_0	7	3	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H1417	002	0	1	04	01	H1417_002_0	7	4	000000000000000000000001110000000000000000000000	DME	1	20	20	1	2			2	
H1417	003	0	1	04	01	H1417_003_0	9	1	000000000000000000000000001000000000000000000000	Renal Dialysis	1	10	10	1	2			2	
H1417	003	0	1	04	01	H1417_003_0	9	2	000100000000000000000000000000000000000000000000	Home Health	2				1	20.00	20.00	2	
H1417	003	0	1	04	01	H1417_003_0	9	3	000000000000000000000001110000000000000000000000	DME	1	20	20	2	2			2	
H1417	003	0	1	04	01	H1417_003_0	9	4	011011111111111111111000000100000011000000101101	Out Patient Services	1	15	15	2	2			2	
H1417	003	0	1	04	01	H1417_003_0	9	5	000000000000000000000000000000001100111111000010	Preventive	1	15	15	2	2			2	
H1417	003	0	1	04	01	H1417_003_0	9	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1417	004	0	1	04	01	H1417_004_0	9	1	000000000000000000000000001000000000000000000000	Renal Dialysis	1	10	10	1	2			2	
H1417	004	0	1	04	01	H1417_004_0	9	2	000100000000000000000000000000000000000000000000	Home Health	2				1	20.00	20.00	2	
H1417	004	0	1	04	01	H1417_004_0	9	3	000000000000000000000001110000000000000000000000	DME	1	20	20	2	2			2	
H1417	004	0	1	04	01	H1417_004_0	9	4	011011111111111111111000000100000011000000101111	Out Patient Services	1	15	15	2	2			2	
H1417	004	0	1	04	01	H1417_004_0	9	5	000000000000000000000000000000001100111111000000	Preventive	1	15	15	2	2			2	
H1417	004	0	1	04	01	H1417_004_0	9	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1417	005	0	1	04	01	H1417_005_0	8	1	000000000000000000000000000100001100111111100010	Wellness	2				1	0.00	0.00	2	
H1417	005	0	1	04	01	H1417_005_0	8	7	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	10.00	10.00	2	
H1417	005	0	1	04	01	H1417_005_0	8	6	000000000000000000100000000000000000000000000000	ASC	2				1	200.00	200.00	2	
H1417	005	0	1	04	01	H1417_005_0	8	5	011011111111111111011000000000000011000000001101	Office Visits - Therapy	2				1	30.00	30.00	2	
H1417	005	0	1	04	01	H1417_005_0	8	4	000000000000000000000001110000000000000000000000	DME	1	20	20	1	2			2	
H1417	005	0	1	04	01	H1417_005_0	8	3	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H1417	005	0	1	04	01	H1417_005_0	8	2	000100000000000000000000000000000000000000000000	Home Health	2				1	10.00	10.00	2	
H1417	006	0	1	04	01	H1417_006_0	9	4	011011111111111111111000000100000011000000101111	Out Patient Services	1	15	15	2	2			2	
H1417	006	0	1	04	01	H1417_006_0	9	3	000000000000000000000001110000000000000000000000	DME	1	20	20	2	2			2	
H1417	006	0	1	04	01	H1417_006_0	9	2	000100000000000000000000000000000000000000000000	Home Health	2				1	20.00	20.00	2	
H1417	006	0	1	04	01	H1417_006_0	9	1	000000000000000000000000001000000000000000000000	Renal Dialysis	1	10	10	1	2			2	
H1417	006	0	1	04	01	H1417_006_0	9	5	000000000000000000000000000000001100111111000000	Preventive	1	15	15	2	2			2	
H1417	006	0	1	04	01	H1417_006_0	9	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H1417	007	0	1	04	01	H1417_007_0	8	1	000000000000000000100000000000000000000000000000	ASC	2				1	400.00	400.00	2	
H1417	007	0	1	04	01	H1417_007_0	8	6	000000000000000000000000000000001100111111000000	Wellness	2				1	0.00	0.00	2	
H1417	007	0	1	04	01	H1417_007_0	8	5	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	45.00	45.00	2	
H1417	007	0	1	04	01	H1417_007_0	8	4	000000000000000000000100000000000000000000000000	Ambulance	2				1	200.00	200.00	2	
H1417	007	0	1	04	01	H1417_007_0	8	3	000000000000000000000001110000000000000000000000	DME	1	30	30	2	2			2	
H1417	007	0	1	04	01	H1417_007_0	8	2	011111111111111111011000000100000011000000101111	Professional Services	2				1	60.00	60.00	2	
H1417	008	0	1	04	01	H1417_008_0	10	4	000000000000000000000100000000000000000000000000	Ambulance	2				1	200.00	200.00	2	
H1417	008	0	1	04	01	H1417_008_0	10	3	000000000000000000000001110000000000000000000000	DME	1	30	30	2	2			2	
H1417	008	0	1	04	01	H1417_008_0	10	2	011111111111111111011000000100000011000000101111	Professional Services	2				1	60.00	60.00	2	
H1417	008	0	1	04	01	H1417_008_0	10	1	000000000000000000100000000000000000000000000000	ASC	2				1	400.00	400.00	2	
H1417	008	0	1	04	01	H1417_008_0	10	5	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	45.00	45.00	2	
H1417	008	0	1	04	01	H1417_008_0	10	6	000000000000000000000000000000001100111111000000	Wellness	2				1	0.00	0.00	2	
H1417	009	0	1	04	01	H1417_009_0	10	4	000000000000000000000100000000000000000000000000	Ambulance	2				1	200.00	200.00	2	
H1417	009	0	1	04	01	H1417_009_0	10	3	000000000000000000000001110000000000000000000000	DME	1	30	30	2	2			2	
H1417	009	0	1	04	01	H1417_009_0	10	2	011111111111111111011000000100000011000000101111	Professional Services	2				1	60.00	60.00	2	
H1417	009	0	1	04	01	H1417_009_0	10	1	000000000000000000100000000000000000000000000000	ASC	2				1	400.00	400.00	2	
H1417	009	0	1	04	01	H1417_009_0	10	5	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	45.00	45.00	2	
H1417	009	0	1	04	01	H1417_009_0	10	6	000000000000000000000000000000001100111111000000	Wellness	2				1	0.00	0.00	2	
H1417	801	0	1	04	01	H1417_801_0	9	3	000000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H1417	801	0	1	04	01	H1417_801_0	9	1	011011110110111111101101111100001111111111101111	OON Medicare Covered Benefits	1	20	20	1	2			2	
H1417	801	0	1	04	01	H1417_801_0	9	2	000100000000000000000000000000000000000000000000	Home Health	1	20	20	2	2			2	
H1417	802	0	1	04	01	H1417_802_0	9	1	011011110110111111101101111100001111111111101111	OON Medicare Covered Benefits	1	20	20	1	2			2	
H1417	802	0	1	04	01	H1417_802_0	9	2	000100000000000000000000000000000000000000000000	Home Health	1	20	20	2	2			2	
H1417	802	0	1	04	01	H1417_802_0	9	3	000000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H1417	809	0	1	04	01	H1417_809_0	9	3	000000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H1417	809	0	1	04	01	H1417_809_0	9	2	000100000000000000000000000000000000000000000000	Home Health	1	20	20	2	2			2	
H1417	809	0	1	04	01	H1417_809_0	9	1	011011110110111111101101111100001111111111101111	OON Medicare Covered Benefits	1	20	20	1	2			2	
H1418	002	0	1	04	01	H1418_002_0	3	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1418	002	0	1	04	01	H1418_002_0	3	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	3	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	3	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	3	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1418	002	0	1	04	01	H1418_002_0	3	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H1418	002	0	1	04	01	H1418_002_0	3	2	000011010111000000000000000000000111100000001101		2				1	40.00	40.00	2	
H1418	002	0	1	04	01	H1418_002_0	3	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	40.00	40.00	2	
H1418	007	0	1	04	01	H1418_007_0	3	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H1418	007	0	1	04	01	H1418_007_0	3	2	000011010111000000000000000000000111100000001101		2				1	35.00	35.00	2	
H1418	007	0	1	04	01	H1418_007_0	3	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H1418	007	0	1	04	01	H1418_007_0	3	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1418	007	0	1	04	01	H1418_007_0	3	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1418	007	0	1	04	01	H1418_007_0	3	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H1418	007	0	1	04	01	H1418_007_0	3	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H1418	007	0	1	04	01	H1418_007_0	3	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1418	801	0	1	04	01	H1418_801_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1418	801	0	1	04	01	H1418_801_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1418	801	0	1	04	01	H1418_801_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1418	802	0	1	04	01	H1418_802_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1418	802	0	1	04	01	H1418_802_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1418	802	0	1	04	01	H1418_802_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1418	803	0	1	04	01	H1418_803_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1418	803	0	1	04	01	H1418_803_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1418	803	0	1	04	01	H1418_803_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1418	804	0	1	04	01	H1418_804_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1418	804	0	1	04	01	H1418_804_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1418	804	0	1	04	01	H1418_804_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1420	001	0	1	04	01	H1420_001_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H1420	001	0	1	04	01	H1420_001_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H1420	001	0	1	04	01	H1420_001_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H1420	001	0	1	04	01	H1420_001_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H1420	001	0	1	04	01	H1420_001_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H1420	003	0	1	04	01	H1420_003_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H1420	003	0	1	04	01	H1420_003_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H1420	003	0	1	04	01	H1420_003_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H1420	003	0	1	04	01	H1420_003_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H1420	003	0	1	04	01	H1420_003_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	15.00	15.00	2	
H1420	801	0	1	04	01	H1420_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H1420	801	0	1	04	01	H1420_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H1420	801	0	1	04	01	H1420_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H1420	802	0	1	04	01	H1420_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H1420	802	0	1	04	01	H1420_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H1420	802	0	1	04	01	H1420_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	10	000000000000000000000000000000000000000000000010	Group 10	1	30	50	6	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	3	000100000000001101100001110001000001111111100000	Group 3	1	30	30	6	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
H1509	004	0	1	04	01	H1509_004_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1509	004	0	1	04	01	H1509_004_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1509	005	0	1	04	01	H1509_005_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1509	005	0	1	04	01	H1509_005_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H1509	005	0	1	04	01	H1509_005_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1509	005	0	1	04	01	H1509_005_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1509	005	0	1	04	01	H1509_005_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1509	006	0	1	04	01	H1509_006_0	7	3	000000000000000000000000000000000000000000000010	Group 3	2				1	0.00	0.00	2	
H1509	006	0	1	04	01	H1509_006_0	7	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1509	006	0	1	04	01	H1509_006_0	7	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H1509	006	0	1	04	01	H1509_006_0	7	4	000000000000000000000000001000000000000000000000	Group 4	1	20	20	6	2			2	
H1509	007	0	1	04	01	H1509_007_0	7	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
H1509	007	0	1	04	01	H1509_007_0	7	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H1509	007	0	1	04	01	H1509_007_0	7	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H1509	008	0	1	04	01	H1509_008_0	6	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H1509	008	0	1	04	01	H1509_008_0	6	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
H1509	008	0	1	04	01	H1509_008_0	6	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	008	0	1	04	01	H1509_008_0	6	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H1509	008	0	1	04	01	H1509_008_0	6	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H1509	008	0	1	04	01	H1509_008_0	6	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H1509	008	0	1	04	01	H1509_008_0	6	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H1509	008	0	1	04	01	H1509_008_0	6	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	008	0	1	04	01	H1509_008_0	6	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H1509	801	0	1	04	01	H1509_801_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	0	40	2	1	0.00	7.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H1509	801	0	1	04	01	H1509_801_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H1509	801	0	1	04	01	H1509_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H1509	801	0	1	04	01	H1509_801_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H1509	803	0	1	04	01	H1509_803_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	0	40	2	1	0.00	7.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H1509	803	0	1	04	01	H1509_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H1509	803	0	1	04	01	H1509_803_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H1509	804	0	1	04	01	H1509_804_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H1509	804	0	1	04	01	H1509_804_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1509	804	0	1	04	01	H1509_804_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H1509	804	0	1	04	01	H1509_804_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H1509	804	0	1	04	01	H1509_804_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	804	0	1	04	01	H1509_804_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1509	804	0	1	04	01	H1509_804_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	0	40	2	1	0.00	7.00	2	
H1509	804	0	1	04	01	H1509_804_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1509	804	0	1	04	01	H1509_804_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H1509	804	0	1	04	01	H1509_804_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H1509	805	0	1	04	01	H1509_805_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H1509	805	0	1	04	01	H1509_805_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H1509	805	0	1	04	01	H1509_805_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1509	805	0	1	04	01	H1509_805_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	0	40	2	1	0.00	7.00	2	
H1510	001	0	1	04	01	H1510_001_0	5	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1510	001	0	1	04	01	H1510_001_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1510	001	0	1	04	01	H1510_001_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H1510	001	0	1	04	01	H1510_001_0	5	4	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H1510	001	0	1	04	01	H1510_001_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1510	001	0	1	04	01	H1510_001_0	5	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H1510	004	0	1	04	01	H1510_004_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1510	004	0	1	04	01	H1510_004_0	6	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1510	004	0	1	04	01	H1510_004_0	6	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1510	004	0	1	04	01	H1510_004_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1510	004	0	1	04	01	H1510_004_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H1510	004	0	1	04	01	H1510_004_0	6	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H1510	005	0	1	04	01	H1510_005_0	3	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1510	005	0	1	04	01	H1510_005_0	3	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H1510	005	0	1	04	01	H1510_005_0	3	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1510	005	0	1	04	01	H1510_005_0	3	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1510	005	0	1	04	01	H1510_005_0	3	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H1510	005	0	1	04	01	H1510_005_0	3	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1510	805	0	1	04	01	H1510_805_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1510	805	0	1	04	01	H1510_805_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1510	805	0	1	04	01	H1510_805_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1510	806	0	1	04	01	H1510_806_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1510	806	0	1	04	01	H1510_806_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1510	806	0	1	04	01	H1510_806_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1510	807	0	1	04	01	H1510_807_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1510	807	0	1	04	01	H1510_807_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1510	807	0	1	04	01	H1510_807_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1510	808	0	1	04	01	H1510_808_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1510	808	0	1	04	01	H1510_808_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1510	808	0	1	04	01	H1510_808_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1517	001	0	1	04	01	H1517_001_0	9	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
H1517	001	0	1	04	01	H1517_001_0	9	10	000100000010000001001000000100001111110100000000	OON No Copayment	2				1	0.00	0.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	11	000000000000000000000000000000000000000000001000	OON $0 Copayment Comprehensive Dental	2				1	0.00	0.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
H1517	001	0	1	04	01	H1517_001_0	9	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H1517	001	0	1	04	01	H1517_001_0	9	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
H1517	001	0	1	04	01	H1517_001_0	9	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
H1517	001	0	1	04	01	H1517_001_0	9	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
H1517	801	0	1	04	01	H1517_801_0	4	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H1517	801	0	1	04	01	H1517_801_0	4	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H1517	802	0	1	04	01	H1517_802_0	4	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H1517	802	0	1	04	01	H1517_802_0	4	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H1517	803	0	1	04	01	H1517_803_0	4	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H1517	803	0	1	04	01	H1517_803_0	4	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	10	000100000010000001001000000100001111110100000000	OON No-Copayment	2				1	0.00	0.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	11	000000000000000000000000000000000000000000001000	OON $0 Copayment Comprehensive Dental	2				1	0.00	0.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
H1608	001	0	1	04	01	H1608_001_0	12	1	011111111111111111111000011100001111111111101101	OON	1	20	20	2	2			2	
H1608	001	0	1	04	01	H1608_001_0	12	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H1608	001	0	1	04	01	H1608_001_0	12	3	000000000000000000000001100000000000000000000000	DME/PROS	1	30	30	2	2			2	
H1608	001	0	1	04	01	H1608_001_0	12	4	000000000000000000000000000000000000000000000010	Eye Wear	1	0	0	2	1	0.00	0.00	2	
H1608	001	0	1	04	01	H1608_001_0	12	5	000000000000000000000000000000000000000000010000	Preventive Dental	1	50	50	2	2			2	
H1608	002	0	1	04	01	H1608_002_0	10	1	011111111111111111111001111100001111111111100101	OON	1	10	10	2	2			2	
H1608	002	0	1	04	01	H1608_002_0	10	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H1608	002	0	1	04	01	H1608_002_0	10	4	100000000000000000000000000000000000000000010010	Allowance Items	1	0	0	2	1	0.00	0.00	2	
H1608	002	0	1	04	01	H1608_002_0	10	3	000000000000000000000000000000000000000000001000	Comp Dental	1	0	50	2	2			1	25.00
H1608	003	0	1	04	01	H1608_003_0	10	1	011111111111111111111001111100001111111111101101	OON	1	20	20	2	2			2	
H1608	003	0	1	04	01	H1608_003_0	10	3	000000000000000000000000000000000000000000010000	Preventive Dental	1	50	50	2	2			2	
H1608	003	0	1	04	01	H1608_003_0	10	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H1608	003	0	1	04	01	H1608_003_0	10	4	100000000000000000000000000000000000000000000010	Allowance Items	1	0	0	2	1	0.00	0.00	2	
H1608	801	0	1	04	01	H1608_801_0	9	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H1608	801	0	1	04	01	H1608_801_0	9	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H1608	802	0	1	04	01	H1608_802_0	9	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H1608	802	0	1	04	01	H1608_802_0	9	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H1608	803	0	1	04	01	H1608_803_0	10	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H1608	803	0	1	04	01	H1608_803_0	10	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H1681	001	0	1	04	01	H1681_001_0	4	5	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H1681	001	0	1	04	01	H1681_001_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H1681	001	0	1	04	01	H1681_001_0	4	7	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1681	001	0	1	04	01	H1681_001_0	4	4	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H1681	001	0	1	04	01	H1681_001_0	4	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1681	001	0	1	04	01	H1681_001_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1681	001	0	1	04	01	H1681_001_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H1681	001	0	1	04	01	H1681_001_0	4	2	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H1681	002	0	1	04	01	H1681_002_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H1681	002	0	1	04	01	H1681_002_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1681	002	0	1	04	01	H1681_002_0	4	7	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1681	002	0	1	04	01	H1681_002_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H1681	002	0	1	04	01	H1681_002_0	4	5	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H1681	002	0	1	04	01	H1681_002_0	4	4	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H1681	002	0	1	04	01	H1681_002_0	4	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1681	002	0	1	04	01	H1681_002_0	4	2	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	2	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1681	003	0	1	04	01	H1681_003_0	4	4	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H1681	003	0	1	04	01	H1681_003_0	4	5	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	7	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1681	003	0	1	04	01	H1681_003_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1681	801	0	1	04	01	H1681_801_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1681	801	0	1	04	01	H1681_801_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1681	801	0	1	04	01	H1681_801_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1681	802	0	1	04	01	H1681_802_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1681	802	0	1	04	01	H1681_802_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1681	802	0	1	04	01	H1681_802_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1681	803	0	1	04	01	H1681_803_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1681	803	0	1	04	01	H1681_803_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1681	803	0	1	04	01	H1681_803_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1681	804	0	1	04	01	H1681_804_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1681	804	0	1	04	01	H1681_804_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1681	804	0	1	04	01	H1681_804_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	2	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1716	001	0	1	04	01	H1716_001_0	3	4	100000000000000000000000000000000000000000000011		2				1	0.00	0.00	2	
H1716	001	0	1	04	01	H1716_001_0	3	5	000000000000000000000000001000000000000000000000		1	0	50	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1716	001	0	1	04	01	H1716_001_0	3	1	011111111111111111111001100100000111111111001111		1	30	30	6	2			2	
H1716	002	0	1	04	01	H1716_002_0	4	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H1716	002	0	1	04	01	H1716_002_0	4	1	011111111111111111111001100100000111111111001101		1	25	25	6	2			2	
H1716	002	0	1	04	01	H1716_002_0	4	2	000000000000000000000100000000000000000000000000		2				1	125.00	125.00	2	
H1716	002	0	1	04	01	H1716_002_0	4	3	000000000000000000000000000000000000000000000010		1	0	0	6	2			2	
H1716	002	0	1	04	01	H1716_002_0	4	4	000000000000000000000000010000000000000000100000		1	20	25	6	2			2	
H1716	002	0	1	04	01	H1716_002_0	4	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1716	004	0	1	04	01	H1716_004_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H1716	004	0	1	04	01	H1716_004_0	4	4	000000000000000000000000010000000000000000100000		1	20	25	6	2			2	
H1716	004	0	1	04	01	H1716_004_0	4	3	000000000000000000000000000000001000000000010000		1	50	50	6	2			2	
H1716	004	0	1	04	01	H1716_004_0	4	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1716	004	0	1	04	01	H1716_004_0	4	6	100000000000000000000000000000000000000000000111		2				1	0.00	0.00	2	
H1716	004	0	1	04	01	H1716_004_0	4	1	011111111111111111111001100100000111111111001101		1	25	25	6	2			2	
H1716	006	0	1	04	01	H1716_006_0	3	6	100000000000000000000000000000000000000000000111		2				1	0.00	0.00	2	
H1716	006	0	1	04	01	H1716_006_0	3	4	000000000000000000000000010000000000000000100000		1	20	25	6	2			2	
H1716	006	0	1	04	01	H1716_006_0	3	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H1716	006	0	1	04	01	H1716_006_0	3	3	000000000000000000000000000000001000000000010000		1	50	50	6	2			2	
H1716	006	0	1	04	01	H1716_006_0	3	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H1716	006	0	1	04	01	H1716_006_0	3	1	011111111111111111111001100100000111111111001101		1	25	25	6	2			2	
H1716	009	0	1	04	01	H1716_009_0	5	5	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H1716	009	0	1	04	01	H1716_009_0	5	4	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1716	009	0	1	04	01	H1716_009_0	5	3	000000000000000000000000000000001000000000010000		1	50	50	6	2			2	
H1716	009	0	1	04	01	H1716_009_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1716	009	0	1	04	01	H1716_009_0	5	1	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H1716	009	0	1	04	01	H1716_009_0	5	6	100000000000000000000000000000000000000000000111		2				1	0.00	0.00	2	
H1716	010	0	1	04	01	H1716_010_0	3	7	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H1716	010	0	1	04	01	H1716_010_0	3	5	000000000000000000000000001000000000000000000000		1	0	50	6	2			2	
H1716	010	0	1	04	01	H1716_010_0	3	4	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H1716	010	0	1	04	01	H1716_010_0	3	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1716	010	0	1	04	01	H1716_010_0	3	2	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1716	010	0	1	04	01	H1716_010_0	3	1	011111111111111111111001100110000111111111001111		1	30	30	6	2			2	
H1716	010	0	1	04	01	H1716_010_0	3	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1716	801	0	1	04	01	H1716_801_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1716	801	0	1	04	01	H1716_801_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1716	801	0	1	04	01	H1716_801_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1716	802	0	1	04	01	H1716_802_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1716	803	0	1	04	01	H1716_803_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1716	803	0	1	04	01	H1716_803_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1716	803	0	1	04	01	H1716_803_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1716	804	0	1	04	01	H1716_804_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1716	804	0	1	04	01	H1716_804_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1716	804	0	1	04	01	H1716_804_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1717	001	0	1	04	01	H1717_001_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H1717	001	0	1	04	01	H1717_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1717	001	0	1	04	01	H1717_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1717	006	0	1	04	01	H1717_006_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1717	007	0	1	04	01	H1717_007_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1717	008	0	1	04	01	H1717_008_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1717	008	0	1	04	01	H1717_008_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H1717	008	0	1	04	01	H1717_008_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1717	008	0	1	04	01	H1717_008_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1717	008	0	1	04	01	H1717_008_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1717	009	0	1	04	01	H1717_009_0	5	3	000000000000000000000000000000000000000000000010	Group 3	2				1	0.00	0.00	2	
H1717	009	0	1	04	01	H1717_009_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H1717	009	0	1	04	01	H1717_009_0	5	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H1717	009	0	1	04	01	H1717_009_0	5	4	000000000000000000000000001000000000000000000000	Group 4	1	20	20	6	2			2	
H1717	010	0	1	04	01	H1717_010_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H1717	010	0	1	04	01	H1717_010_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H1717	010	0	1	04	01	H1717_010_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H1717	010	0	1	04	01	H1717_010_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H1717	010	0	1	04	01	H1717_010_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	1	010100100000101101101000000001000001111111000000	Group 1	1	40	40	2	2			2	
H1717	801	0	1	04	01	H1717_801_0	5	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
H1717	801	0	1	04	01	H1717_801_0	5	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	3	000010000010000000000000000000000010000000000000	Group 3	2				1	25.00	25.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
H1717	801	0	1	04	01	H1717_801_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1717	801	0	1	04	01	H1717_801_0	5	4	000001010100000000000000000000000000000000001101	Group 4	2				1	35.00	35.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	1	010100100000101101101000000001000001111111000000	Group 1	1	40	40	2	2			2	
H1717	803	0	1	04	01	H1717_803_0	5	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
H1717	803	0	1	04	01	H1717_803_0	5	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
H1717	803	0	1	04	01	H1717_803_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	4	000001010100000000000000000000000000000000001101	Group 4	2				1	35.00	35.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	3	000010000010000000000000000000000010000000000000	Group 3	2				1	25.00	25.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1717	803	0	1	04	01	H1717_803_0	5	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	1	010100100000101101101000000001000001111111000000	Group 1	1	40	40	2	2			2	
H1717	804	0	1	04	01	H1717_804_0	5	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
H1717	804	0	1	04	01	H1717_804_0	5	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
H1717	804	0	1	04	01	H1717_804_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	0	40	2	1	0.00	7.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	4	000001010100000000000000000000000000000000001101	Group 4	2				1	35.00	35.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	3	000010000010000000000000000000000010000000000000	Group 3	2				1	25.00	25.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1717	804	0	1	04	01	H1717_804_0	5	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	1	010100100000101101101000000001000001111111000000	Group 1	1	40	40	2	2			2	
H1717	805	0	1	04	01	H1717_805_0	5	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
H1717	805	0	1	04	01	H1717_805_0	5	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	3	000010000010000000000000000000000010000000000000	Group 3	2				1	25.00	25.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
H1717	805	0	1	04	01	H1717_805_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	0	40	2	1	0.00	7.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H1717	805	0	1	04	01	H1717_805_0	5	4	000001010100000000000000000000000000000000001101	Group 4	2				1	35.00	35.00	2	
H1806	001	0	1	04	01	H1806_001_0	7	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H1806	001	0	1	04	01	H1806_001_0	7	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1806	001	0	1	04	01	H1806_001_0	7	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1806	001	0	1	04	01	H1806_001_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1806	001	0	1	04	01	H1806_001_0	7	4	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H1806	001	0	1	04	01	H1806_001_0	7	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	4	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	2	000000000000000000000100000000000000000000000000		2				1	75.00	75.00	2	
H1806	002	0	1	04	01	H1806_002_0	7	7	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H1806	002	0	1	04	01	H1806_002_0	7	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H1806	801	0	1	04	01	H1806_801_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1806	801	0	1	04	01	H1806_801_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1806	801	0	1	04	01	H1806_801_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1806	803	0	1	04	01	H1806_803_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1806	803	0	1	04	01	H1806_803_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1806	803	0	1	04	01	H1806_803_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1806	804	0	1	04	01	H1806_804_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1806	804	0	1	04	01	H1806_804_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1806	804	0	1	04	01	H1806_804_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1806	805	0	1	04	01	H1806_805_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H1806	805	0	1	04	01	H1806_805_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H1806	805	0	1	04	01	H1806_805_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	4	000000000000000000000000010000000000000000000000		2				2			2	
H1846	001	0	1	04	01	H1846_001_0	6	10	000000000000000000000000000000000000000000100000	Medicare Part B Rx Drugs	1	10	10	3	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	1	000000000000000000000000001000000000000000000000		2				1	0.00	0.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	11	011001001101000000011000000000000000000000000000		2				1	30.00	30.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	12	000000100010100000000000000000001000011110000000		2				1	10.00	30.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	13	100100000000000000000010000111110000000000010010		2				2			2	
H1846	001	0	1	04	01	H1846_001_0	6	9	000000000000000000000001100000000000000000000000	Medical Supplies	1	20	20	2	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	8	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	7	000000000000001110000000000000000000000001000000	Outpatient Diagnostic Test	2				1	10.00	30.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	6	000000000000010000000000000000000001100000000000		2				1	0.00	30.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	5	000000000000000001100000000000000000000000000000		2				1	200.00	200.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	3	000000010000000000000000000000000000000000000000	Physician Specialist Services	2				1	30.00	30.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	2	000010000000000000000000000000000110000000000000	Primary Care Physician Services	2				1	10.00	10.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	15	000000000000000000000000000000000000000000000001		2				1	30.00	30.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	14	000000000000000000000000000000000000000000001100		2				1	30.00	30.00	2	
H1846	801	0	1	04	01	H1846_801_0	2	1	011011110110111111111101111100001111111111101111	OON Medicare Covered Benefits	1	20	20	1	2			2	
H1846	801	0	1	04	01	H1846_801_0	2	2	000100000000000000000000000000000000000000000000	Home Health	2				2			2	
H1846	801	0	1	04	01	H1846_801_0	2	3	000000001001000000000000000000000000000000000000	OON Mental Health	1	50	50	1	2			2	
H1846	802	0	1	04	01	H1846_802_0	2	3	000000001001000000010000000000000000000000000000	OON Mental Health	1	50	50	1	2			2	
H1846	802	0	1	04	01	H1846_802_0	2	1	011011110110111111111101111100001111111111101111	OON Medicare Covered Benefits	1	20	20	1	2			2	
H1846	802	0	1	04	01	H1846_802_0	2	2	000100000000000000000000000000000000000000000000	Home Health	2				2			2	
H1944	803	0	1	02	01	H1944_803_0	6	1	0100011101001000000010000000000000000000001101	Group 1	2				1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	2	0010000000000000000000000000000000000000000000	Group 2	2				1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	3	0001000000000000011000011100100000111111100010	Group 3	1	30	30	6	1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	4	0000100000100000000000000000000001000000000000	Group 4	2				1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	9	0000000000000000000000000010000010000000000000	Group 9	2				1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	6	0000000000000111000000000000000000000000000000	Group 6	1	30	30	6	1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	7	0000000000000000100000000000000000000000000000	Group 7	2				1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	8	0000000000000000000001000000000000000000000000	Group 8	2				1	30.00	30.00	2	
H1944	803	0	1	02	01	H1944_803_0	6	5	0000000010010000000100000000000000000000000000	Group 5	2				1	30.00	30.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	10	100000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H2001	001	0	1	04	01	H2001_001_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H2001	001	0	1	04	01	H2001_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	0	30	6	1	0.00	7.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	8	000000000000000010000000000000000000000000000000	Group 8	2				1	20.00	20.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	4	000000000000000000000001110000000000000000000010	Group 4	1	30	30	6	2			2	
H2001	003	0	1	04	01	H2001_003_0	4	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	6	000000000000010000000000000000000000000000000000	Group 6	1	25	25	6	1	7.00	7.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	8	000010000010000010000000000000000010000000000000	Group 8	2				1	20.00	20.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H2001	003	0	1	04	01	H2001_003_0	4	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	10	100000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H2001	003	0	1	04	01	H2001_003_0	4	3	000100000000001101100000000001000001111111100000	Group 3	1	25	25	6	2			2	
H2001	007	0	1	04	01	H2001_007_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2001	007	0	1	04	01	H2001_007_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2001	007	0	1	04	01	H2001_007_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				2			2	
H2001	007	0	1	04	01	H2001_007_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2001	007	0	1	04	01	H2001_007_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2001	801	0	1	04	01	H2001_801_0	2	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H2001	801	0	1	04	01	H2001_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H2001	801	0	1	04	01	H2001_801_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
H2001	801	0	1	04	01	H2001_801_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H2001	803	0	1	04	01	H2001_803_0	2	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H2001	803	0	1	04	01	H2001_803_0	2	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H2001	803	0	1	04	01	H2001_803_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
H2001	803	0	1	04	01	H2001_803_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H2001	804	0	1	04	01	H2001_804_0	2	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H2001	804	0	1	04	01	H2001_804_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H2001	804	0	1	04	01	H2001_804_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H2001	804	0	1	04	01	H2001_804_0	2	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
H2001	804	0	1	04	01	H2001_804_0	2	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H2001	804	0	1	04	01	H2001_804_0	2	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H2001	804	0	1	04	01	H2001_804_0	2	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H2001	804	0	1	04	01	H2001_804_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
H2001	804	0	1	04	01	H2001_804_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H2001	804	0	1	04	01	H2001_804_0	2	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H2001	805	0	1	04	01	H2001_805_0	2	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
H2001	805	0	1	04	01	H2001_805_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H2001	805	0	1	04	01	H2001_805_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
H2003	001	0	1	04	01	H2003_001_0	4	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H2003	001	0	1	04	01	H2003_001_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	35.00	2	
H2003	001	0	1	04	01	H2003_001_0	4	3	000000000000000000000000001000000000000000000010	Group 3	2				1	0.00	0.00	2	
H2003	002	0	1	04	01	H2003_002_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2003	002	0	1	04	01	H2003_002_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H2003	002	0	1	04	01	H2003_002_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2003	002	0	1	04	01	H2003_002_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2003	002	0	1	04	01	H2003_002_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2029	001	0	1	04	01	H2029_001_0	4	2	011011111101100000011100000100000011100011001101		2				1	10.00	10.00	2	
H2029	001	0	1	04	01	H2029_001_0	4	1	100100000010000000100001101000000100000000100111		2				1	0.00	0.00	2	
H2029	001	0	1	04	01	H2029_001_0	4	3	000000000000011110000000000000001000011100000000		2				1	0.00	10.00	2	
H2029	001	0	1	04	01	H2029_001_0	4	4	000000000000000001000000000000000000000000000000		2				1	10.00	15.00	2	
H2029	001	0	1	04	01	H2029_001_0	4	5	000000000000000000000000010000000000000000000000		1	0	20	6	2			2	
H2029	001	0	1	04	01	H2029_001_0	4	6	000000000000000000000000000000000000000000011000		1	20	50	6	2			2	
H2029	801	0	1	04	01	H2029_801_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2029	801	0	1	04	01	H2029_801_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2029	801	0	1	04	01	H2029_801_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2029	802	0	1	04	01	H2029_802_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2029	802	0	1	04	01	H2029_802_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2029	802	0	1	04	01	H2029_802_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2029	803	0	1	04	01	H2029_803_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2029	803	0	1	04	01	H2029_803_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2029	803	0	1	04	01	H2029_803_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2029	804	0	1	04	01	H2029_804_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2029	804	0	1	04	01	H2029_804_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2029	804	0	1	04	01	H2029_804_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2047	001	0	1	04	01	H2047_001_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H2047	001	0	1	04	01	H2047_001_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H2047	001	0	1	04	01	H2047_001_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H2047	001	0	1	04	01	H2047_001_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	10.00	10.00	2	
H2047	001	0	1	04	01	H2047_001_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H2047	002	0	1	04	01	H2047_002_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H2047	002	0	1	04	01	H2047_002_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	15.00	15.00	2	
H2047	002	0	1	04	01	H2047_002_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H2047	002	0	1	04	01	H2047_002_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H2047	002	0	1	04	01	H2047_002_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H2047	801	0	1	04	01	H2047_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H2047	801	0	1	04	01	H2047_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H2047	801	0	1	04	01	H2047_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H2047	802	0	1	04	01	H2047_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H2047	802	0	1	04	01	H2047_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H2047	802	0	1	04	01	H2047_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	1	011101111111111111111111110101000111111111100101	Group 1	1	30	30	6	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	3	100000000000000000000000001000000000000000010010	Group 3	2				1	0.00	0.00	2	
H2111	001	0	1	04	01	H2111_001_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	10.00	2	
H2111	001	0	1	04	01	H2111_001_0	4	4	000000000000000000000000000000001000000000001000	Group 4	1	0	30	6	2			2	
H2111	008	0	1	04	01	H2111_008_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2111	008	0	1	04	01	H2111_008_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2111	008	0	1	04	01	H2111_008_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2111	008	0	1	04	01	H2111_008_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2111	008	0	1	04	01	H2111_008_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2111	009	0	1	04	01	H2111_009_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2111	009	0	1	04	01	H2111_009_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2111	009	0	1	04	01	H2111_009_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2111	009	0	1	04	01	H2111_009_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2111	009	0	1	04	01	H2111_009_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2111	010	0	1	04	01	H2111_010_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2111	010	0	1	04	01	H2111_010_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2111	010	0	1	04	01	H2111_010_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2111	010	0	1	04	01	H2111_010_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2111	010	0	1	04	01	H2111_010_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2111	011	0	1	04	01	H2111_011_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2111	011	0	1	04	01	H2111_011_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2111	011	0	1	04	01	H2111_011_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2111	011	0	1	04	01	H2111_011_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H2111	011	0	1	04	01	H2111_011_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2111	012	0	1	04	01	H2111_012_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2111	012	0	1	04	01	H2111_012_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2111	012	0	1	04	01	H2111_012_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2111	012	0	1	04	01	H2111_012_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2111	012	0	1	04	01	H2111_012_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H2111	013	0	1	04	01	H2111_013_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2111	013	0	1	04	01	H2111_013_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H2111	013	0	1	04	01	H2111_013_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2111	013	0	1	04	01	H2111_013_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2111	013	0	1	04	01	H2111_013_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2228	001	0	1	04	01	H2228_001_0	5	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H2228	001	0	1	04	01	H2228_001_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2228	001	0	1	04	01	H2228_001_0	5	3	000000000000000000000000000000000000000000000010	Group 3	2				1	0.00	0.00	2	
H2228	001	0	1	04	01	H2228_001_0	5	4	000000000000000000000000001000000000000000000000	Group 4	1	20	20	6	2			2	
H2228	002	0	1	04	01	H2228_002_0	6	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H2228	002	0	1	04	01	H2228_002_0	6	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2228	002	0	1	04	01	H2228_002_0	6	3	000000000000000000000000000000000000000000000010	Group 3	2				1	0.00	0.00	2	
H2228	002	0	1	04	01	H2228_002_0	6	4	000000000000000000000000001000000000000000000000	Group 4	1	20	20	6	2			2	
H2228	004	0	1	04	01	H2228_004_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2228	004	0	1	04	01	H2228_004_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2228	004	0	1	04	01	H2228_004_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2228	004	0	1	04	01	H2228_004_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2228	004	0	1	04	01	H2228_004_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H2228	009	0	1	04	01	H2228_009_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H2228	009	0	1	04	01	H2228_009_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H2228	009	0	1	04	01	H2228_009_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H2228	009	0	1	04	01	H2228_009_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H2228	009	0	1	04	01	H2228_009_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H2229	028	0	1	04	01	H2229_028_0	6	7	100000000000000000000010000010000000000000010000	Benefits Not Covered	2				2			2	
H2229	028	0	1	04	01	H2229_028_0	6	8	000000000000000000000000000000001000000000000000	Hlth/Wllness-Fitness  Smoking Cessation	2				1	0.00	30.00	2	
H2229	028	0	1	04	01	H2229_028_0	6	1	000100000000000001100001100000000000000000100000	Coinsurance w/ Auth Requested	1	20	20	6	2			2	
H2229	028	0	1	04	01	H2229_028_0	6	2	000000000000011110000000011100110101111111000000	Coinsurance w/out Auth Requested	1	20	20	6	2			2	
H2229	028	0	1	04	01	H2229_028_0	6	3	011000000000000000001000000000000000000000000000	Copay w/ Auth Requested	2				1	30.00	30.00	2	
H2229	028	0	1	04	01	H2229_028_0	6	4	000011111111100000010000000000000010000000001101	Copay w/o Auth Requested	2				1	30.00	30.00	2	
H2229	028	0	1	04	01	H2229_028_0	6	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	0.00	0.00	2	
H2229	028	0	1	04	01	H2229_028_0	6	6	000000000000000000000000000001000000000000000010	Routine Eyewear, Wigs, Fitness Benefits	2				1	0.00	0.00	2	
H2229	029	0	1	04	01	H2229_029_0	6	3	011000000000000000001000000000000000000000000000	Copay w/ Auth Requested	2				1	30.00	30.00	2	
H2229	029	0	1	04	01	H2229_029_0	6	2	000000000000011110000000011100110101111111000000	Coinsurance w/out Auth Requested	1	20	20	6	2			2	
H2229	029	0	1	04	01	H2229_029_0	6	8	000000000000000000000000000000001000000000000000	Hlth/Wllness-Fitness  Smoking Cessation	2				1	0.00	30.00	2	
H2229	029	0	1	04	01	H2229_029_0	6	7	100000000000000000000010000010000000000000010000	Benefits Not Covered	2				2			2	
H2229	029	0	1	04	01	H2229_029_0	6	6	000000000000000000000000000001000000000000000010	Routine Eyewear, Wigs, Fitness Benefits	2				1	0.00	0.00	2	
H2229	029	0	1	04	01	H2229_029_0	6	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	0.00	0.00	2	
H2229	029	0	1	04	01	H2229_029_0	6	4	000011111111100000010000000000000010000000001101	Copay w/o Auth Requested	2				1	30.00	30.00	2	
H2229	029	0	1	04	01	H2229_029_0	6	1	000100000000000001100001100000000000000000100000	Coinsurance w/ Auth Requested	1	20	20	6	2			2	
H2229	030	0	1	04	01	H2229_030_0	4	1	000100000000000001100001100000000000000000100000	Coinsurance w/ Auth Requested	1	20	20	6	2			2	
H2229	030	0	1	04	01	H2229_030_0	4	7	100000000000000000000010000010000000000000010000	Benefits Not Covered	2				2			2	
H2229	030	0	1	04	01	H2229_030_0	4	6	000000000000000000000000000001000000000000000010	Routine Eyewear, Wigs, Fitness Benefits	2				1	0.00	0.00	2	
H2229	030	0	1	04	01	H2229_030_0	4	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	0.00	0.00	2	
H2229	030	0	1	04	01	H2229_030_0	4	4	000011111111100000010000000000000010000000001101	Copay w/o Auth Requested	2				1	30.00	30.00	2	
H2229	030	0	1	04	01	H2229_030_0	4	3	011000000000000000001000000000000000000000000000	Copay w/ Auth Requested	2				1	30.00	30.00	2	
H2229	030	0	1	04	01	H2229_030_0	4	2	000000000000011110000000011100110101111111000000	Coinsurance w/out Auth Requested	1	20	20	6	2			2	
H2229	030	0	1	04	01	H2229_030_0	4	8	000000000000000000000000000000001000000000000000	Hlth/Wllness-Fitness  Smoking Cessation	2				1	0.00	30.00	2	
H2229	801	0	1	04	01	H2229_801_0	4	3	011000000000000000001000000000000000000000000000	Copay w/ Auth Requested	2				1	30.00	30.00	2	
H2229	801	0	1	04	01	H2229_801_0	4	2	000000000000011110000000011100110101111111000000	Coinsurance w/out Auth Requested	1	20	20	6	2			2	
H2229	801	0	1	04	01	H2229_801_0	4	1	000100000000000001100001100000000000000000100000	Coinsurance w/ Auth Requested	1	20	20	6	2			2	
H2229	801	0	1	04	01	H2229_801_0	4	4	000011111111100000010000000000000010000000001101	Copay w/o Auth Requested	2				1	30.00	30.00	2	
H2229	801	0	1	04	01	H2229_801_0	4	8	000000000000000000000000000000001000000000000000		2				1	0.00	30.00	2	
H2229	801	0	1	04	01	H2229_801_0	4	7	100000000000000000000010000010000000000000010000	Benefits Not Covered	2				2			2	
H2229	801	0	1	04	01	H2229_801_0	4	6	000000000000000000000000000001000000000000000010	Routine Eyewear, Wigs, Fitness Benefits	2				1	0.00	0.00	2	
H2229	801	0	1	04	01	H2229_801_0	4	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	0.00	0.00	2	
H2229	802	0	1	04	01	H2229_802_0	4	1	000100000000000001100001100000000000000000100000	Coinsurance w/ Auth Requested	1	20	20	6	2			2	
H2229	802	0	1	04	01	H2229_802_0	4	2	000000000000011110000000011100110101111111000000	Coinsurance w/out Auth Requested	1	20	20	6	2			2	
H2229	802	0	1	04	01	H2229_802_0	4	8	000000000000000000000000000000001000000000000000		2				1	0.00	30.00	2	
H2229	802	0	1	04	01	H2229_802_0	4	7	100000000000000000000010000010000000000000010000	Benefits Not Covered	2				2			2	
H2229	802	0	1	04	01	H2229_802_0	4	6	000000000000000000000000000001000000000000000010	Routine Eyewear, Wigs, Fitness Benefits	2				1	0.00	0.00	2	
H2229	802	0	1	04	01	H2229_802_0	4	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	0.00	0.00	2	
H2229	802	0	1	04	01	H2229_802_0	4	4	000011111111100000010000000000000010000000001101	Copay w/o Auth Requested	2				1	30.00	30.00	2	
H2229	802	0	1	04	01	H2229_802_0	4	3	011000000000000000001000000000000000000000000000	Copay w/ Auth Requested	2				1	30.00	30.00	2	
H2229	803	0	1	04	01	H2229_803_0	4	1	000100000000000001100001100000000000000000100000	Coinsurance w/ Auth Requested	1	20	20	6	2			2	
H2229	803	0	1	04	01	H2229_803_0	4	4	000011111111100000010000000000000010000000001101	Copay w/o Auth Requested	2				1	30.00	30.00	2	
H2229	803	0	1	04	01	H2229_803_0	4	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	0.00	0.00	2	
H2229	803	0	1	04	01	H2229_803_0	4	6	000000000000000000000000000001000000000000000010	Routine Eyewear, Wigs, Fitness Benefits	2				1	0.00	0.00	2	
H2229	803	0	1	04	01	H2229_803_0	4	7	100000000000000000000010000010000000000000010000	Benefits Not Covered	2				2			2	
H2229	803	0	1	04	01	H2229_803_0	4	3	011000000000000000001000000000000000000000000000	Copay w/ Auth Requested	2				1	30.00	30.00	2	
H2229	803	0	1	04	01	H2229_803_0	4	2	000000000000011110000000011100110101111111000000	Coinsurance w/out Auth Requested	1	20	20	6	2			2	
H2229	803	0	1	04	01	H2229_803_0	4	8	000000000000000000000000000000001000000000000000		2				1	0.00	30.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	8	000000000000000000000000000000000000000010100000		2				1	0.00	0.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	7	000000000000000000000000000001000000000000000000		2				1	0.00	0.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	6	000000000000000000000000000000000000010000000000		1	20	20	1	1	40.00	40.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	9	000000000000000000000000000000000000000001000000		1	20	20	1	1	25.00	25.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	3	000000000000000000000100000000000000000000000000		2				1	0.00	100.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	2	000010010100000000000000000000000010000000011101		2				1	40.00	40.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	10	000000000000000000000000000000001000000000000000		2				1	0.00	40.00	2	
H2230	002	0	1	04	01	H2230_002_0	8	1	011101101011111111111001111100000101101100000000		1	20	20	1	2			2	
H2230	002	0	1	04	01	H2230_002_0	8	4	100000000000000000000000000000000000000000000000		2				1	0.00	0.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	8	000000000000000000000000000000000000000010100000		2				1	0.00	0.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	7	000000000000000000000000000001000000000000000000		2				1	0.00	0.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	6	000000000000000000000000000000000000010000000000		1	20	20	1	1	40.00	40.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	4	100000000000000000000000000000000000000000000000		2				1	0.00	0.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	3	000000000000000000000100000000000000000000000000		2				1	0.00	100.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	2	000010010100000000000000000000000010000000011101		2				1	40.00	40.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	10	000000000000000000000000000000001000000000000000		2				1	0.00	40.00	2	
H2230	006	0	1	04	01	H2230_006_0	7	1	011101101011111111111001111100000101101100000000		1	20	20	1	2			2	
H2230	006	0	1	04	01	H2230_006_0	7	9	000000000000000000000000000000000000000001000000		1	20	20	1	1	25.00	25.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	1	011101101011111111111001111100000101101100000000		1	20	20	1	2			2	
H2230	801	0	1	04	01	H2230_801_0	5	10	000000000000000000000000000000001000000000000000		2				1	0.00	40.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	9	000000000000000000000000000000000000000001000000		1	20	20	1	1	25.00	25.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	8	000000000000000000000000000000000000000010100000		2				1	0.00	0.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	7	000000000000000000000000000001000000000000000000		2				1	0.00	0.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	6	000000000000000000000000000000000000010000000000		1	20	20	1	1	40.00	40.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	4	100000000000000000000000000000000000000000000000		2				1	0.00	0.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	3	000000000000000000000100000000000000000000000000		2				1	0.00	100.00	2	
H2230	801	0	1	04	01	H2230_801_0	5	2	000010010100000000000000000000000010000000011101		2				1	40.00	40.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	1	011101101011111111111001111100000101101100000000		1	20	20	1	2			2	
H2230	809	0	1	04	01	H2230_809_0	5	8	000000000000000000000000000000000000000010100000		2				1	0.00	0.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	7	000000000000000000000000000001000000000000000000		2				1	0.00	0.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	6	000000000000000000000000000000000000010000000000		1	20	20	1	1	40.00	40.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	9	000000000000000000000000000000000000000001000000		1	20	20	1	1	25.00	25.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	4	100000000000000000000000000000000000000000000000		2				1	0.00	0.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	3	000000000000000000000100000000000000000000000000		2				1	0.00	100.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	2	000010010100000000000000000000000010000000011101		2				1	40.00	40.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	10	000000000000000000000000000000001000000000000000		2				1	0.00	40.00	2	
H2230	809	0	1	04	01	H2230_809_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H2322	001	0	1	04	01	H2322_001_0	8	1	111111111111111111111100011100001111111111101111		1	20	20	2	2			2	
H2322	001	0	1	04	01	H2322_001_0	8	2	000000000000000000000001100000000000000000000000		1	50	50	2	2			2	
H2322	003	0	1	04	01	H2322_003_0	6	1	111111111111111111111100011100001111111111101111		1	20	20	2	2			2	
H2322	003	0	1	04	01	H2322_003_0	6	2	000000000000000000000001100000000000000000000000		1	50	50	2	2			2	
H2322	004	0	1	04	01	H2322_004_0	8	1	111111111111111111111100011100001111111111101111		1	20	20	2	2			2	
H2322	004	0	1	04	01	H2322_004_0	8	2	000000000000000000000001100000000000000000000000		1	50	50	2	2			2	
H2322	005	0	1	04	01	H2322_005_0	6	1	111111111111111111111100011100001111111111101111		1	20	20	2	2			2	
H2322	005	0	1	04	01	H2322_005_0	6	2	000000000000000000000001100000000000000000000000		1	50	50	2	2			2	
H2322	006	0	1	04	01	H2322_006_0	9	1	111111111111111111111100011100001111111111101111		1	20	20	2	2			2	
H2322	006	0	1	04	01	H2322_006_0	9	2	000000000000000000000001100000000000000000000000		1	50	50	2	2			2	
H2322	007	0	1	04	01	H2322_007_0	8	1	111111111111111111111100011100001111111111101111		1	20	20	2	2			2	
H2322	007	0	1	04	01	H2322_007_0	8	2	000000000000000000000001100000000000000000000000		1	50	50	2	2			2	
H2322	801	0	1	04	01	H2322_801_0	3	1	111111110110111111101101111100001111111111101111		1	0	20	2	2			2	
H2322	801	0	1	04	01	H2322_801_0	3	2	000000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H2322	803	0	1	04	01	H2322_803_0	3	1	111111110110111111101101111100001111111111101111		1	0	20	2	2			2	
H2322	803	0	1	04	01	H2322_803_0	3	2	000000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H2322	804	0	1	04	01	H2322_804_0	3	1	111111110110111111101101111100001111111111101111		1	0	20	2	2			2	
H2322	804	0	1	04	01	H2322_804_0	3	2	000000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H2406	001	0	1	04	01	H2406_001_0	4	1	011101111111111111111111110101001111111111101101	Group 1	1	30	30	6	2			2	
H2406	001	0	1	04	01	H2406_001_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	35.00	2	
H2406	001	0	1	04	01	H2406_001_0	4	3	000000000000000000000000001000000000000000000010	Group 3	2				1	0.00	0.00	2	
H2411	002	0	1	04	01	H2411_002_0	7	3	000000000000000000000000000000000000000000000010		1	20	20	2	2			2	
H2411	002	0	1	04	01	H2411_002_0	7	2	000000000000000000000000000000001000000000000000		2				1	0.00	25.00	2	
H2411	002	0	1	04	01	H2411_002_0	7	1	011100000000011111111001111100000000000000000000		1	20	20	2	2			2	
H2411	002	0	1	04	01	H2411_002_0	7	4	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H2411	002	0	1	04	01	H2411_002_0	7	6	000011111111100000000000000000000111111111001101		2				1	40.00	40.00	2	
H2411	002	0	1	04	01	H2411_002_0	7	5	000000000000000000000000000000000000000000100000		2				1	10.00	55.00	2	
H2411	801	0	1	04	01	H2411_801_0	4	1	011111111111111111111001111100000111111111001101		1	20	20	2	2			2	
H2411	801	0	1	04	01	H2411_801_0	4	2	000000000000000000000000000000001000000000000000		2				1	0.00	20.00	2	
H2411	801	0	1	04	01	H2411_801_0	4	4	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H2411	801	0	1	04	01	H2411_801_0	4	3	000000000000000000000000000000000000000000000010		1	20	20	2	2			2	
H2411	801	0	1	04	01	H2411_801_0	4	5	000000000000000000000000000000000000000000100000		2				1	10.00	60.00	2	
H2411	803	0	1	04	01	H2411_803_0	4	3	000000000000000000000000000000000000000000000010		1	20	20	2	2			2	
H2411	803	0	1	04	01	H2411_803_0	4	2	000000000000000000000000000000001000000000000000		2				1	0.00	20.00	2	
H2411	803	0	1	04	01	H2411_803_0	4	1	011111111111111111111001111100000111111111001101		1	20	20	2	2			2	
H2411	803	0	1	04	01	H2411_803_0	4	4	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H2411	803	0	1	04	01	H2411_803_0	4	5	000000000000000000000000000000000000000000100000		2				1	10.00	60.00	2	
H2481	003	0	1	04	01	H2481_003_0	4	5	100000000000000000000000000000000000000000001000	Hearing aids non covered	2				2			2	
H2481	003	0	1	04	01	H2481_003_0	4	4	000000010111000000000000000000000000000000000000	$40 level	2				1	40.00	40.00	2	
H2481	003	0	1	04	01	H2481_003_0	4	3	001011101000100000011000000010001000000000010101	$20 level	2				1	20.00	20.00	2	
H2481	003	0	1	04	01	H2481_003_0	4	2	000100000000011111000001100100000011111100100000	20% services	1	20	20	2	2			2	
H2481	003	0	1	04	01	H2481_003_0	4	1	010000000000000000000000000000000000000000000000	Hospital related	2				1	20.00	20.00	2	
H2481	003	0	1	04	01	H2481_003_0	4	8	000000000000000000000100000000000000000000000000	$50 level	2				1	50.00	50.00	2	
H2481	003	0	1	04	01	H2481_003_0	4	7	000000000000000000000000011001000100000011000010	no costshare	1	0	0	2	2			2	
H2481	003	0	1	04	01	H2481_003_0	4	6	000000000000000000100000000000000000000000000000	Outpatient surgery	2				1	200.00	200.00	2	
H2481	004	0	1	04	01	H2481_004_0	7	5	100000000000000000000000000000000000000000001000	Hearing aids non covered	2				2			2	
H2481	004	0	1	04	01	H2481_004_0	7	4	000000010111000000000000000000000000000000000000	$40 level	2				1	40.00	40.00	2	
H2481	004	0	1	04	01	H2481_004_0	7	3	001011101000100000011000000010001000000000010101	$20 level	2				1	20.00	20.00	2	
H2481	004	0	1	04	01	H2481_004_0	7	2	000100000000011111000001100100000011111100100000	20% services	1	20	20	2	2			2	
H2481	004	0	1	04	01	H2481_004_0	7	1	010000000000000000000000000000000000000000000000	Hospital related	2				1	20.00	20.00	2	
H2481	004	0	1	04	01	H2481_004_0	7	6	000000000000000000100000000000000000000000000000	Outpatient surgery	2				1	200.00	200.00	2	
H2481	004	0	1	04	01	H2481_004_0	7	7	000000000000000000000000011001000100000011000010	no costshare	1	0	0	2	2			2	
H2481	004	0	1	04	01	H2481_004_0	7	8	000000000000000000000100000000000000000000000000	$50 level	2				1	50.00	50.00	2	
H2481	005	0	1	04	01	H2481_005_0	5	1	010000000000000000000000000000000000000000000000	Hospital related	2				1	20.00	20.00	2	
H2481	005	0	1	04	01	H2481_005_0	5	2	000100000000011111000001100100000011111100100000	20% services	1	20	20	2	2			2	
H2481	005	0	1	04	01	H2481_005_0	5	3	001011101000100000011000000010001000000000010101	$20 level	2				1	20.00	20.00	2	
H2481	005	0	1	04	01	H2481_005_0	5	4	000000010111000000000000000000000000000000000000	$40 level	2				1	40.00	40.00	2	
H2481	005	0	1	04	01	H2481_005_0	5	5	100000000000000000000000000000000000000000001000	Hearing aids non covered	2				2			2	
H2481	005	0	1	04	01	H2481_005_0	5	6	000000000000000000100000000000000000000000000000	Outpatient surgery	2				1	200.00	200.00	2	
H2481	005	0	1	04	01	H2481_005_0	5	7	000000000000000000000000011001000100000011000010	no costshare	1	0	0	2	2			2	
H2481	005	0	1	04	01	H2481_005_0	5	8	000000000000000000000100000000000000000000000000	$50 level	2				1	50.00	50.00	2	
H2481	006	0	1	04	01	H2481_006_0	7	1	010000000000000000000000000000000000000000000000	Hospital related	2				1	20.00	20.00	2	
H2481	006	0	1	04	01	H2481_006_0	7	2	000100000000011111000001100100000011111100100000	20% services	1	20	20	2	2			2	
H2481	006	0	1	04	01	H2481_006_0	7	3	001011101000100000011000000010001000000000010101	$20 level	2				1	20.00	20.00	2	
H2481	006	0	1	04	01	H2481_006_0	7	8	000000000000000000000100000000000000000000000000	$50 level	2				1	50.00	50.00	2	
H2481	006	0	1	04	01	H2481_006_0	7	5	100000000000000000000000000000000000000000001000	Hearing aids non covered	2				2			2	
H2481	006	0	1	04	01	H2481_006_0	7	6	000000000000000000100000000000000000000000000000	Outpatient surgery	2				1	200.00	200.00	2	
H2481	006	0	1	04	01	H2481_006_0	7	7	000000000000000000000000011001000100000011000010	no costshare	1	0	0	2	2			2	
H2481	006	0	1	04	01	H2481_006_0	7	4	000000010111000000000000000000000000000000000000	$40 level	2				1	40.00	40.00	2	
H2542	001	0	1	04	01	H2542_001_0	7	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H2542	001	0	1	04	01	H2542_001_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H2542	001	0	1	04	01	H2542_001_0	7	1	000000000000000000000000010000000000000000100000		1	20	40	6	2			2	
H2542	001	0	1	04	01	H2542_001_0	7	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H2542	001	0	1	04	01	H2542_001_0	7	7	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H2542	001	0	1	04	01	H2542_001_0	7	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H2542	001	0	1	04	01	H2542_001_0	7	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H2542	002	0	1	04	01	H2542_002_0	6	1	000000000000000000000000010000000000000000100000		1	20	40	6	2			2	
H2542	002	0	1	04	01	H2542_002_0	6	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H2542	002	0	1	04	01	H2542_002_0	6	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H2542	002	0	1	04	01	H2542_002_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H2542	002	0	1	04	01	H2542_002_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H2542	002	0	1	04	01	H2542_002_0	6	7	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H2542	002	0	1	04	01	H2542_002_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H2542	801	0	1	04	01	H2542_801_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2542	801	0	1	04	01	H2542_801_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2542	801	0	1	04	01	H2542_801_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2542	802	0	1	04	01	H2542_802_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2542	802	0	1	04	01	H2542_802_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2542	802	0	1	04	01	H2542_802_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2542	803	0	1	04	01	H2542_803_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2542	803	0	1	04	01	H2542_803_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2542	803	0	1	04	01	H2542_803_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2542	804	0	1	04	01	H2542_804_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H2542	804	0	1	04	01	H2542_804_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H2542	804	0	1	04	01	H2542_804_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H2611	001	0	1	04	01	H2611_001_0	9	1	011111111111111111111101111100001111111111101111		1	20	20	1	2			2	
H2611	002	0	1	04	01	H2611_002_0	9	5	000000000000010000000000000000000000000000000000	Group 5	1	0	20	1	2			2	
H2611	002	0	1	04	01	H2611_002_0	9	2	010001111111100000010000000000000000000000001101	Group 2	2				1	15.00	15.00	2	
H2611	002	0	1	04	01	H2611_002_0	9	1	000010000000000000000000000000000010000000000000	Group 1	2				1	5.00	5.00	2	
H2611	002	0	1	04	01	H2611_002_0	9	3	000100000000000011101100010000000111111111000010	Group 3	2				1	0.00	0.00	2	
H2611	002	0	1	04	01	H2611_002_0	9	4	001000000000001100000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	003	0	1	04	01	H2611_003_0	8	1	010010100000100000000000000000000010000000000000	Group 1	2				1	5.00	5.00	2	
H2611	003	0	1	04	01	H2611_003_0	8	2	000001011111000000010000000000000000000000001101	Group 2	2				1	15.00	15.00	2	
H2611	003	0	1	04	01	H2611_003_0	8	3	000100000000000001101100010000000111111111000010	Group 3	2				1	0.00	0.00	2	
H2611	003	0	1	04	01	H2611_003_0	8	4	001000000000011110000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	005	0	1	04	01	H2611_005_0	6	5	000000000000010000000000000000000000000000000000	Group 5	1	0	20	1	2			2	
H2611	005	0	1	04	01	H2611_005_0	6	4	001000000000001110000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	005	0	1	04	01	H2611_005_0	6	3	000100000000000001101100010000000101111111000010	Group 3	2				1	0.00	0.00	2	
H2611	005	0	1	04	01	H2611_005_0	6	2	010001011111000000010000000000000000000000001101	Group 2	2				1	15.00	15.00	2	
H2611	005	0	1	04	01	H2611_005_0	6	1	000010100000100000000000000000000010000000000000	Group 1	2				1	5.00	5.00	2	
H2611	006	0	1	04	01	H2611_006_0	6	4	001000000000011110000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	006	0	1	04	01	H2611_006_0	6	3	000100000000000001101100010000000101111111000010	Group 3	2				1	0.00	0.00	2	
H2611	006	0	1	04	01	H2611_006_0	6	2	000001011111000000010000000000000000000000001101	Group 2	2				1	15.00	15.00	2	
H2611	006	0	1	04	01	H2611_006_0	6	1	010010100000100000000000000000000010000000000000	Group 1	2				1	5.00	5.00	2	
H2611	008	0	1	04	01	H2611_008_0	8	2	000000000000000000000000000000000000000000000010	OON Routine Eye Wear	2				2			2	
H2611	008	0	1	04	01	H2611_008_0	8	1	011111111111111111111101111100001111111111101111		1	20	20	1	2			2	
H2611	010	0	1	04	01	H2611_010_0	4	3	000100000000000011101100010000000101111111000010	Group 3	2				1	0.00	0.00	2	
H2611	010	0	1	04	01	H2611_010_0	4	1	000010000000000000000000000000000010000000000000	Group 1	2				1	5.00	5.00	2	
H2611	010	0	1	04	01	H2611_010_0	4	2	010001111111100000010000000000000000000000001101	Group 2	2				1	15.00	15.00	2	
H2611	010	0	1	04	01	H2611_010_0	4	4	001000000000011100000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	012	0	1	04	01	H2611_012_0	6	4	001000000000011110000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	012	0	1	04	01	H2611_012_0	6	3	000100000000000001101100010000000101111111000010	Group 3	2				1	0.00	0.00	2	
H2611	012	0	1	04	01	H2611_012_0	6	2	010001111111100000010000000000000000000000001101	Group 2	2				1	30.00	30.00	2	
H2611	012	0	1	04	01	H2611_012_0	6	1	000010000000000000000000000000000010000000000000	Group 1	2				1	15.00	15.00	2	
H2611	016	0	1	04	01	H2611_016_0	7	4	001000000000011100000001101100001000000000100000	Group 4	1	20	20	1	2			2	
H2611	016	0	1	04	01	H2611_016_0	7	3	000100000000000011101100010000000101111111000010	Group 3	2				1	0.00	0.00	2	
H2611	016	0	1	04	01	H2611_016_0	7	2	010001111111100000010000000000000000000000001101	Group 2	2				1	15.00	15.00	2	
H2611	016	0	1	04	01	H2611_016_0	7	1	000010000000000000000000000000000010000000000000	Group 1	2				1	5.00	5.00	2	
H2611	801	0	1	04	01	H2611_801_0	3	1	011111111111111111111101111100001111111111101111		1	20	20	1	2			2	
H2611	802	0	1	04	01	H2611_802_0	5	1	011111111111111111111101111100001111111111101111		1	20	20	1	2			2	
H2611	807	0	1	04	01	H2611_807_0	3	1	011111111111111111111101111100001111111111101111		1	20	20	1	2			2	
H2611	809	0	1	04	01	H2611_809_0	5	1	011111111111111111111101111100001111111111101111		1	20	20	1	2			2	
H2701	001	0	1	04	01	H2701_001_0	5	1	011111111111110011011000000000001111111111001101	Part B  and Preventative Services	2				1	30.00	30.00	2	
H2701	001	0	1	04	01	H2701_001_0	5	3	000000000000001100100000000000000000000000000000	Outpatient Facility  Radiological	2				1	150.00	150.00	2	
H2701	001	0	1	04	01	H2701_001_0	5	5	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	100.00	100.00	2	
H2701	001	0	1	04	01	H2701_001_0	5	6	000000000000000000000000000100000000000000010010	Preventative Dental  Eye Wear	2				1	0.00	0.00	2	
H2701	001	0	1	04	01	H2701_001_0	5	4	000000000000000000000000001000000000000000100000	Part B Rx  ESRD	1	20	20	1	2			2	
H2701	001	0	1	04	01	H2701_001_0	5	2	000000000000000000000001110000000000000000000000	DME/PROS/Supplies	1	50	50	1	2			2	
H2701	003	0	1	04	01	H2701_003_0	6	2	000000000000000000000001110000000000000000000000	DME/PROS/Supplies	1	50	50	1	2			2	
H2701	003	0	1	04	01	H2701_003_0	6	4	000000000000000000000000000000000000000000100000	Part B Rx	1	30	30	1	2			2	
H2701	003	0	1	04	01	H2701_003_0	6	5	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	100.00	100.00	2	
H2701	003	0	1	04	01	H2701_003_0	6	6	000000000000001100000000000000000000000000000000	Diag/Therapeutic Radiological	2				1	200.00	200.00	2	
H2701	003	0	1	04	01	H2701_003_0	6	7	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H2701	003	0	1	04	01	H2701_003_0	6	8	000000000000000000000000000100000000000000000010	Outpatient Blood	2				1	0.00	0.00	2	
H2701	003	0	1	04	01	H2701_003_0	6	1	011111111111110011011000000000001111111111001101	Part B  and Preventative Services	2				1	45.00	45.00	2	
H2701	003	0	1	04	01	H2701_003_0	6	3	000000000000000000100000000000000000000000000000	Outpatient Facility	2				1	450.00	450.00	2	
H2701	805	0	1	04	01	H2701_805_0	6	3	000000001001000000000000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H2701	805	0	1	04	01	H2701_805_0	6	2	011011110110111111111101111100001111111111101111	Standard Medicare	1	20	20	1	2			2	
H2701	805	0	1	04	01	H2701_805_0	6	1	000100000000000000000000000000000000000000000000	No Co-pay/Co-insurance	2				1	0.00	0.00	2	
H2701	806	0	1	04	01	H2701_806_0	6	3	000000001001000000000000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H2701	806	0	1	04	01	H2701_806_0	6	1	000100000000000000000000000000000000000000000000	No Co-pay/Co-insurance	2				1	0.00	0.00	2	
H2701	806	0	1	04	01	H2701_806_0	6	2	011011110110111111111101111100001111111111101111	Standard Medicare	1	20	20	1	2			2	
H2701	807	0	1	04	01	H2701_807_0	6	3	000000001001000000000000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H2701	807	0	1	04	01	H2701_807_0	6	2	011011110110111111111101111100001111111111101111	Standard Medicare	1	20	20	1	2			2	
H2701	807	0	1	04	01	H2701_807_0	6	1	000100000000000000000000000000000000000000000000	No Co-pay/Co-insurance	2				1	0.00	0.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2775	001	0	1	04	01	H2775_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2775	001	0	1	04	01	H2775_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2775	002	0	1	04	01	H2775_002_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2775	002	0	1	04	01	H2775_002_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	003	0	1	04	01	H2775_003_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	003	0	1	04	01	H2775_003_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	004	0	1	04	01	H2775_004_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	004	0	1	04	01	H2775_004_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	005	0	1	04	01	H2775_005_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2775	005	0	1	04	01	H2775_005_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	006	0	1	04	01	H2775_006_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	006	0	1	04	01	H2775_006_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2775	007	0	1	04	01	H2775_007_0	4	5	000000000000000000000000000000000001000001000000	Nutrition Therapy	1	0	20	3	2			2	
H2775	007	0	1	04	01	H2775_007_0	4	6	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H2775	007	0	1	04	01	H2775_007_0	4	1	011111110110111111111101101101001100011110100000	Out-Of-Network Services	1	20	20	3	2			2	
H2775	007	0	1	04	01	H2775_007_0	4	2	000000001001000000000000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2775	007	0	1	04	01	H2775_007_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2775	007	0	1	04	01	H2775_007_0	4	4	000000000000000000000000000000000010100000000000	Routine Physical Exam	2				2			2	
H2775	008	0	1	04	01	H2775_008_0	6	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	9	000000000010000000000000000000000000000000000000	Other Health Care	2				1	25.00	25.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	8	000000000000011110000001100000000000000000000000	Diagnostic and DME	1	30	30	3	2			2	
H2775	008	0	1	04	01	H2775_008_0	6	7	000000000000000000000000000000000000000011000000	Diabetes Monitoring, Nutrition Therapy	2				1	10.00	10.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	6	000100001001000001100000000000000000000000000000	OP Mental Health, HHC, OP Surgery	1	30	30	3	2			2	
H2775	008	0	1	04	01	H2775_008_0	6	5	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	95.00	95.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2775	008	0	1	04	01	H2775_008_0	6	12	000000000000000000000000000101001111111100000000	Preventative Services	2				1	0.00	0.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	13	000000000000000000000000000000000000000000000101	Vision / Hearing Exam	2				1	35.00	35.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2775	008	0	1	04	01	H2775_008_0	6	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2775	008	0	1	04	01	H2775_008_0	6	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H2775	008	0	1	04	01	H2775_008_0	6	3	000000000000000000010000000000000000000000000000	Outpatient Substance Abuse	1	50	50	3	2			2	
H2775	008	0	1	04	01	H2775_008_0	6	4	000011110100100000001000000000000000000000000000	Physician Services and Rehab Therapies	2				1	35.00	35.00	2	
H2775	009	0	1	04	01	H2775_009_0	4	2	000000001001000000000000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2775	009	0	1	04	01	H2775_009_0	4	1	011111110110111111111101101101001100011110100000	Out-Of-Network Services	1	20	20	3	2			2	
H2775	009	0	1	04	01	H2775_009_0	4	5	000000000000000000000000000000000001000001000000	Nutrition Therapy	1	0	20	3	2			2	
H2775	009	0	1	04	01	H2775_009_0	4	4	000000000000000000000000000000000010100000000000	Routine Physical Exam	2				2			2	
H2775	009	0	1	04	01	H2775_009_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2775	009	0	1	04	01	H2775_009_0	4	6	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H2775	801	0	1	04	01	H2775_801_0	5	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2775	801	0	1	04	01	H2775_801_0	5	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2775	801	0	1	04	01	H2775_801_0	5	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2775	802	0	1	04	01	H2775_802_0	5	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2775	802	0	1	04	01	H2775_802_0	5	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2775	802	0	1	04	01	H2775_802_0	5	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2775	803	0	1	04	01	H2775_803_0	5	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2775	803	0	1	04	01	H2775_803_0	5	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2775	803	0	1	04	01	H2775_803_0	5	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2869	001	0	1	04	01	H2869_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2869	001	0	1	04	01	H2869_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2869	001	0	1	04	01	H2869_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2869	001	0	1	04	01	H2869_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2869	001	0	1	04	01	H2869_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2869	001	0	1	04	01	H2869_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2869	001	0	1	04	01	H2869_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2869	002	0	1	04	01	H2869_002_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2869	002	0	1	04	01	H2869_002_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2869	003	0	1	04	01	H2869_003_0	7	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H2869	003	0	1	04	01	H2869_003_0	7	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	4	000011110100100000001000000000000000000000000000	Physician Services and Rehab Therapies	2				1	35.00	35.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	5	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	95.00	95.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	6	000100001001000001100000000000000000000000000000	OP Mental Health, HHC, OP Surgery	1	30	30	3	2			2	
H2869	003	0	1	04	01	H2869_003_0	7	7	000000000000000000000000000000000000000011000000	Diabetes Monitoring, Nutrition Therapy	2				1	10.00	10.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	8	000000000000011110000001100000000000000000000000	Diagnostic and DME	1	30	30	3	2			2	
H2869	003	0	1	04	01	H2869_003_0	7	9	000000000010000000000000000000000000000000000000	Other Health Care	2				1	25.00	25.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	3	000000000000000000010000000000000000000000000000	Outpatient Substance Abuse	1	50	50	3	2			2	
H2869	003	0	1	04	01	H2869_003_0	7	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2869	003	0	1	04	01	H2869_003_0	7	12	000000000000000000000000000101001111111100000000	Preventative Services	2				1	0.00	0.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	13	000000000000000000000000000000000000000000000101	Vision / Hearing Exam	2				1	35.00	35.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2869	003	0	1	04	01	H2869_003_0	7	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2869	801	0	1	04	01	H2869_801_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2869	801	0	1	04	01	H2869_801_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2869	801	0	1	04	01	H2869_801_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2869	802	0	1	04	01	H2869_802_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2869	802	0	1	04	01	H2869_802_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2869	802	0	1	04	01	H2869_802_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2869	803	0	1	04	01	H2869_803_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2869	803	0	1	04	01	H2869_803_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2869	803	0	1	04	01	H2869_803_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2905	001	0	1	04	01	H2905_001_0	9	8	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
H2905	001	0	1	04	01	H2905_001_0	9	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
H2905	001	0	1	04	01	H2905_001_0	9	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
H2905	001	0	1	04	01	H2905_001_0	9	7	000000000010000001100000000000000000010001000000	$20-$35 Group	2				1	20.00	35.00	2	
H2905	001	0	1	04	01	H2905_001_0	9	4	000000000000000000000001110000000000000000000000	50% Group	1	50	50	1	2			2	
H2905	001	0	1	04	01	H2905_001_0	9	3	000001111101100000011000001000000111101110001101	$35 Group	2				1	35.00	35.00	2	
H2905	001	0	1	04	01	H2905_001_0	9	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
H2905	001	0	1	04	01	H2905_001_0	9	10	000000000000000000000000000000001000000000000000	Health Education  Wellness Group	2				1	0.00	35.00	2	
H2905	001	0	1	04	01	H2905_001_0	9	1	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
H2905	001	0	1	04	01	H2905_001_0	9	9	000000000000000000000000000000000000010000000000	Colorectal Screening	1	40	40	1	2			2	
H2905	801	0	1	04	01	H2905_801_0	4	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
H2905	801	0	1	04	01	H2905_801_0	4	10	000000000000000000000000000000001000000000000000	Health Education  Wellness Group	2				1	0.00	35.00	2	
H2905	801	0	1	04	01	H2905_801_0	4	1	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
H2905	801	0	1	04	01	H2905_801_0	4	3	000001111101100000011000001000000111101110001101	$35 Group	2				1	35.00	35.00	2	
H2905	801	0	1	04	01	H2905_801_0	4	9	000000000000000000000000000000000000010000000000	Colorectal Screening	1	40	40	1	2			2	
H2905	801	0	1	04	01	H2905_801_0	4	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
H2905	801	0	1	04	01	H2905_801_0	4	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
H2905	801	0	1	04	01	H2905_801_0	4	7	000000000010000001100000000000000000010001000000	$20-$35 Group	2				1	20.00	35.00	2	
H2905	801	0	1	04	01	H2905_801_0	4	8	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
H2905	801	0	1	04	01	H2905_801_0	4	4	000000000000000000000001110000000000000000000000	50% Group	1	50	50	1	2			2	
H2905	802	0	1	04	01	H2905_802_0	4	9	000000000000000000000000000000000000010000000000	Colorectal Screening	1	40	40	1	2			2	
H2905	802	0	1	04	01	H2905_802_0	4	8	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
H2905	802	0	1	04	01	H2905_802_0	4	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
H2905	802	0	1	04	01	H2905_802_0	4	7	000000000010000001100000000000000000010001000000	$20-$35 Group	2				1	20.00	35.00	2	
H2905	802	0	1	04	01	H2905_802_0	4	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
H2905	802	0	1	04	01	H2905_802_0	4	4	000000000000000000000001110000000000000000000000	50% Group	1	50	50	1	2			2	
H2905	802	0	1	04	01	H2905_802_0	4	3	000001111101100000011000001000000111101110001101	$35 Group	2				1	35.00	35.00	2	
H2905	802	0	1	04	01	H2905_802_0	4	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
H2905	802	0	1	04	01	H2905_802_0	4	10	000000000000000000000000000000001000000000000000	Health Education  Wellness Group	2				1	0.00	35.00	2	
H2905	802	0	1	04	01	H2905_802_0	4	1	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
H2905	803	0	1	04	01	H2905_803_0	4	9	000000000000000000000000000000000000010000000000	Colorectal Screening	1	40	40	1	2			2	
H2905	803	0	1	04	01	H2905_803_0	4	1	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	10	000000000000000000000000000000001000000000000000	Health Education  Wellness Group	2				1	0.00	35.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	8	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
H2905	803	0	1	04	01	H2905_803_0	4	7	000000000010000001100000000000000000010001000000	$20-$35 Group	2				1	20.00	35.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	3	000001111101100000011000001000000111101110001101	$35 Group	2				1	35.00	35.00	2	
H2905	803	0	1	04	01	H2905_803_0	4	4	000000000000000000000001110000000000000000000000	50% Group	1	50	50	1	2			2	
H2906	003	0	1	04	01	H2906_003_0	7	2	000000000000000000000000000000000000000000010000	Out of Network Preventive Dental	1	0	0	2	2			2	
H2906	003	0	1	04	01	H2906_003_0	7	1	011111111111111111111111111101001111111111100001	Out of Network Services	1	20	20	1	2			2	
H2906	003	0	1	04	01	H2906_003_0	7	4	000000000000000000000000000000000000000000000010	Eye Wear	1	0	20	2	2			2	
H2906	003	0	1	04	01	H2906_003_0	7	3	000000000000000000000000000000000000000000000100	Eye exams	2				1	15.00	15.00	2	
H2906	003	0	1	04	01	H2906_003_0	7	5	000000000000000000000000000000000000000000001000	Out of Network Comprehensive Dental	1	20	50	2	2			1	50.00
H2914	001	0	1	04	01	H2914_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2914	001	0	1	04	01	H2914_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2914	001	0	1	04	01	H2914_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2914	002	0	1	04	01	H2914_002_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2914	002	0	1	04	01	H2914_002_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2914	003	0	1	04	01	H2914_003_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2914	003	0	1	04	01	H2914_003_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H2914	004	0	1	04	01	H2914_004_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H2914	004	0	1	04	01	H2914_004_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H2914	801	0	1	04	01	H2914_801_0	5	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2914	801	0	1	04	01	H2914_801_0	5	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2914	801	0	1	04	01	H2914_801_0	5	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2914	802	0	1	04	01	H2914_802_0	5	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2914	802	0	1	04	01	H2914_802_0	5	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2914	802	0	1	04	01	H2914_802_0	5	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2914	803	0	1	04	01	H2914_803_0	5	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H2914	803	0	1	04	01	H2914_803_0	5	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H2914	803	0	1	04	01	H2914_803_0	5	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H2947	001	0	1	04	01	H2947_001_0	10	4	000000000000000000000000000010000000000000010010	Group 4	1	100	100	1	2			2	
H2947	001	0	1	04	01	H2947_001_0	10	5	000000000000000000000100000000000000000000000000	Group 5	2				1	100.00	100.00	2	
H2947	001	0	1	04	01	H2947_001_0	10	6	000000000000000000000000000000001000000000000000	Group 6	1	50	50	1	2			2	
H2947	001	0	1	04	01	H2947_001_0	10	3	000000000000000000000000000000000000000000001101	Group 3	2				1	30.00	30.00	2	
H2947	001	0	1	04	01	H2947_001_0	10	1	001111111111111111111000001100000111111111100000	Group1	1	20	20	1	2			2	
H2947	001	0	1	04	01	H2947_001_0	10	2	010000000000000000000001110000000000000000000000	Group 2	1	40	40	1	2			2	
H2947	002	0	1	04	01	H2947_002_0	7	5	000000000000000000000100000000000000000000000000	Group 5	2				1	100.00	100.00	2	
H2947	002	0	1	04	01	H2947_002_0	7	1	001100000000011111111001111100000111111111100000	Group 1	1	20	20	1	2			2	
H2947	002	0	1	04	01	H2947_002_0	7	2	010000000000000000000000000000000000000000000000	Group 2	1	40	40	1	2			2	
H2947	002	0	1	04	01	H2947_002_0	7	3	000010000000000000000000000000000000000000001100	Group 3	2				1	20.00	20.00	2	
H2947	002	0	1	04	01	H2947_002_0	7	4	000001111111100000000000000000000000000000000001	Group 4	2				1	30.00	30.00	2	
H2947	002	0	1	04	01	H2947_002_0	7	6	000000000000000000000000000010000000000000010010	Group 6	1	100	100	1	2			2	
H2947	002	0	1	04	01	H2947_002_0	7	7	000000000000000000000000000000001000000000000000	Group 7	1	50	50	1	2			2	
H2947	801	0	1	04	01	H2947_801_0	4	1	010111110111111111111101111110001111111111101111	Group 1	1	20	20	1	2			2	
H2947	801	0	1	04	01	H2947_801_0	4	2	001000001000000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H2947	802	0	1	04	01	H2947_802_0	4	1	010111110111111111111101111110001111111111101111	Group 1	1	20	20	1	2			2	
H2947	802	0	1	04	01	H2947_802_0	4	2	001000001000000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H2947	803	0	1	04	01	H2947_803_0	4	1	010111110111111111111101111110001111111111101111	Group 1	1	20	20	1	2			2	
H2947	803	0	1	04	01	H2947_803_0	4	2	001000001000000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H2997	001	0	1	04	01	H2997_001_0	8	1	000100000000000000000000001100000000000010001010	20% Coinsurance Group	1	20	20	1	2			2	
H2997	001	0	1	04	01	H2997_001_0	8	9	000000000000000000000000000000000000000000010000	50% Coinsurance Preventive Dental	1	50	50	6	2			2	
H2997	001	0	1	04	01	H2997_001_0	8	8	000000000000000000000000000000001000000000000000	ONN Health Education/Wellness Programs	2				1	0.00	0.00	2	
H2997	001	0	1	04	01	H2997_001_0	8	7	000000000000011110000001110000000000000000100000	30% Coinsurance Group	1	30	30	1	2			2	
H2997	001	0	1	04	01	H2997_001_0	8	6	000000000000000000100000000000000000000000000000	OON Ambulatory Surgical Center (ASC)	2				1	200.00	200.00	2	
H2997	001	0	1	04	01	H2997_001_0	8	5	000000000000000001000000000000000000000000000000	OON Hopsital Sevices	2				1	35.00	225.00	2	
H2997	001	0	1	04	01	H2997_001_0	8	2	000010000000000000000000000000000000000000000000	$30 Copayment Group	2				1	30.00	30.00	2	
H2997	001	0	1	04	01	H2997_001_0	8	3	011001111111100000011000000000000111111101000101	$35 Copayment Group	2				1	35.00	35.00	2	
H2997	001	0	1	04	01	H2997_001_0	8	4	000000000000000000000100000000000000000000000000	OON Ambulance	2				1	100.00	100.00	2	
H3195	001	0	1	04	01	H3195_001_0	7	1	111111111111111111111111111111111111111111111111	OON Healthcare Services	1	20	20	2	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	002	0	1	04	01	H3206_002_0	5	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3206	002	0	1	04	01	H3206_002_0	5	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	002	0	1	04	01	H3206_002_0	5	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	002	0	1	04	01	H3206_002_0	5	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	002	0	1	04	01	H3206_002_0	5	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	002	0	1	04	01	H3206_002_0	5	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	002	0	1	04	01	H3206_002_0	5	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	003	0	1	04	01	H3206_003_0	3	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3206	003	0	1	04	01	H3206_003_0	3	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	003	0	1	04	01	H3206_003_0	3	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	003	0	1	04	01	H3206_003_0	3	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	003	0	1	04	01	H3206_003_0	3	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	003	0	1	04	01	H3206_003_0	3	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	003	0	1	04	01	H3206_003_0	3	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	801	0	1	04	01	H3206_801_0	3	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	801	0	1	04	01	H3206_801_0	3	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	801	0	1	04	01	H3206_801_0	3	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	801	0	1	04	01	H3206_801_0	3	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	802	0	1	04	01	H3206_802_0	3	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3206	802	0	1	04	01	H3206_802_0	3	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	802	0	1	04	01	H3206_802_0	3	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	802	0	1	04	01	H3206_802_0	3	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	802	0	1	04	01	H3206_802_0	3	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	802	0	1	04	01	H3206_802_0	3	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	802	0	1	04	01	H3206_802_0	3	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	803	0	1	04	01	H3206_803_0	3	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	803	0	1	04	01	H3206_803_0	3	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	3	000001010100000000000001100000000000000000001111	50.00	2				1	50.00	50.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	2	010010100000100000001000000000000010000000000000	35.00	2				1	35.00	35.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	1	000100000000000000000000001100001101111100100000	0.00	2				1	0.00	0.00	2	
H3206	804	0	1	04	01	H3206_804_0	2	4	000000000000011010000000010000000000000011000000	10%	1	10	10	3	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	5	000000000010000101100000000000000000000000000000	20%	1	20	20	3	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	6	001000001001000000010000000000000000000000000000	50%	1	50	50	3	2			2	
H3206	804	0	1	04	01	H3206_804_0	2	7	000000000000000000000100000000000000000000000000	75	2				1	75.00	75.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	3	000000000000000000000000000000000000011100000000	Preventive screening copayments	2				1	10.00	10.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	2	000000000000000000000000000000000001000000000000	Preventive Screening Coinsurance	1	0	20	2	2			2	
H3207	001	0	1	04	01	H3207_001_0	11	11	000100000000000000000000000100001100000011100000	No cost share or not covered services	2				1	0.00	0.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	10	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	75.00	75.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	1	000000000000011010000000000000000000000000000000	Diagnostic Tests	1	10	10	2	2			2	
H3207	001	0	1	04	01	H3207_001_0	11	9	010000100010100100001001100000000010100000000111	Therapies, DME and Misc	1	20	20	2	2			2	
H3207	001	0	1	04	01	H3207_001_0	11	5	000000000000000000000000000000000000000000001000	Comp dental	2				1	20.00	75.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	7	000000000000000001100000000000000000000000000000	Outpatient services	2				1	150.00	150.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	8	000000010000000000000000000000000000000000000000	Specialist Physicians	2				1	40.00	40.00	2	
H3207	001	0	1	04	01	H3207_001_0	11	4	001011001101000000010000010000000000000000000000	Professional Services	2				1	20.00	20.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	3	000000000000000000000000000000000000011100000000	Preventive screening copayments	2				1	10.00	10.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	2	000000000000000000000000000000000001000000000000	Preventive Screening Coinsurance	1	0	20	2	2			2	
H3207	002	0	1	04	01	H3207_002_0	11	11	000100000000000000000000000100001100000011100000	No cost share or not covered services	2				1	0.00	0.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	10	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	75.00	75.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	1	000000000000011010000000000000000000000000000000	Diagnostic Tests	1	10	10	2	2			2	
H3207	002	0	1	04	01	H3207_002_0	11	4	001011001101000000010000010000000000000000000000	Professional Services	2				1	20.00	20.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	9	010000100010100100001001100000000010100000000111	Therapies, DME and Misc	1	20	20	2	2			2	
H3207	002	0	1	04	01	H3207_002_0	11	8	000000010000000000000000000000000000000000000000	Specialist Physicians	2				1	40.00	40.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	7	000000000000000001100000000000000000000000000000	Outpatient services	2				1	150.00	150.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H3207	002	0	1	04	01	H3207_002_0	11	5	000000000000000000000000000000000000000000001000	Comp dental	2				1	20.00	75.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	1	000000000000011010000000000000000000000000000000	Diagnostic Tests	1	10	10	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	9	10	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	75.00	75.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	11	000100000000000000000000000100001100000011100000	No cost share or not covered services	2				1	0.00	0.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	2	000000000000000000000000000000000001000000000000	Preventive Screening Coinsurance	1	0	20	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	9	3	000000000000000000000000000000000000011100000000	Preventive screening copayments	2				1	10.00	10.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	9	010000100010100100001001100000000010100000000111	Therapies, DME and Misc	1	20	20	2	2			2	
H3207	003	0	1	04	01	H3207_003_0	9	7	000000000000000001100000000000000000000000000000	Outpatient services	2				1	150.00	150.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	5	000000000000000000000000000000000000000000001000	Comp dental	2				1	20.00	75.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	4	001011001101000000010000010000000000000000000000	Professional Services	2				1	20.00	20.00	2	
H3207	003	0	1	04	01	H3207_003_0	9	8	000000010000000000000000000000000000000000000000	Specialist Physicians	2				1	40.00	40.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	9	010000100010100100001001100000000010100000000111	Therapies, DME and Misc	1	20	20	2	2			2	
H3207	004	0	1	04	01	H3207_004_0	10	1	000000000000011010000000000000000000000000000000	Diagnostic Tests	1	10	10	2	2			2	
H3207	004	0	1	04	01	H3207_004_0	10	10	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	75.00	75.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	11	000100000000000000000000000100001100000011100000	No cost share or not covered services	2				1	0.00	0.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	2	000000000000000000000000000000000001000000000000	Preventive Screening Coinsurance	1	0	20	2	2			2	
H3207	004	0	1	04	01	H3207_004_0	10	3	000000000000000000000000000000000000011100000000	Preventive screening copayments	2				1	10.00	10.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	4	001011001101000000010000010000000000000000000000	Professional Services	2				1	20.00	20.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	5	000000000000000000000000000000000000000000001000	Comp dental	2				1	20.00	75.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	6	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	7	000000000000000001100000000000000000000000000000	Outpatient services	2				1	150.00	150.00	2	
H3207	004	0	1	04	01	H3207_004_0	10	8	000000010000000000000000000000000000000000000000	Specialist Physicians	2				1	40.00	40.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	001	0	1	04	01	H3208_001_0	10	10	100000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	001	0	1	04	01	H3208_001_0	10	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	001	0	1	04	01	H3208_001_0	10	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	9	000000000000000000000000000010000000000000000000	OON:  50% coinsurance	1	50	50	1	2			2	
H3208	001	0	1	04	01	H3208_001_0	10	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	5	000000000000000000010000000000000000000000001000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	001	0	1	04	01	H3208_001_0	10	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	001	0	1	04	01	H3208_001_0	10	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	003	0	1	04	01	H3208_003_0	7	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	003	0	1	04	01	H3208_003_0	7	2	000000000000000000000000011000000000000010000000	OON: 20% copay	1	20	20	1	2			2	
H3208	003	0	1	04	01	H3208_003_0	7	1	011111111111101101111001100100001011111101101000	OON: 30% coinsurance	1	30	30	1	2			2	
H3208	003	0	1	04	01	H3208_003_0	7	4	000000000000000000000100000000000000000000000000	OON:  $150 copay	2				1	150.00	150.00	2	
H3208	003	0	1	04	01	H3208_003_0	7	8	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	30	1	2			2	
H3208	003	0	1	04	01	H3208_003_0	7	7	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	30	1	2			2	
H3208	003	0	1	04	01	H3208_003_0	7	6	000000000000000000000000000010000000000000000000		1	50	50	1	2			2	
H3208	003	0	1	04	01	H3208_003_0	7	5	100000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	1	011001100100101101101001101100000001111101100000	OON:  20% coinsurance	1	20	20	1	2			2	
H3208	004	0	1	04	01	H3208_004_0	10	10	100000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	004	0	1	04	01	H3208_004_0	10	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	004	0	1	04	01	H3208_004_0	10	2	000110000000000000000000000000000000000000000000	OON: $20 copay	2				1	20.00	20.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	9	000000000000000000000000000010000000000000000000	OON:  50% coinsurance	1	50	50	1	2			2	
H3208	004	0	1	04	01	H3208_004_0	10	4	000000011011000000000000000000000000000000000000	OON: $40 copay	2				1	40.00	40.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	8	000000000000000000000100000000000000000000000000	OON: $100 copay	2				1	100.00	100.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	40.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	6	000000000000000000000000010000000000000010000000	OON: 10% copay	1	10	10	1	2			2	
H3208	004	0	1	04	01	H3208_004_0	10	5	000000000000000000010000000000000000000000001000	OON: Outpatient Substance Abuse Services	2				1	40.00	100.00	2	
H3208	004	0	1	04	01	H3208_004_0	10	3	000000000000000000000000000000000000000000000101	OON: $50 copay	2				1	50.00	50.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	801	0	1	04	01	H3208_801_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	801	0	1	04	01	H3208_801_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	801	0	1	04	01	H3208_801_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	801	0	1	04	01	H3208_801_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	801	0	1	04	01	H3208_801_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	802	0	1	04	01	H3208_802_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	802	0	1	04	01	H3208_802_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	802	0	1	04	01	H3208_802_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	802	0	1	04	01	H3208_802_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	802	0	1	04	01	H3208_802_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	803	0	1	04	01	H3208_803_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	803	0	1	04	01	H3208_803_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	803	0	1	04	01	H3208_803_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	803	0	1	04	01	H3208_803_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	803	0	1	04	01	H3208_803_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	804	0	1	04	01	H3208_804_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	804	0	1	04	01	H3208_804_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	804	0	1	04	01	H3208_804_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	804	0	1	04	01	H3208_804_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	804	0	1	04	01	H3208_804_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	805	0	1	04	01	H3208_805_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	805	0	1	04	01	H3208_805_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	805	0	1	04	01	H3208_805_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	805	0	1	04	01	H3208_805_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	806	0	1	04	01	H3208_806_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	806	0	1	04	01	H3208_806_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	806	0	1	04	01	H3208_806_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	806	0	1	04	01	H3208_806_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	806	0	1	04	01	H3208_806_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	806	0	1	04	01	H3208_806_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H3208	807	0	1	04	01	H3208_807_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H3208	807	0	1	04	01	H3208_807_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H3208	807	0	1	04	01	H3208_807_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H3208	807	0	1	04	01	H3208_807_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3208	807	0	1	04	01	H3208_807_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H3209	001	0	1	04	01	H3209_001_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	10.00	2	
H3209	001	0	1	04	01	H3209_001_0	4	1	011101111111111111111111110101000111111111100101	Group 1	1	30	30	6	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	3	100000000000000000000000001000000000000000010010	Group 3	2				1	0.00	0.00	2	
H3209	001	0	1	04	01	H3209_001_0	4	4	000000000000000000000000000000001000000000001000	Group 4	1	0	30	6	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	1	011101111111111111111111110101000111111111100101	Group 1	1	30	30	6	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	3	000000000000000000000000000000001000000000001000	Group 3	1	0	30	6	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	4	100000000000000000000000000000000000000000010010	Group 4	2				1	0.00	0.00	2	
H3209	003	0	1	04	01	H3209_003_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3209	003	0	1	04	01	H3209_003_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H3209	003	0	1	04	01	H3209_003_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3209	003	0	1	04	01	H3209_003_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3209	003	0	1	04	01	H3209_003_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	1	010101100100111111101000010100000111111111101111		1	30	30	2	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	2	000000000000000000000001100000000000000000000000		1	40	40	2	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	3	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	4	000010000000000000000000000000000000000000000000		2				1	25.00	25.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	5	000000010010000000000000000000000000000000000000		2				1	45.00	45.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	6	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	7	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	005	0	1	04	01	H3335_005_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	005	0	1	04	01	H3335_005_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	005	0	1	04	01	H3335_005_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	005	0	1	04	01	H3335_005_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	006	0	1	04	01	H3335_006_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	006	0	1	04	01	H3335_006_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	006	0	1	04	01	H3335_006_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	006	0	1	04	01	H3335_006_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	008	0	1	04	01	H3335_008_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	008	0	1	04	01	H3335_008_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	008	0	1	04	01	H3335_008_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	008	0	1	04	01	H3335_008_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	009	0	1	04	01	H3335_009_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	009	0	1	04	01	H3335_009_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	009	0	1	04	01	H3335_009_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	009	0	1	04	01	H3335_009_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	014	0	1	04	01	H3335_014_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	014	0	1	04	01	H3335_014_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	014	0	1	04	01	H3335_014_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	014	0	1	04	01	H3335_014_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	015	0	1	04	01	H3335_015_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	015	0	1	04	01	H3335_015_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	015	0	1	04	01	H3335_015_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	015	0	1	04	01	H3335_015_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	017	0	1	04	01	H3335_017_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	017	0	1	04	01	H3335_017_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	017	0	1	04	01	H3335_017_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	017	0	1	04	01	H3335_017_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	018	0	1	04	01	H3335_018_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	018	0	1	04	01	H3335_018_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	018	0	1	04	01	H3335_018_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	018	0	1	04	01	H3335_018_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	020	0	1	04	01	H3335_020_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	020	0	1	04	01	H3335_020_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	020	0	1	04	01	H3335_020_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	020	0	1	04	01	H3335_020_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	021	0	1	04	01	H3335_021_0	7	1	010111110110111111101001110100000111111111101111		1	30	30	2	2			2	
H3335	021	0	1	04	01	H3335_021_0	7	2	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	021	0	1	04	01	H3335_021_0	7	3	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	021	0	1	04	01	H3335_021_0	7	4	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
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H3335	032	0	1	04	01	H3335_032_0	8	1	010101100100111111101000010100000111111111101111		1	30	30	2	2			2	
H3335	032	0	1	04	01	H3335_032_0	8	7	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	6	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	5	000000010010000000000000000000000000000000000000		2				1	45.00	45.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	4	000010000000000000000000000000000000000000000000		2				1	25.00	25.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	3	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	036	0	1	04	01	H3335_036_0	9	3	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	036	0	1	04	01	H3335_036_0	9	5	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	036	0	1	04	01	H3335_036_0	9	4	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	036	0	1	04	01	H3335_036_0	9	2	000000000000000000000001100000000000000000000000		1	40	40	2	2			2	
H3335	036	0	1	04	01	H3335_036_0	9	1	010111110110111111101000010100000111111111101111		1	30	30	2	2			2	
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H3335	037	0	1	04	01	H3335_037_0	9	5	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
H3335	037	0	1	04	01	H3335_037_0	9	3	001000001001000000010000000000000000000000000000		1	50	50	2	2			2	
H3335	037	0	1	04	01	H3335_037_0	9	2	000000000000000000000001100000000000000000000000		1	40	40	2	2			2	
H3335	037	0	1	04	01	H3335_037_0	9	1	010111110110111111101000010100000111111111101111		1	30	30	2	2			2	
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H3335	038	0	1	04	01	H3335_038_0	9	4	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	038	0	1	04	01	H3335_038_0	9	5	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
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H3335	039	0	1	04	01	H3335_039_0	9	4	000000000000000000000100000000000000000000000000		2				1	175.00	175.00	2	
H3335	039	0	1	04	01	H3335_039_0	9	5	000000000000000000000000001000001000000000000000		1	0	0	2	1	0.00	0.00	2	
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H3335	041	0	1	04	01	H3335_041_0	4	2	000010000000000000000000000000000000000000000000		2				1	25.00	25.00	2	
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H3335	811	0	1	04	01	H3335_811_0	3	3	000100000000000000000000000000001000000000000000		1	0	0	2	2			2	
H3335	813	0	1	04	01	H3335_813_0	4	2	001000001001000000000000000000000000000000000000		1	50	50	2	2			2	
H3335	813	0	1	04	01	H3335_813_0	4	1	010011110110111111111101111100000111111111111111		1	20	20	2	2			2	
H3335	813	0	1	04	01	H3335_813_0	4	3	000100000000000000000000000000001000000000000000		1	0	0	2	2			2	
H3335	819	0	1	04	01	H3335_819_0	3	1	010011110110111111111101111100000111111111111111		1	20	20	2	2			2	
H3335	819	0	1	04	01	H3335_819_0	3	2	001000001001000000000000000000000000000000000000		1	50	50	2	2			2	
H3335	819	0	1	04	01	H3335_819_0	3	3	000100000000000000000000000000001000000000000000		1	0	0	2	2			2	
H3335	820	0	1	04	01	H3335_820_0	3	1	010011110110111111111101111100000111111111111111		1	20	20	2	2			2	
H3335	820	0	1	04	01	H3335_820_0	3	2	001000001001000000000000000000000000000000000000		1	50	50	2	2			2	
H3335	820	0	1	04	01	H3335_820_0	3	3	000100000000000000000000000000001000000000000000		1	0	0	2	2			2	
H3335	822	0	1	04	01	H3335_822_0	4	1	010011110110111111111101111100000111111111111111		1	20	20	2	2			2	
H3335	822	0	1	04	01	H3335_822_0	4	2	001000001001000000000000000000000000000000000000		1	50	50	2	2			2	
H3335	822	0	1	04	01	H3335_822_0	4	3	000100000000000000000000000000001000000000000000		1	0	0	2	2			2	
H3342	001	0	1	04	01	H3342_001_0	7	12	000000000000000001000000000000000000000000000000	$50.00 to $250.00	2				1	50.00	250.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	2	000010000000000000000000000000000100000000000000	$30 Copayment	2				1	30.00	30.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	3	010101010110000000000000000100000001110000000000	$50.00 Copayment	2				1	50.00	50.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	4	001000001001000000011100000000000000001100000000	$100 Copayment	2				1	100.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	5	000000000000000000100000000000000000000000000000	$250 Copayment	2				1	250.00	250.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	6	000000000000000000000000001000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
H3342	001	0	1	04	01	H3342_001_0	7	7	000000000000000100000001110000000000000011101000	20% Coinsurance	1	20	20	2	2			2	
H3342	001	0	1	04	01	H3342_001_0	7	8	100000000000000000000000000000001000000000000011	50% Coinsurance	1	50	50	2	2			2	
H3342	001	0	1	04	01	H3342_001_0	7	9	000000100000100000000000000000000000000000000000	$50 to $100 Copayment	2				1	50.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	1	000000000000000000000000000000000010000000000000	$30.00 to $50.00 Copayment	2				1	30.00	50.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	10	000000000000011010000000000000000000000000000000	$50 to $150 Copayment	2				1	50.00	150.00	2	
H3342	001	0	1	04	01	H3342_001_0	7	11	000000000000000000000000000000000000000000000100	20% - 50% Coinsurance	1	20	50	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	9	2	000000000000000000000000000000000010000000000000	$30 to $50 Copayment Group	2				1	30.00	50.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	13	000000000000000001000000000000000000000000000000	$50 to $500 Copayment Group	2				1	50.00	500.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	12	000000000000000000000100000000000000000000000000	$200 Copayment Group	2				1	200.00	200.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	11	000000000000000000000000000000000000000000000100	20% - 50% Coinsurance Group	1	20	50	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	9	10	000000000000011010000000000000000000000000000000	$50 to $150 Copayment Group	2				1	50.00	150.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	1	000010000000000000000000000000000100000000000000	$30.00 Copayment Group	2				1	30.00	30.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	9	000000100000100000000000000000000000000000000000	$50 to $100 Copayment Group	2				1	50.00	100.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	4	001000001001000000011000000000000000001100000000	$100 Copayment Group	2				1	100.00	100.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	5	000000000000000000100000000000000000000000000000	$500 Copayment Group	2				1	500.00	500.00	2	
H3342	002	0	1	04	01	H3342_002_0	9	6	000000000000000000000000001000000000000000000000	10% Coinsurance Group	1	10	10	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	9	7	000000000000000100000001110000000000000011101000	20% Coinsurance Group	1	20	20	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	9	8	100000000000000000000000000000001000000000000011	50% Coinsurance Group	1	50	50	2	2			2	
H3342	002	0	1	04	01	H3342_002_0	9	3	010101010110000000000000000100000001110000000000	$50.00 Copayment Group	2				1	50.00	50.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	2	000000000000000000000000000000000010000000000000	$25 to $50 Copayment Group	2				1	25.00	50.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	13	000000000000000001000000000000000000000000000000	$50 to $450 Copayment Group	2				1	50.00	450.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	12	000000000000000000000100000000000000000000000000	$200 Copayment Group	2				1	200.00	200.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	11	000000000000000000000000000000000000000000000100	20% - 50% Coinsurance Group	1	20	50	2	2			2	
H3342	004	0	1	04	01	H3342_004_0	8	10	000000000000011010000000000000000000000000000000	$50 to $150 Copayment Group	2				1	50.00	150.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	1	000010000000000000000000000000000100000000000000	$25.00 Copayment Group	2				1	25.00	25.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	3	010101010110000000000000000100000001110000000000	$50.00 Copayment Group	2				1	50.00	50.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	9	000000100000100000000000000000000000000000000000	$50 to $100 Copayment Group	2				1	50.00	100.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	8	100000000000000000000000000000001000000000000011	50% Coinsurance Group	1	50	50	2	2			2	
H3342	004	0	1	04	01	H3342_004_0	8	7	000000000000000100000001110000000000000011101000	20% Coinsurance Group	1	20	20	2	2			2	
H3342	004	0	1	04	01	H3342_004_0	8	6	000000000000000000000000001000000000000000000000	10% Coinsurance Group	1	10	10	2	2			2	
H3342	004	0	1	04	01	H3342_004_0	8	5	000000000000000000100000000000000000000000000000	$450 Copayment Group	2				1	450.00	450.00	2	
H3342	004	0	1	04	01	H3342_004_0	8	4	001000001001000000011000000000000000001100000000	$100 Copayment Group	2				1	100.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	1	000010000000000000000000000000000100000000000000	$30.00 Copayment Group	2				1	30.00	30.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	10	000000000000011010000000000000000000000000000000	$50 to $150 Copayment Group	2				1	50.00	150.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	11	000000000000000000000000000000000000000000000100	20% - 50% Coinsurance Group	1	20	50	2	2			2	
H3342	012	0	1	04	01	H3342_012_0	9	12	000000000000000000000100000000000000000000000000	$200 Copayment Group	2				1	200.00	200.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	13	000000000000000001000000000000000000000000000000	$50 to $500 Copayment Group	2				1	50.00	500.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	2	000000000000000000000000000000000010000000000000	$30 to $50 Copayment Group	2				1	30.00	50.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	6	000000000000000000000000001000000000000000000000	10% Coinsurance Group	1	10	10	2	2			2	
H3342	012	0	1	04	01	H3342_012_0	9	4	001000001001000000011000000000000000001100000000	$100 Copayment Group	2				1	100.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	9	000000100000100000000000000000000000000000000000	$50 to $100 Copayment Group	2				1	50.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	8	100000000000000000000000000000001000000000000011	50% Coinsurance Group	1	50	50	2	2			2	
H3342	012	0	1	04	01	H3342_012_0	9	7	000000000000000100000001110000000000000011101000	20% Coinsurance Group	1	20	20	2	2			2	
H3342	012	0	1	04	01	H3342_012_0	9	3	010101010110000000000000000100000001110000000000	$50.00 Copayment Group	2				1	50.00	50.00	2	
H3342	012	0	1	04	01	H3342_012_0	9	5	000000000000000000100000000000000000000000000000	$500 Copayment Group	2				1	500.00	500.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	9	000000000000000000000000000000000000000000001000	Comprehensive Dental	2				1	30.00	50.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	8	000000000000000000000000000000001100000000000000	Health and Wellness and Immunizations	1	0	20	2	2			2	
H3344	001	0	1	04	01	H3344_001_0	9	1	010000100000100000001000000000000000000000000000	OON Group 1 - Copayment $25	2				1	25.00	25.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	10	000000000000000000000000000000000000000000000010	Eye Wear	2				2			2	
H3344	001	0	1	04	01	H3344_001_0	9	7	000000000000000000000000001000000000000000000010	OON Group 7 - Renal  No copay	2				1	0.00	0.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	3	000000000000000000000100000000000000000000000000	OON Group #3 - $100 copayment	2				1	100.00	100.00	2	
H3344	001	0	1	04	01	H3344_001_0	9	4	000000000110010001100000010100000001111111100001	OON Group 4 - 20% coinsurance	1	20	20	1	2			2	
H3344	001	0	1	04	01	H3344_001_0	9	5	000101000000001110000000100000000000000000000000	OON - Group 5 - 30% coinsurance	1	30	30	1	2			2	
H3344	001	0	1	04	01	H3344_001_0	9	6	001000001001000000010001000000000000000000000000	OON Group 6 - 50% coinsurance	1	50	50	1	2			2	
H3344	001	0	1	04	01	H3344_001_0	9	2	000010010000000000000000000000000010000000000100	OON Group 2 $30 copayment	2				1	30.00	30.00	2	
H3344	003	0	1	04	01	H3344_003_0	9	7	000000000000000000000000000000001100000000000000	OON Groups 7 Health and Wellness,Imm.	1	0	20	2	2			2	
H3344	003	0	1	04	01	H3344_003_0	9	8	000000000000000000000000000000000000000000000010	Eye Wear	2				2			2	
H3344	003	0	1	04	01	H3344_003_0	9	1	010010110000100000001000000000000010000000000100	OON Group 1 - Copayment $25	2				1	25.00	25.00	2	
H3344	003	0	1	04	01	H3344_003_0	9	2	000000000000000000000100000000000000000000000000	OON Group 2 $100 copayment	2				1	100.00	100.00	2	
H3344	003	0	1	04	01	H3344_003_0	9	3	000000000110010001100000010100000001111111100001	OON Group #3 - 20% coinsurance	1	20	20	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	9	4	000101000000001110000000100000000000000000001000	OON Group 4 - 30% coinsurance	1	30	30	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	9	5	101000001001000000010001000000000000000000010000	OON - Group 5 - 50% coinsurance	1	50	50	1	2			2	
H3344	003	0	1	04	01	H3344_003_0	9	6	000000000000000000000000001000000000000000000010	OON Group 6 - Renal	2				1	0.00	0.00	2	
H3344	801	0	1	04	01	H3344_801_0	7	2	000000001001000000010000000000000000000000000000	50% coinsurance	1	50	50	3	2			2	
H3344	801	0	1	04	01	H3344_801_0	7	1	011111110110111111101101111100001111111111101111	20% coinsurance	1	20	20	3	2			2	
H3344	803	0	1	04	01	H3344_803_0	7	1	011111110110111111101101111100001111111111101111	20% coinsurance	1	20	20	3	2			2	
H3344	803	0	1	04	01	H3344_803_0	7	2	000000001001000000010000000000000000000000000000	50% coinsurance	1	50	50	3	2			2	
H3344	804	0	1	04	01	H3344_804_0	7	1	011111110110111111101101111100001111111111101111	20% coinsurance	1	20	20	3	2			2	
H3344	804	0	1	04	01	H3344_804_0	7	2	000000001001000000010000000000000000000000000000	50% coinsurance	1	50	50	3	2			2	
H3346	001	0	1	04	01	H3346_001_0	9	3	000011010101100000010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H3346	001	0	1	04	01	H3346_001_0	9	1	010100100010011111100001111000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
H3346	001	0	1	04	01	H3346_001_0	9	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	9	000000000000000000000010000000000000000000000000	No coverage	2				2			2	
H3346	001	0	1	04	01	H3346_001_0	9	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				1	0.00	0.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				1	0.00	0.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				1	0.00	0.00	2	
H3346	001	0	1	04	01	H3346_001_0	9	5	000000000000000000000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	14	3	000011010101100000010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H3346	002	0	1	04	01	H3346_002_0	14	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H3346	002	0	1	04	01	H3346_002_0	14	1	010100100010011111100001111000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
H3346	002	0	1	04	01	H3346_002_0	14	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H3346	002	0	1	04	01	H3346_002_0	14	9	000000000000000000000010000000000000000000000000	No coverage	2				2			2	
H3346	002	0	1	04	01	H3346_002_0	14	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	14	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	14	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	14	5	000000000000000000000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	10	1	010100100010011111100001111000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
H3346	802	0	1	04	01	H3346_802_0	10	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H3346	802	0	1	04	01	H3346_802_0	10	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	10	6	000000000000000000000010000000000000000000000000	No coverage	2				2			2	
H3346	802	0	1	04	01	H3346_802_0	10	5	000000000000000000000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	10	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H3346	802	0	1	04	01	H3346_802_0	10	3	000011010101100000010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H3346	802	0	1	04	01	H3346_802_0	10	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				1	0.00	0.00	2	
H3404	001	0	1	04	01	H3404_001_0	4	1	011111111111111111111001110100000111111111101111		1	20	20	2	2			2	
H3404	001	0	1	04	01	H3404_001_0	4	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H3404	001	0	1	04	01	H3404_001_0	4	3	000000000000000000000000001000001000000000000000	No Cost Sharing	2				1	0.00	0.00	2	
H3404	002	0	1	04	01	H3404_002_0	4	1	010011111111100000010000000000000000000000001101	Physician Srvices	2				1	20.00	20.00	2	
H3404	002	0	1	04	01	H3404_002_0	4	2	000000000000000000000001110000000000000000100010	20% Coinsurance	1	20	20	6	2			2	
H3404	002	0	1	04	01	H3404_002_0	4	3	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H3404	002	0	1	04	01	H3404_002_0	4	4	001100000000011111101000001100001111111111000000	No Cost Sharing	2				1	0.00	0.00	2	
H3404	801	0	1	04	01	H3404_801_0	4	2	000000000000000000000000000000001000000000000000	Health Education/Wellness Programs	2				1	0.00	0.00	2	
H3404	801	0	1	04	01	H3404_801_0	4	1	011111111111111111111101111100001111111111101111	Medicare Covered Services	1	20	20	2	2			2	
H3404	803	0	1	04	01	H3404_803_0	4	2	000000000000000000000000000000001000000000000000	Health Education/Wellness Programs	2				1	0.00	0.00	2	
H3404	803	0	1	04	01	H3404_803_0	4	1	011111111111111111111101111100001111111111101111	Medicare Covered Services	1	20	20	2	2			2	
H3404	807	0	1	04	01	H3404_807_0	4	2	000000000000000000000000000000001000000000000000	Health Education/Wellness Programs	2				1	0.00	0.00	2	
H3404	807	0	1	04	01	H3404_807_0	4	1	011111111111111111111101111100001111111111101111	Medicare Covered Services	1	20	20	2	2			2	
H3404	808	0	1	04	01	H3404_808_0	4	1	011111111111111111111101111100001111111111101111	Medicare Covered Services	1	20	20	2	2			2	
H3404	808	0	1	04	01	H3404_808_0	4	2	000000000000000000000000000000001000000000000000	Health Education/Wellness Programs	2				1	0.00	0.00	2	
H3405	001	0	1	04	01	H3405_001_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	7	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H3405	001	0	1	04	01	H3405_001_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H3405	001	0	1	04	01	H3405_001_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H3405	001	0	1	04	01	H3405_001_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	7	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H3405	801	0	1	04	01	H3405_801_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3405	801	0	1	04	01	H3405_801_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3405	801	0	1	04	01	H3405_801_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3405	802	0	1	04	01	H3405_802_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3405	802	0	1	04	01	H3405_802_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3405	802	0	1	04	01	H3405_802_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3405	803	0	1	04	01	H3405_803_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3405	803	0	1	04	01	H3405_803_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3405	803	0	1	04	01	H3405_803_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3405	804	0	1	04	01	H3405_804_0	2	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3405	804	0	1	04	01	H3405_804_0	2	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3405	804	0	1	04	01	H3405_804_0	2	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H3437	001	0	1	04	01	H3437_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H3437	001	0	1	04	01	H3437_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H3437	001	0	1	04	01	H3437_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H3437	001	0	1	04	01	H3437_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H3437	001	0	1	04	01	H3437_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H3437	001	0	1	04	01	H3437_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H3437	001	0	1	04	01	H3437_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H3437	002	0	1	04	01	H3437_002_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H3437	002	0	1	04	01	H3437_002_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H3437	003	0	1	04	01	H3437_003_0	4	2	000000001001000000000000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H3437	003	0	1	04	01	H3437_003_0	4	1	011111110110111111111101101101001100011110100000	Out-Of-Network Services	1	20	20	3	2			2	
H3437	003	0	1	04	01	H3437_003_0	4	6	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H3437	003	0	1	04	01	H3437_003_0	4	5	000000000000000000000000000000000001000001000000	Nutrition Therapy	1	0	20	3	2			2	
H3437	003	0	1	04	01	H3437_003_0	4	4	000000000000000000000000000000000010100000000000	Routine Physical Exam	1	0	0	3	2			2	
H3437	003	0	1	04	01	H3437_003_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H3437	801	0	1	04	01	H3437_801_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H3437	801	0	1	04	01	H3437_801_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H3437	801	0	1	04	01	H3437_801_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H3437	802	0	1	04	01	H3437_802_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H3437	802	0	1	04	01	H3437_802_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H3437	802	0	1	04	01	H3437_802_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H3437	803	0	1	04	01	H3437_803_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H3437	803	0	1	04	01	H3437_803_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H3437	803	0	1	04	01	H3437_803_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H3619	001	0	1	04	01	H3619_001_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H3619	001	0	1	04	01	H3619_001_0	6	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H3619	001	0	1	04	01	H3619_001_0	6	4	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H3619	001	0	1	04	01	H3619_001_0	6	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H3619	001	0	1	04	01	H3619_001_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H3619	001	0	1	04	01	H3619_001_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	004	0	1	04	01	H3619_004_0	6	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H3619	004	0	1	04	01	H3619_004_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H3619	004	0	1	04	01	H3619_004_0	6	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H3619	004	0	1	04	01	H3619_004_0	6	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H3619	004	0	1	04	01	H3619_004_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H3619	004	0	1	04	01	H3619_004_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	012	0	1	04	01	H3619_012_0	7	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H3619	012	0	1	04	01	H3619_012_0	7	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H3619	012	0	1	04	01	H3619_012_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H3619	012	0	1	04	01	H3619_012_0	7	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H3619	012	0	1	04	01	H3619_012_0	7	4	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H3619	012	0	1	04	01	H3619_012_0	7	1	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H3619	801	0	1	04	01	H3619_801_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3619	801	0	1	04	01	H3619_801_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3619	801	0	1	04	01	H3619_801_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3619	804	0	1	04	01	H3619_804_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3619	804	0	1	04	01	H3619_804_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3619	804	0	1	04	01	H3619_804_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3619	806	0	1	04	01	H3619_806_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3619	806	0	1	04	01	H3619_806_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3619	806	0	1	04	01	H3619_806_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3619	807	0	1	04	01	H3619_807_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H3619	807	0	1	04	01	H3619_807_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H3619	807	0	1	04	01	H3619_807_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H3620	001	0	1	04	01	H3620_001_0	9	1	011011111111111110011001110000000011111100101101	Out of Network 20%	1	20	20	1	2			2	
H3620	001	0	1	04	01	H3620_001_0	9	3	000000000000000000000110000000000000000000000000	OON AMBULANCE	2				1	125.00	125.00	2	
H3620	001	0	1	04	01	H3620_001_0	9	4	100100000000000000000000001100001100000011010010	NO Copay or Coinsurance	1	0	0	1	2			2	
H3620	001	0	1	04	01	H3620_001_0	9	2	000000000000000001100000000000000000000000000000	OON ASC / OUTPT HOSP	2				1	200.00	200.00	2	
H3620	801	0	1	04	01	H3620_801_0	5	1	011111111111111111111101111100001111111111101111	Out of Network	1	20	20	1	2			2	
H3620	802	0	1	04	01	H3620_802_0	5	1	011111111111111111111101111100001111111111101111	Out of Network	1	20	20	1	2			2	
H3620	803	0	1	04	01	H3620_803_0	5	1	011111111111111111111101111100001111111111101111	Out of Network	1	20	20	1	2			2	
H3620	804	0	1	04	01	H3620_804_0	5	1	011111111111111111111101111100001111111111101111	Out of Network	1	20	20	1	2			2	
H3624	001	0	1	04	01	H3624_001_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H3624	001	0	1	04	01	H3624_001_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H3624	001	0	1	04	01	H3624_001_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H3624	001	0	1	04	01	H3624_001_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H3624	001	0	1	04	01	H3624_001_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H3624	002	0	1	04	01	H3624_002_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H3624	002	0	1	04	01	H3624_002_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H3624	002	0	1	04	01	H3624_002_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H3624	002	0	1	04	01	H3624_002_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H3624	002	0	1	04	01	H3624_002_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H3624	801	0	1	04	01	H3624_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H3624	801	0	1	04	01	H3624_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H3624	801	0	1	04	01	H3624_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H3624	802	0	1	04	01	H3624_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H3624	802	0	1	04	01	H3624_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H3624	802	0	1	04	01	H3624_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H3709	001	0	1	04	01	H3709_001_0	8	1	011111111111111111111001110100000111111111100111	OON: 30% Coinsurance	1	30	30	2	2			2	
H3709	001	0	1	04	01	H3709_001_0	8	2	000000000000000000000000000000001000000000001000	OON:  Remainder	2				1	0.00	0.00	2	
H3709	001	0	1	04	01	H3709_001_0	8	3	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3709	001	0	1	04	01	H3709_001_0	8	4	000000000000000000000000001000000000000000000000	OON:  ESRD	1	20	20	2	2			2	
H3709	003	0	1	04	01	H3709_003_0	5	3	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H3709	003	0	1	04	01	H3709_003_0	5	2	000000000000000000000000000000001000000000001000	OON:  Remainder	2				1	0.00	0.00	2	
H3709	003	0	1	04	01	H3709_003_0	5	1	011111111111111111111001110100000111111111100111	OON: 30% Coinsurance	1	30	30	2	2			2	
H3709	003	0	1	04	01	H3709_003_0	5	4	000000000000000000000000001000000000000000000000	OON:  ESRD	1	20	20	2	2			2	
H3709	801	0	1	04	01	H3709_801_0	5	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	801	0	1	04	01	H3709_801_0	5	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	801	0	1	04	01	H3709_801_0	5	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3709	801	0	1	04	01	H3709_801_0	5	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	802	0	1	04	01	H3709_802_0	4	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	802	0	1	04	01	H3709_802_0	4	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	802	0	1	04	01	H3709_802_0	4	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	802	0	1	04	01	H3709_802_0	4	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3709	803	0	1	04	01	H3709_803_0	4	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	803	0	1	04	01	H3709_803_0	4	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	803	0	1	04	01	H3709_803_0	4	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	803	0	1	04	01	H3709_803_0	4	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3709	804	0	1	04	01	H3709_804_0	4	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	804	0	1	04	01	H3709_804_0	4	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	804	0	1	04	01	H3709_804_0	4	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	804	0	1	04	01	H3709_804_0	4	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3709	805	0	1	04	01	H3709_805_0	4	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	805	0	1	04	01	H3709_805_0	4	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	805	0	1	04	01	H3709_805_0	4	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	805	0	1	04	01	H3709_805_0	4	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3709	806	0	1	04	01	H3709_806_0	4	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	806	0	1	04	01	H3709_806_0	4	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	806	0	1	04	01	H3709_806_0	4	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	806	0	1	04	01	H3709_806_0	4	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3709	807	0	1	04	01	H3709_807_0	4	1	011111111111111111111001110100000111111111100101	OON:  30% Coinsurance	1	30	30	2	2			2	
H3709	807	0	1	04	01	H3709_807_0	4	2	000000000000000000000100000000000000000000000000	OON:  $200 copay	2				1	200.00	200.00	2	
H3709	807	0	1	04	01	H3709_807_0	4	3	000000000000000000000000000000001000000000001010	OON:  Remainder	2				1	0.00	0.00	2	
H3709	807	0	1	04	01	H3709_807_0	4	4	000000000000000000000000001000000000000000000000		1	20	20	2	2			2	
H3812	001	0	1	04	01	H3812_001_0	4	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
H3812	001	0	1	04	01	H3812_001_0	4	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H3812	001	0	1	04	01	H3812_001_0	4	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H3812	005	0	1	04	01	H3812_005_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	10.00	2	
H3812	005	0	1	04	01	H3812_005_0	4	3	100000000000000000000000001000000000000000000010	Group 3	2				1	0.00	0.00	2	
H3812	005	0	1	04	01	H3812_005_0	4	4	000000000000000000000000000000001000000000000000	Group 4	1	0	30	6	2			2	
H3812	005	0	1	04	01	H3812_005_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3812	007	0	1	04	01	H3812_007_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3812	007	0	1	04	01	H3812_007_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H3812	007	0	1	04	01	H3812_007_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3812	007	0	1	04	01	H3812_007_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				2			2	
H3812	007	0	1	04	01	H3812_007_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3812	801	0	1	04	01	H3812_801_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H3812	801	0	1	04	01	H3812_801_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	3	000100000000000111100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H3812	801	0	1	04	01	H3812_801_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	6	000000000000001000000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H3812	801	0	1	04	01	H3812_801_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H3812	803	0	1	04	01	H3812_803_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H3812	803	0	1	04	01	H3812_803_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H3812	803	0	1	04	01	H3812_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3812	803	0	1	04	01	H3812_803_0	2	3	000100000000000111100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H3812	803	0	1	04	01	H3812_803_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H3812	803	0	1	04	01	H3812_803_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H3812	803	0	1	04	01	H3812_803_0	2	6	000000000000001000000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H3812	803	0	1	04	01	H3812_803_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H3812	803	0	1	04	01	H3812_803_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H3812	803	0	1	04	01	H3812_803_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	4	011011100100100000001000000000000000001100000001	$20 copayment	2				1	20.00	20.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	3	000000000000000000000001001000000100000000100000	10% coinsurance	1	10	10	2	2			2	
H3813	001	0	1	04	01	H3813_001_0	9	9	000000000000001000000000000000000000000000000000	$10.00 to $100 copayment	2				1	10.00	100.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	8	000000000000000001100000000000000000000000000000	$10 to $400 copayment	2				1	10.00	400.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	7	000000000000000000000100000000000000000000000000	$50 copayment	2				1	50.00	50.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	6	000000010000000100000000000000000000000000000100	$30 copayment	2				1	30.00	30.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	5	000000001011000000010000000000000000000000000000	$20 group/$30 individual	2				1	20.00	30.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	1	000100000000010000000000000100001011110000001010	No copayment	2				1	0.00	0.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	2	000000000000000010000000110000000000000011000000	$10 copayment	2				1	10.00	10.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	1	000100000000010000000000000100001011110000001010	No copayment	2				1	0.00	0.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	8	000000000000000001100000000000000000000000000000	$10 to $400 copayment	2				1	10.00	400.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	7	000000000000000000000100000000000000000000000000	$50 copayment	2				1	50.00	50.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	6	000000010000000100000000000000000000000000000100	$30 copayment	2				1	30.00	30.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	9	000000000000001000000000000000000000000000000000	$10.00 to $100 copayment	2				1	10.00	100.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	4	011011100100100000001000000000000000001100000001	$20 copayment	2				1	20.00	20.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	3	000000000000000000000001001000000100000000100000	10% coinsurance	1	10	10	2	2			2	
H3813	002	0	1	04	01	H3813_002_0	10	2	000000000000000010000000110000000000000011000000	$10 copayment	2				1	10.00	10.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	5	000000001011000000010000000000000000000000000000	$20 group/$30 individual	2				1	20.00	30.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	4	011011100100100000001000000000000000001100000001	$20 copayment	2				1	20.00	20.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	3	000000000000000000000001001000000100000000100000	10% coinsurance	1	10	10	2	2			2	
H3813	003	0	1	04	01	H3813_003_0	9	2	000000000000000010000000110000000000000011000000	$10 copayment	2				1	10.00	10.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	1	000100000000010000000000000100001011110000001010	No copayment	2				1	0.00	0.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	5	000000001011000000010000000000000000000000000000	$20 group/$30 individual	2				1	20.00	30.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	9	000000000000001000000000000000000000000000000000	$10.00 to $100 copayment	2				1	10.00	100.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	8	000000000000000001100000000000000000000000000000	$10 to $400 copayment	2				1	10.00	400.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	7	000000000000000000000100000000000000000000000000	$50 copayment	2				1	50.00	50.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	6	000000010000000100000000000000000000000000000100	$30 copayment	2				1	30.00	30.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	1	000100000000010000000000000100001011110000001010	No copayment	2				1	0.00	0.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	2	000000000000000010000000110000000000000011000000	$10 copayment	2				1	10.00	10.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	9	000000000000001000000000000000000000000000000000	$10.00 to $100 copayment	2				1	10.00	100.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	8	000000000000000001100000000000000000000000000000	$10 to $400 copayment	2				1	10.00	400.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	7	000000000000000000000100000000000000000000000000	$50 copayment	2				1	50.00	50.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	6	000000010000000100000000000000000000000000000100	$30 copayment	2				1	30.00	30.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	5	000000001011000000010000000000000000000000000000	$20 group/$30 individual	2				1	20.00	30.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	4	011011100100100000001000000000000000001100000001	$20 copayment	2				1	20.00	20.00	2	
H3813	801	0	1	04	01	H3813_801_0	3	3	000000000000000000000001001000000100000000100000	10% coinsurance	1	10	10	2	2			2	
H3813	802	0	1	04	01	H3813_802_0	3	1	000100000000010000000000000100001011110000001010	No copayment	2				1	0.00	0.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	5	000000001011000000010000000000000000000000000000	$20 group/$30 individual	2				1	20.00	30.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	6	000000010000000100000000000000000000000000000100	$30 copayment	2				1	30.00	30.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	7	000000000000000000000100000000000000000000000000	$50 copayment	2				1	50.00	50.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	9	000000000000001000000000000000000000000000000000	$10.00 to $100 copayment	2				1	10.00	100.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	4	011011100100100000001000000000000000001100000001	$20 copayment	2				1	20.00	20.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	3	000000000000000000000001001000000100000000100000	10% coinsurance	1	10	10	2	2			2	
H3813	802	0	1	04	01	H3813_802_0	3	2	000000000000000010000000110000000000000011000000	$10 copayment	2				1	10.00	10.00	2	
H3813	802	0	1	04	01	H3813_802_0	3	8	000000000000000001100000000000000000000000000000	$10 to $400 copayment	2				1	10.00	400.00	2	
H3817	001	0	1	04	01	H3817_001_0	6	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H3817	001	0	1	04	01	H3817_001_0	6	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H3817	001	0	1	04	01	H3817_001_0	6	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H3817	001	0	1	04	01	H3817_001_0	6	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H3817	001	0	1	04	01	H3817_001_0	6	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H3817	001	0	1	04	01	H3817_001_0	6	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H3817	001	0	1	04	01	H3817_001_0	6	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H3817	002	0	1	04	01	H3817_002_0	6	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H3817	002	0	1	04	01	H3817_002_0	6	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H3817	002	0	1	04	01	H3817_002_0	6	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H3817	002	0	1	04	01	H3817_002_0	6	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H3817	002	0	1	04	01	H3817_002_0	6	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H3817	002	0	1	04	01	H3817_002_0	6	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H3817	002	0	1	04	01	H3817_002_0	6	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H3817	003	0	1	04	01	H3817_003_0	9	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H3817	003	0	1	04	01	H3817_003_0	9	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	9	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	9	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H3817	003	0	1	04	01	H3817_003_0	9	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H3817	003	0	1	04	01	H3817_003_0	9	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H3817	003	0	1	04	01	H3817_003_0	9	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H3817	006	0	1	04	01	H3817_006_0	6	2	000000000000000000000100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H3817	006	0	1	04	01	H3817_006_0	6	10	000000000000000001000000000000000000000000000000	$0 to $500	2				1	0.00	500.00	2	
H3817	006	0	1	04	01	H3817_006_0	6	3	000000000000000000100000000000000000000000000000	$500	2				1	500.00	500.00	2	
H3817	006	0	1	04	01	H3817_006_0	6	4	000000000000000000000000001000000000000000100000	20% coinsurance	1	20	20	2	2			2	
H3817	006	0	1	04	01	H3817_006_0	6	9	000000000000000000000000000000001000000000000000	$0 copay	2				1	0.00	0.00	2	
H3817	006	0	1	04	01	H3817_006_0	6	8	000000000000010000000000000000000000000000000000	0to 40% coinsurance	1	0	40	2	2			2	
H3817	006	0	1	04	01	H3817_006_0	6	7	000000000000000000000000000000000000000000000010	$0 copay	2				1	0.00	0.00	2	
H3817	006	0	1	04	01	H3817_006_0	6	1	000011111111100000010000000000000010000000001101	$35.00 copay	2				1	35.00	35.00	2	
H3817	006	0	1	04	01	H3817_006_0	6	5	000100000000001110000001100000000000000000000000	40% coinsurance	1	40	40	2	2			2	
H3817	006	0	1	04	01	H3817_006_0	6	6	011000000000000000001000010100000101111111000000	$0 copay	2				1	0.00	0.00	2	
H3909	001	0	1	04	01	H3909_001_0	8	1	011111111111111111111001110100000111111111101111	Group 1	1	30	30	1	2			2	
H3909	001	0	1	04	01	H3909_001_0	8	2	000000000000000000000000001000001000000000000000	Group 2	1	0	0	1	2			2	
H3909	001	0	1	04	01	H3909_001_0	8	3	000000000000000000000100000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H3909	007	0	1	04	01	H3909_007_0	6	1	011111111111111111111001110100000111111111101111	Group 1	1	30	30	1	2			2	
H3909	007	0	1	04	01	H3909_007_0	6	2	000000000000000000000000001000001000000000000000	Group 2	1	0	0	1	2			2	
H3909	007	0	1	04	01	H3909_007_0	6	3	000000000000000000000100000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H3909	801	0	1	04	01	H3909_801_0	7	1	011111110110111111101101111100001111111111101111	Group 1	1	30	30	1	2			2	
H3909	801	0	1	04	01	H3909_801_0	7	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H3909	802	0	1	04	01	H3909_802_0	6	1	011111110110111111101101111100001111111111101111	Group 1	1	30	30	1	2			2	
H3909	802	0	1	04	01	H3909_802_0	6	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H3912	001	0	1	04	01	H3912_001_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	001	0	1	04	01	H3912_001_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	35.00	2	
H3912	001	0	1	04	01	H3912_001_0	4	3	000000000000000000000000001000000000000000000010	Group 3	2				1	0.00	0.00	2	
H3912	001	0	1	04	01	H3912_001_0	4	4	000000000000000000000000000000001000000000000000	Group 4	1	0	30	6	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3912	005	0	1	04	01	H3912_005_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	006	0	1	04	01	H3912_006_0	5	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3912	006	0	1	04	01	H3912_006_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3912	006	0	1	04	01	H3912_006_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H3912	006	0	1	04	01	H3912_006_0	5	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3912	006	0	1	04	01	H3912_006_0	5	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	007	0	1	04	01	H3912_007_0	5	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3912	007	0	1	04	01	H3912_007_0	5	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3912	007	0	1	04	01	H3912_007_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H3912	007	0	1	04	01	H3912_007_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3912	007	0	1	04	01	H3912_007_0	5	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	008	0	1	04	01	H3912_008_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3912	008	0	1	04	01	H3912_008_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3912	008	0	1	04	01	H3912_008_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H3912	008	0	1	04	01	H3912_008_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3912	008	0	1	04	01	H3912_008_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	009	0	1	04	01	H3912_009_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3912	009	0	1	04	01	H3912_009_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3912	009	0	1	04	01	H3912_009_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H3912	009	0	1	04	01	H3912_009_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3912	009	0	1	04	01	H3912_009_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	011	0	1	04	01	H3912_011_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H3912	011	0	1	04	01	H3912_011_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H3912	011	0	1	04	01	H3912_011_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H3912	011	0	1	04	01	H3912_011_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H3912	011	0	1	04	01	H3912_011_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H3916	001	0	1	04	01	H3916_001_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	001	0	1	04	01	H3916_001_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	001	0	1	04	01	H3916_001_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	001	0	1	04	01	H3916_001_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	001	0	1	04	01	H3916_001_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	001	0	1	04	01	H3916_001_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H3916	001	0	1	04	01	H3916_001_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	001	0	1	04	01	H3916_001_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	002	0	1	04	01	H3916_002_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	002	0	1	04	01	H3916_002_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	002	0	1	04	01	H3916_002_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	002	0	1	04	01	H3916_002_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	002	0	1	04	01	H3916_002_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	002	0	1	04	01	H3916_002_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	002	0	1	04	01	H3916_002_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H3916	002	0	1	04	01	H3916_002_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	003	0	1	04	01	H3916_003_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	003	0	1	04	01	H3916_003_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	003	0	1	04	01	H3916_003_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	003	0	1	04	01	H3916_003_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	003	0	1	04	01	H3916_003_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H3916	003	0	1	04	01	H3916_003_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	003	0	1	04	01	H3916_003_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	003	0	1	04	01	H3916_003_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	005	0	1	04	01	H3916_005_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H3916	005	0	1	04	01	H3916_005_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	005	0	1	04	01	H3916_005_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	005	0	1	04	01	H3916_005_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	005	0	1	04	01	H3916_005_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	005	0	1	04	01	H3916_005_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	012	0	1	04	01	H3916_012_0	5	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H3916	012	0	1	04	01	H3916_012_0	5	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	012	0	1	04	01	H3916_012_0	5	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	012	0	1	04	01	H3916_012_0	5	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	012	0	1	04	01	H3916_012_0	5	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H3916	012	0	1	04	01	H3916_012_0	5	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	012	0	1	04	01	H3916_012_0	5	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	015	0	1	04	01	H3916_015_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	015	0	1	04	01	H3916_015_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H3916	015	0	1	04	01	H3916_015_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	015	0	1	04	01	H3916_015_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	015	0	1	04	01	H3916_015_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	015	0	1	04	01	H3916_015_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	015	0	1	04	01	H3916_015_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	018	0	1	04	01	H3916_018_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H3916	018	0	1	04	01	H3916_018_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	018	0	1	04	01	H3916_018_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	018	0	1	04	01	H3916_018_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H3916	018	0	1	04	01	H3916_018_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	019	0	1	04	01	H3916_019_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	019	0	1	04	01	H3916_019_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	2			2	
H3916	019	0	1	04	01	H3916_019_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	019	0	1	04	01	H3916_019_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	019	0	1	04	01	H3916_019_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			2	
H3916	019	0	1	04	01	H3916_019_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	2			2	
H3916	019	0	1	04	01	H3916_019_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	019	0	1	04	01	H3916_019_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	020	0	1	04	01	H3916_020_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	2			2	
H3916	020	0	1	04	01	H3916_020_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	020	0	1	04	01	H3916_020_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			2	
H3916	020	0	1	04	01	H3916_020_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	2			2	
H3916	020	0	1	04	01	H3916_020_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	021	0	1	04	01	H3916_021_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	021	0	1	04	01	H3916_021_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	2			2	
H3916	021	0	1	04	01	H3916_021_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	021	0	1	04	01	H3916_021_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	021	0	1	04	01	H3916_021_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	021	0	1	04	01	H3916_021_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	021	0	1	04	01	H3916_021_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	2			2	
H3916	021	0	1	04	01	H3916_021_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			2	
H3916	022	0	1	04	01	H3916_022_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	022	0	1	04	01	H3916_022_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H3916	022	0	1	04	01	H3916_022_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	022	0	1	04	01	H3916_022_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H3916	022	0	1	04	01	H3916_022_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	022	0	1	04	01	H3916_022_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	022	0	1	04	01	H3916_022_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	023	0	1	04	01	H3916_023_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	023	0	1	04	01	H3916_023_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	023	0	1	04	01	H3916_023_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H3916	023	0	1	04	01	H3916_023_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	023	0	1	04	01	H3916_023_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	023	0	1	04	01	H3916_023_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H3916	023	0	1	04	01	H3916_023_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	024	0	1	04	01	H3916_024_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	024	0	1	04	01	H3916_024_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	024	0	1	04	01	H3916_024_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H3916	024	0	1	04	01	H3916_024_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	024	0	1	04	01	H3916_024_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H3916	025	0	1	04	01	H3916_025_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	025	0	1	04	01	H3916_025_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	025	0	1	04	01	H3916_025_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			2	
H3916	025	0	1	04	01	H3916_025_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	2			2	
H3916	025	0	1	04	01	H3916_025_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H3916	025	0	1	04	01	H3916_025_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	30	30	1	2			2	
H3916	025	0	1	04	01	H3916_025_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	025	0	1	04	01	H3916_025_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	026	0	1	04	01	H3916_026_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	026	0	1	04	01	H3916_026_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	2			2	
H3916	026	0	1	04	01	H3916_026_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	026	0	1	04	01	H3916_026_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	026	0	1	04	01	H3916_026_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	027	0	1	04	01	H3916_027_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	027	0	1	04	01	H3916_027_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	2			2	
H3916	027	0	1	04	01	H3916_027_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	027	0	1	04	01	H3916_027_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	027	0	1	04	01	H3916_027_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	027	0	1	04	01	H3916_027_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	027	0	1	04	01	H3916_027_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	027	0	1	04	01	H3916_027_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	028	0	1	04	01	H3916_028_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H3916	028	0	1	04	01	H3916_028_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H3916	028	0	1	04	01	H3916_028_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H3916	028	0	1	04	01	H3916_028_0	7	2	000000000000000000000110000000000000000000000000	Group 2	1	20	20	1	2			2	
H3916	028	0	1	04	01	H3916_028_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H3916	028	0	1	04	01	H3916_028_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H3916	028	0	1	04	01	H3916_028_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	2	2			1	250.00
H3916	028	0	1	04	01	H3916_028_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H3916	801	0	1	04	01	H3916_801_0	5	1	011111110110111111111101111100000111111111101111	Group 1	1	20	20	1	2			2	
H3916	801	0	1	04	01	H3916_801_0	5	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H3916	801	0	1	04	01	H3916_801_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	20	20	1	2			2	
H3916	802	0	1	04	01	H3916_802_0	5	1	011111110110111111111101111100000111111111101111	Group 1	1	20	20	1	2			2	
H3916	802	0	1	04	01	H3916_802_0	5	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H3916	802	0	1	04	01	H3916_802_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	20	20	1	2			2	
H3916	804	0	1	04	01	H3916_804_0	5	1	011111110110111111111101111100000111111111101111	Group 1	1	20	20	1	2			2	
H3916	804	0	1	04	01	H3916_804_0	5	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H3916	804	0	1	04	01	H3916_804_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	20	20	1	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	7	100000000000000000000000000100001100000000000000	Group 7	2				1	0.00	0.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	4	000010000010000000000000000000000010000000000000	Group 4	2				1	15.00	15.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H3921	003	0	1	04	01	H3921_003_0	4	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	7	000000000000000000000000000100001100000000000000	Group 7	2				1	0.00	0.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	10	000000000000000010000000000000000000000000000000	Group 10	2				1	20.00	20.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	003	0	1	04	01	H3921_003_0	4	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H3921	008	0	1	04	01	H3921_008_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H3921	008	0	1	04	01	H3921_008_0	3	7	100000000000000000000000000100001100000000000000	Group 7	2				1	0.00	0.00	2	
H3921	008	0	1	04	01	H3921_008_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H3921	008	0	1	04	01	H3921_008_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H3921	008	0	1	04	01	H3921_008_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H3921	008	0	1	04	01	H3921_008_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H3921	008	0	1	04	01	H3921_008_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	008	0	1	04	01	H3921_008_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H3921	008	0	1	04	01	H3921_008_0	3	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H3921	801	0	1	04	01	H3921_801_0	2	6	000000000000000000000100000000000000000000000000	Group 6	2				1	150.00	150.00	2	
H3921	801	0	1	04	01	H3921_801_0	2	5	000000000000000010000000000000000000000000000000	Group 5	2				1	20.00	20.00	2	
H3921	801	0	1	04	01	H3921_801_0	2	4	000000000000010000000000000000000000000000000000	Group 4	1	0	30	2	1	0.00	7.00	2	
H3921	801	0	1	04	01	H3921_801_0	2	3	000000001001000000010000000000000000000000000000	Group 3	2				1	35.00	45.00	2	
H3921	801	0	1	04	01	H3921_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	801	0	1	04	01	H3921_801_0	2	1	010111110110101101101001110001000011111111101111	Group 1	1	30	30	2	2			2	
H3921	801	0	1	04	01	H3921_801_0	2	7	000000000000000000000000001000000000000000000000	Group 7	1	20	20	2	2			2	
H3921	801	0	1	04	01	H3921_801_0	2	8	000000000000000000000000000100001100000000000000	Group 8	2				1	0.00	0.00	2	
H3921	803	0	1	04	01	H3921_803_0	2	3	000000001001000000010000000000000000000000000000	Group 3	2				1	35.00	45.00	2	
H3921	803	0	1	04	01	H3921_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	803	0	1	04	01	H3921_803_0	2	1	010111110110101101101001110001000011111111101111	Group 1	1	30	30	2	2			2	
H3921	803	0	1	04	01	H3921_803_0	2	4	000000000000010000000000000000000000000000000000	Group 4	1	0	30	2	1	0.00	7.00	2	
H3921	803	0	1	04	01	H3921_803_0	2	5	000000000000000010000000000000000000000000000000	Group 5	2				1	20.00	20.00	2	
H3921	803	0	1	04	01	H3921_803_0	2	6	000000000000000000000100000000000000000000000000	Group 6	2				1	150.00	150.00	2	
H3921	803	0	1	04	01	H3921_803_0	2	7	000000000000000000000000001000000000000000000000	Group 7	1	20	20	2	2			2	
H3921	803	0	1	04	01	H3921_803_0	2	8	000000000000000000000000000100001100000000000000	Group 8	2				1	0.00	0.00	2	
H3921	804	0	1	04	01	H3921_804_0	2	3	000000001001000000010000000000000000000000000000	Group 3	2				1	35.00	45.00	2	
H3921	804	0	1	04	01	H3921_804_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	804	0	1	04	01	H3921_804_0	2	1	010111110110101101101001110001000011111111101111	Group 1	1	30	30	2	2			2	
H3921	804	0	1	04	01	H3921_804_0	2	4	000000000000010000000000000000000000000000000000	Group 4	1	0	30	2	1	0.00	7.00	2	
H3921	804	0	1	04	01	H3921_804_0	2	8	000000000000000000000000000100001100000000000000	Group 8	2				1	0.00	0.00	2	
H3921	804	0	1	04	01	H3921_804_0	2	7	000000000000000000000000001000000000000000000000	Group 7	1	20	20	2	2			2	
H3921	804	0	1	04	01	H3921_804_0	2	6	000000000000000000000100000000000000000000000000	Group 6	2				1	150.00	150.00	2	
H3921	804	0	1	04	01	H3921_804_0	2	5	000000000000000010000000000000000000000000000000	Group 5	2				1	20.00	20.00	2	
H3921	805	0	1	04	01	H3921_805_0	2	1	010111110110101101101001110001000011111111101111	Group 1	1	30	30	2	2			2	
H3921	805	0	1	04	01	H3921_805_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H3921	805	0	1	04	01	H3921_805_0	2	3	000000001001000000010000000000000000000000000000	Group 3	2				1	35.00	45.00	2	
H3921	805	0	1	04	01	H3921_805_0	2	7	000000000000000000000000001000000000000000000000	Group 7	1	20	20	2	2			2	
H3921	805	0	1	04	01	H3921_805_0	2	6	000000000000000000000100000000000000000000000000	Group 6	2				1	150.00	150.00	2	
H3921	805	0	1	04	01	H3921_805_0	2	5	000000000000000010000000000000000000000000000000	Group 5	2				1	20.00	20.00	2	
H3921	805	0	1	04	01	H3921_805_0	2	4	000000000000010000000000000000000000000000000000	Group 4	1	0	30	2	1	0.00	7.00	2	
H3921	805	0	1	04	01	H3921_805_0	2	8	000000000000000000000000000100001100000000000000	Group 8	2				1	0.00	0.00	2	
H3923	009	0	1	04	01	H3923_009_0	8	1	011111111111111111111111111100001111111111100111	25% Copay group	1	25	25	3	2			2	
H3923	009	0	1	04	01	H3923_009_0	8	2	100000000000000000000000000011110000000000011000	100% Copay Group	1	100	100	3	2			2	
H3923	013	0	1	04	01	H3923_013_0	9	1	011111111111111111111111111100001111111111100111	25% Copay Group	1	25	25	3	2			2	
H3923	013	0	1	04	01	H3923_013_0	9	2	100000000000000000000000000011110000000000011000	100% Copay Group	1	100	100	3	2			2	
H3923	017	0	1	04	01	H3923_017_0	8	1	011111111111111111111111111100001111111111100111	20% Copay Items	1	20	20	3	2			2	
H3923	017	0	1	04	01	H3923_017_0	8	2	100000000000000000000000000011110000000000011000	100% Copay services	1	100	100	3	2			2	
H3923	021	0	1	04	01	H3923_021_0	9	1	011111111111111111111111111100001111111111100111	30% Copay Group	1	30	30	3	2			2	
H3923	021	0	1	04	01	H3923_021_0	9	2	100000000000000000000000000011110000000000011000	100% Cooay items	1	100	100	3	2			2	
H3923	801	0	1	04	01	H3923_801_0	11	1	011111111111111111111111111100001111111111100111	All out of network	1	0	100	1	2			1	135.00
H3923	801	0	1	04	01	H3923_801_0	11	2	100000000000000000000000000011110000000000011000	Non-covered	1	100	100	2	2			2	
H3923	802	0	1	04	01	H3923_802_0	10	1	011111111111111111111111111100001111111111100111	All out of network	1	0	100	1	2			1	135.00
H3923	802	0	1	04	01	H3923_802_0	10	2	100000000000000000000000000011110000000000011000	Non-covered	1	100	100	1	2			2	
H3923	803	0	1	04	01	H3923_803_0	10	1	011111111111111111111111111100001111111111100111	All out of network	1	0	100	1	2			1	135.00
H3923	803	0	1	04	01	H3923_803_0	10	2	100000000000000000000000000011110000000000011000	Non-covered	1	100	100	1	2			2	
H3924	001	0	1	04	01	H3924_001_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	001	0	1	04	01	H3924_001_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	001	0	1	04	01	H3924_001_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	001	0	1	04	01	H3924_001_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	001	0	1	04	01	H3924_001_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	002	0	1	04	01	H3924_002_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	002	0	1	04	01	H3924_002_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	002	0	1	04	01	H3924_002_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	002	0	1	04	01	H3924_002_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	002	0	1	04	01	H3924_002_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	003	0	1	04	01	H3924_003_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	003	0	1	04	01	H3924_003_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	003	0	1	04	01	H3924_003_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	003	0	1	04	01	H3924_003_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	003	0	1	04	01	H3924_003_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	005	0	1	04	01	H3924_005_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	005	0	1	04	01	H3924_005_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	005	0	1	04	01	H3924_005_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	005	0	1	04	01	H3924_005_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	005	0	1	04	01	H3924_005_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	006	0	1	04	01	H3924_006_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	006	0	1	04	01	H3924_006_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	006	0	1	04	01	H3924_006_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	006	0	1	04	01	H3924_006_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	006	0	1	04	01	H3924_006_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	007	0	1	04	01	H3924_007_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	007	0	1	04	01	H3924_007_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	007	0	1	04	01	H3924_007_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	007	0	1	04	01	H3924_007_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	007	0	1	04	01	H3924_007_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	009	0	1	04	01	H3924_009_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	009	0	1	04	01	H3924_009_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	009	0	1	04	01	H3924_009_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	009	0	1	04	01	H3924_009_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	009	0	1	04	01	H3924_009_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	010	0	1	04	01	H3924_010_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	010	0	1	04	01	H3924_010_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	010	0	1	04	01	H3924_010_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	010	0	1	04	01	H3924_010_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	010	0	1	04	01	H3924_010_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	011	0	1	04	01	H3924_011_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	011	0	1	04	01	H3924_011_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	011	0	1	04	01	H3924_011_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	011	0	1	04	01	H3924_011_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	011	0	1	04	01	H3924_011_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	013	0	1	04	01	H3924_013_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	013	0	1	04	01	H3924_013_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	013	0	1	04	01	H3924_013_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	013	0	1	04	01	H3924_013_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	013	0	1	04	01	H3924_013_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	014	0	1	04	01	H3924_014_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	014	0	1	04	01	H3924_014_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	014	0	1	04	01	H3924_014_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	014	0	1	04	01	H3924_014_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	014	0	1	04	01	H3924_014_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	015	0	1	04	01	H3924_015_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	015	0	1	04	01	H3924_015_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	015	0	1	04	01	H3924_015_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	015	0	1	04	01	H3924_015_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	015	0	1	04	01	H3924_015_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	017	0	1	04	01	H3924_017_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	017	0	1	04	01	H3924_017_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	017	0	1	04	01	H3924_017_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	017	0	1	04	01	H3924_017_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	017	0	1	04	01	H3924_017_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	018	0	1	04	01	H3924_018_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	018	0	1	04	01	H3924_018_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	018	0	1	04	01	H3924_018_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	018	0	1	04	01	H3924_018_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	018	0	1	04	01	H3924_018_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	019	0	1	04	01	H3924_019_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	019	0	1	04	01	H3924_019_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	019	0	1	04	01	H3924_019_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	019	0	1	04	01	H3924_019_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	019	0	1	04	01	H3924_019_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	021	0	1	04	01	H3924_021_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	021	0	1	04	01	H3924_021_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	021	0	1	04	01	H3924_021_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	021	0	1	04	01	H3924_021_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	021	0	1	04	01	H3924_021_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	022	0	1	04	01	H3924_022_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	022	0	1	04	01	H3924_022_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	022	0	1	04	01	H3924_022_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	022	0	1	04	01	H3924_022_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	022	0	1	04	01	H3924_022_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	023	0	1	04	01	H3924_023_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	023	0	1	04	01	H3924_023_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	023	0	1	04	01	H3924_023_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	023	0	1	04	01	H3924_023_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	023	0	1	04	01	H3924_023_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	025	0	1	04	01	H3924_025_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	025	0	1	04	01	H3924_025_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	025	0	1	04	01	H3924_025_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	025	0	1	04	01	H3924_025_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	025	0	1	04	01	H3924_025_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	026	0	1	04	01	H3924_026_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	026	0	1	04	01	H3924_026_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	026	0	1	04	01	H3924_026_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	026	0	1	04	01	H3924_026_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	026	0	1	04	01	H3924_026_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	027	0	1	04	01	H3924_027_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	027	0	1	04	01	H3924_027_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	027	0	1	04	01	H3924_027_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	027	0	1	04	01	H3924_027_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	027	0	1	04	01	H3924_027_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	029	0	1	04	01	H3924_029_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	029	0	1	04	01	H3924_029_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	029	0	1	04	01	H3924_029_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	029	0	1	04	01	H3924_029_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	029	0	1	04	01	H3924_029_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	030	0	1	04	01	H3924_030_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	030	0	1	04	01	H3924_030_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	030	0	1	04	01	H3924_030_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	030	0	1	04	01	H3924_030_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	030	0	1	04	01	H3924_030_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	031	0	1	04	01	H3924_031_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	031	0	1	04	01	H3924_031_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	031	0	1	04	01	H3924_031_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	031	0	1	04	01	H3924_031_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	031	0	1	04	01	H3924_031_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	033	0	1	04	01	H3924_033_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	033	0	1	04	01	H3924_033_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	033	0	1	04	01	H3924_033_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	033	0	1	04	01	H3924_033_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	033	0	1	04	01	H3924_033_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	034	0	1	04	01	H3924_034_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	034	0	1	04	01	H3924_034_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	034	0	1	04	01	H3924_034_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	034	0	1	04	01	H3924_034_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	034	0	1	04	01	H3924_034_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	035	0	1	04	01	H3924_035_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	035	0	1	04	01	H3924_035_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	035	0	1	04	01	H3924_035_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	035	0	1	04	01	H3924_035_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	035	0	1	04	01	H3924_035_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	036	0	1	04	01	H3924_036_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	036	0	1	04	01	H3924_036_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	036	0	1	04	01	H3924_036_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	036	0	1	04	01	H3924_036_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	036	0	1	04	01	H3924_036_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	037	0	1	04	01	H3924_037_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	037	0	1	04	01	H3924_037_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	037	0	1	04	01	H3924_037_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	037	0	1	04	01	H3924_037_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	037	0	1	04	01	H3924_037_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	038	0	1	04	01	H3924_038_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	038	0	1	04	01	H3924_038_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	038	0	1	04	01	H3924_038_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	038	0	1	04	01	H3924_038_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	038	0	1	04	01	H3924_038_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	039	0	1	04	01	H3924_039_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	039	0	1	04	01	H3924_039_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	039	0	1	04	01	H3924_039_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	039	0	1	04	01	H3924_039_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	039	0	1	04	01	H3924_039_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	040	0	1	04	01	H3924_040_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	040	0	1	04	01	H3924_040_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	040	0	1	04	01	H3924_040_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	040	0	1	04	01	H3924_040_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	040	0	1	04	01	H3924_040_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	041	0	1	04	01	H3924_041_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	041	0	1	04	01	H3924_041_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	041	0	1	04	01	H3924_041_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	041	0	1	04	01	H3924_041_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	041	0	1	04	01	H3924_041_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	042	0	1	04	01	H3924_042_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	042	0	1	04	01	H3924_042_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	042	0	1	04	01	H3924_042_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	042	0	1	04	01	H3924_042_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	042	0	1	04	01	H3924_042_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	043	0	1	04	01	H3924_043_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	043	0	1	04	01	H3924_043_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	043	0	1	04	01	H3924_043_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	043	0	1	04	01	H3924_043_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	043	0	1	04	01	H3924_043_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	044	0	1	04	01	H3924_044_0	3	1	000010000000000000000000000000000010000000000000	Primary Care Physician Services	2				1	20.00	20.00	2	
H3924	044	0	1	04	01	H3924_044_0	3	3	011100101011111111110101111100001100000001100000	All other OON Services	1	20	20	1	2			2	
H3924	044	0	1	04	01	H3924_044_0	3	2	000001010100000000001000000000000001111110001101	Specialty OON Services	2				1	30.00	30.00	2	
H3924	044	0	1	04	01	H3924_044_0	3	5	100000000000000000000000000000000000000000000010	Eyewear and Hearing Aids OON	2				1	0.00	0.00	2	
H3924	044	0	1	04	01	H3924_044_0	3	4	000000000000000000000000000000000000000000010000	Preventive Dental OON	1	20	20	2	2			2	
H3924	801	0	1	04	01	H3924_801_0	2	1	011111111111111111111101111100001111111111101111	OON Medicare Covered Services	1	20	20	1	2			2	
H3924	802	0	1	04	01	H3924_802_0	2	1	011111111111111111111101111100001111111111101111	OON Medicare Covered Services	1	20	20	1	2			2	
H4005	001	0	1	04	01	H4005_001_0	3	1	000100000010011111100101110100000111111100111111	Group 1	1	20	20	2	2			2	
H4005	001	0	1	04	01	H4005_001_0	3	4	100010010001000000000000001000001000000000000000	Group 4	1	0	0	2	2			2	
H4005	001	0	1	04	01	H4005_001_0	3	3	001000000000000000000000000000000000000000000000	Group 3	2				1	75.00	75.00	2	
H4005	001	0	1	04	01	H4005_001_0	3	2	010001101100100000011000000000000000000011000000	Group 2	1	25	25	2	2			2	
H4005	003	0	1	04	01	H4005_003_0	7	2	010001101100100000011000000000000000000011000000	Group 2	1	25	25	3	2			2	
H4005	003	0	1	04	01	H4005_003_0	7	3	001000000000000000000000000000000000000000000000	Group 3	2				1	75.00	75.00	2	
H4005	003	0	1	04	01	H4005_003_0	7	4	100010010001000000000000001000001000000000000000	Group 4	1	0	0	2	2			2	
H4005	003	0	1	04	01	H4005_003_0	7	1	000100000010011111100101110100000111111100111111	Group 1	1	20	20	2	2			2	
H4005	004	0	1	04	01	H4005_004_0	6	3	001000000000000000000000000000000000000000000000	Group 3	2				1	75.00	75.00	2	
H4005	004	0	1	04	01	H4005_004_0	6	2	010001101100100000011000000000000000000011000000	Group 2	1	25	25	3	2			2	
H4005	004	0	1	04	01	H4005_004_0	6	1	000100000010011111100101110100000111111100111111	Group 1	1	20	20	2	2			2	
H4005	004	0	1	04	01	H4005_004_0	6	4	100010010001000000000000001000001000000000000000	Group 4	1	0	0	2	2			2	
H4005	801	0	1	04	01	H4005_801_0	5	3	001000000000000000000000000000000000000000000000	Group 3	2				1	75.00	75.00	2	
H4005	801	0	1	04	01	H4005_801_0	5	2	010001101100100000011000000000000000000011000000	Group 2	1	25	25	3	2			2	
H4005	801	0	1	04	01	H4005_801_0	5	1	000100000010011111100101110100000111111100111111	Group 1	1	20	20	2	2			2	
H4005	801	0	1	04	01	H4005_801_0	5	4	100010010001000000000000001000001000000000000000	Group 4	1	0	0	2	2			2	
H4005	802	0	1	04	01	H4005_802_0	4	1	000100000010011111100101110100000111111100111111	Group 1	1	20	20	2	2			2	
H4005	802	0	1	04	01	H4005_802_0	4	2	010001101100100000011000000000000000000011000000	Group 2	1	25	25	3	2			2	
H4005	802	0	1	04	01	H4005_802_0	4	3	001000000000000000000000000000000000000000000000	Group 3	2				1	75.00	75.00	2	
H4005	802	0	1	04	01	H4005_802_0	4	4	100010010001000000000000001000001000000000000000	Group 4	1	0	0	2	2			2	
H4005	804	0	1	04	01	H4005_804_0	4	1	000100000010011111100101110100000111111100111111	Group 1	1	20	20	2	2			2	
H4005	804	0	1	04	01	H4005_804_0	4	2	010001101100100000011000000000000000000011000000	Group 2	1	25	25	3	2			2	
H4005	804	0	1	04	01	H4005_804_0	4	3	001000000000000000000000000000000000000000000000	Group 3	2				1	75.00	75.00	2	
H4005	804	0	1	04	01	H4005_804_0	4	4	100010010001000000000000001000001000000000000000	Group 4	1	0	0	2	2			2	
H4011	001	0	1	04	01	H4011_001_0	7	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			2	
H4011	001	0	1	04	01	H4011_001_0	7	2	011111110110111111101101111100001111111111111101		1	20	20	1	2			2	
H4011	001	0	1	04	01	H4011_001_0	7	3	100000000000000000000010000000000000000000000010		2				1	0.00	0.00	2	
H4011	003	0	1	04	01	H4011_003_0	9	3	100000000000000000000010000001100000000000000010		2				1	0.00	0.00	2	
H4011	003	0	1	04	01	H4011_003_0	9	2	011111110110111111101101111100000111111111111101		1	20	20	1	2			2	
H4011	003	0	1	04	01	H4011_003_0	9	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			2	
H4011	003	0	1	04	01	H4011_003_0	9	4	000000000000000000000000000010001000000000000000		2				1	0.00	0.00	2	
H4011	004	0	1	04	01	H4011_004_0	9	2	011111110110111111101101111100000111111111111101		1	20	20	1	2			2	
H4011	004	0	1	04	01	H4011_004_0	9	3	100000000000000000000010000001100000000000000010		2				1	0.00	0.00	2	
H4011	004	0	1	04	01	H4011_004_0	9	4	000000000000000000000000000010001000000000000000		2				1	0.00	0.00	2	
H4011	004	0	1	04	01	H4011_004_0	9	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			2	
H4011	801	0	1	04	01	H4011_801_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	801	0	1	04	01	H4011_801_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	802	0	1	04	01	H4011_802_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	802	0	1	04	01	H4011_802_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	803	0	1	04	01	H4011_803_0	6	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	803	0	1	04	01	H4011_803_0	6	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	805	0	1	04	01	H4011_805_0	6	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	805	0	1	04	01	H4011_805_0	6	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	806	0	1	04	01	H4011_806_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	806	0	1	04	01	H4011_806_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	807	0	1	04	01	H4011_807_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	807	0	1	04	01	H4011_807_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	809	0	1	04	01	H4011_809_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	809	0	1	04	01	H4011_809_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	810	0	1	04	01	H4011_810_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	810	0	1	04	01	H4011_810_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	811	0	1	04	01	H4011_811_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	811	0	1	04	01	H4011_811_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	813	0	1	04	01	H4011_813_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	813	0	1	04	01	H4011_813_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	814	0	1	04	01	H4011_814_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	814	0	1	04	01	H4011_814_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	815	0	1	04	01	H4011_815_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	815	0	1	04	01	H4011_815_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	817	0	1	04	01	H4011_817_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	817	0	1	04	01	H4011_817_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	818	0	1	04	01	H4011_818_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	818	0	1	04	01	H4011_818_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4011	819	0	1	04	01	H4011_819_0	5	1	000000001001000000010000000000000000000000000000		1	50	50	1	2			1	135.00
H4011	819	0	1	04	01	H4011_819_0	5	2	111111110110111111101101111100001111111111111111		1	20	20	1	2			1	135.00
H4036	001	0	1	04	01	H4036_001_0	10	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
H4036	001	0	1	04	01	H4036_001_0	10	10	000100000010000001001000000100001111110100000000	OON No Copayment	2				1	0.00	0.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	11	000000000000000000000000000000000000000000001000	OON $0 Copayment Comprehensive Dental	2				1	0.00	0.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
H4036	001	0	1	04	01	H4036_001_0	10	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
H4036	001	0	1	04	01	H4036_001_0	10	3	000000000000000000000001110000000000000000000000	30 % Coinsurance OON	1	30	30	3	2			2	
H4036	001	0	1	04	01	H4036_001_0	10	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
H4036	801	0	1	04	01	H4036_801_0	3	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H4036	801	0	1	04	01	H4036_801_0	3	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H4036	802	0	1	04	01	H4036_802_0	3	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H4036	802	0	1	04	01	H4036_802_0	3	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H4036	803	0	1	04	01	H4036_803_0	3	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H4036	803	0	1	04	01	H4036_803_0	3	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H4209	001	0	1	04	01	H4209_001_0	5	3	000000000000000000000000000000000000000000000110	Vision (See OON General Notes)	2				1	0.00	0.00	2	
H4209	001	0	1	04	01	H4209_001_0	5	2	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	150.00	150.00	2	
H4209	001	0	1	04	01	H4209_001_0	5	1	011101111111111111111001111100001111111111101001	Thirty Percent Coinsurance Group	1	30	30	1	2			2	
H4209	001	0	1	04	01	H4209_001_0	5	4	000010000000000000000000000000000000000000000000	Primary Care	2				1	35.00	35.00	2	
H4209	001	0	1	04	01	H4209_001_0	5	5	100000000000000000000000000000000000000000000000	Hearing Aids (See OON General Notes)	2				1	0.00	0.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	1	011101111111111111111001111100001111111111101001	Thirty Percent Coinsurance Group	1	30	30	1	2			2	
H4209	003	0	1	04	01	H4209_003_0	5	2	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	150.00	150.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	3	000000000000000000000000000000000000000000000110	Vision (See OON General Notes)	2				1	0.00	0.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	4	000010000000000000000000000000000000000000000000	Primary Care	2				1	35.00	35.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	5	100000000000000000000000000000000000000000000000	Hearing Aids (See OON General Notes)	2				1	0.00	0.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	3	000000000000000000000000000000000000000000000110	Vision (See OON General Notes)	2				1	0.00	0.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	2	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	150.00	150.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	1	011101111111111111111000011100001111111111101001	Twenty Percent Coinsurance Group	1	20	20	1	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	4	000010000000000000000000000000000000000000000000	Primary Care	2				1	35.00	35.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	7	100000000000000000000000000000000000000000000000	Hearing Aids (See OON General Notes)	2				1	0.00	0.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	6	000000000000000000000001100000000000000000000000	Thirty Percent Coinsurance	1	30	30	3	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	5	000000000000000000000000000000000000000000010000	Dental	1	50	50	2	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	1	011101111111111111111000011100001111111111101001	Twenty Percent Coinsurance Group	1	20	20	1	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	2	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	150.00	150.00	2	
H4209	006	0	1	04	01	H4209_006_0	5	3	000000000000000000000000000000000000000000000110	Vision (See OON General Notes)	2				1	0.00	0.00	2	
H4209	006	0	1	04	01	H4209_006_0	5	4	000010000000000000000000000000000000000000000000	Primary Care	2				1	35.00	35.00	2	
H4209	006	0	1	04	01	H4209_006_0	5	5	000000000000000000000000000000000000000000010000	Dental	1	50	50	2	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	6	000000000000000000000001100000000000000000000000	Thirty Percent Coinsurance	1	30	30	3	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	7	100000000000000000000000000000000000000000000000	Hearing Aids (See OON General Notes)	2				1	0.00	0.00	2	
H4209	809	0	1	04	01	H4209_809_0	4	1	011111111111111111111101111100001111111111101111		1	0	50	1	2			2	
H4209	810	0	1	04	01	H4209_810_0	4	1	011111111111111111111101111100001111111111101111		1	0	50	1	2			2	
H4209	811	0	1	04	01	H4209_811_0	4	1	011111111111111111111101111100001111111111101111		1	0	50	1	2			2	
H4209	812	0	1	04	01	H4209_812_0	4	1	011111111111111111111101111100001111111111101111		1	0	50	1	2			2	
H4362	001	0	1	04	01	H4362_001_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4362	001	0	1	04	01	H4362_001_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4362	001	0	1	04	01	H4362_001_0	5	3	000000000000000000000000000000001000000000010010	Tier 3	2				2			2	
H4362	001	0	1	04	01	H4362_001_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H4362	001	0	1	04	01	H4362_001_0	5	5	100000000000000000000000000000000000000000000000	Tier 5	2				1	0.00	0.00	2	
H4362	002	0	1	04	01	H4362_002_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4362	002	0	1	04	01	H4362_002_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4362	002	0	1	04	01	H4362_002_0	5	3	000000000000000000000000000000001000000000010010	Tier 3	2				2			2	
H4362	002	0	1	04	01	H4362_002_0	5	5	100000000000000000000000000000000000000000000000	Tier 5	2				1	0.00	0.00	2	
H4362	002	0	1	04	01	H4362_002_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H4362	801	0	1	04	01	H4362_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4362	801	0	1	04	01	H4362_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4362	801	0	1	04	01	H4362_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4362	802	0	1	04	01	H4362_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4362	802	0	1	04	01	H4362_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4362	802	0	1	04	01	H4362_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4408	001	0	1	04	01	H4408_001_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	90.00	2	
H4408	001	0	1	04	01	H4408_001_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4408	001	0	1	04	01	H4408_001_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	2	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4408	002	0	1	04	01	H4408_002_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	90.00	2	
H4408	002	0	1	04	01	H4408_002_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4408	002	0	1	04	01	H4408_002_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	2	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4408	002	0	1	04	01	H4408_002_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4408	006	0	1	04	01	H4408_006_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4408	006	0	1	04	01	H4408_006_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	2	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4408	006	0	1	04	01	H4408_006_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H4408	007	0	1	04	01	H4408_007_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4408	007	0	1	04	01	H4408_007_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	90.00	2	
H4408	007	0	1	04	01	H4408_007_0	4	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4408	801	0	1	04	01	H4408_801_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4408	801	0	1	04	01	H4408_801_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4408	801	0	1	04	01	H4408_801_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4408	803	0	1	04	01	H4408_803_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4408	803	0	1	04	01	H4408_803_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4408	803	0	1	04	01	H4408_803_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4408	804	0	1	04	01	H4408_804_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4408	804	0	1	04	01	H4408_804_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4408	804	0	1	04	01	H4408_804_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4408	805	0	1	04	01	H4408_805_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4408	805	0	1	04	01	H4408_805_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4408	805	0	1	04	01	H4408_805_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4520	001	0	1	04	01	H4520_001_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	001	0	1	04	01	H4520_001_0	6	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	001	0	1	04	01	H4520_001_0	6	4	000000000000000000000000010000000000000000000000		1	20	40	3	2			2	
H4520	001	0	1	04	01	H4520_001_0	6	5	000000000000000000000000000000001000000000000000		1	50	50	3	2			2	
H4520	001	0	1	04	01	H4520_001_0	6	6	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H4520	001	0	1	04	01	H4520_001_0	6	1	011111111111111111111001100100000111111111101111		1	30	30	6	2			2	
H4520	002	0	1	04	01	H4520_002_0	10	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	002	0	1	04	01	H4520_002_0	10	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	002	0	1	04	01	H4520_002_0	10	4	000000000000000000000000010000000000000000100000		1	15	40	3	2			2	
H4520	002	0	1	04	01	H4520_002_0	10	5	000000000000000000000000000000001000000000000000		1	50	50	3	2			2	
H4520	002	0	1	04	01	H4520_002_0	10	6	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	002	0	1	04	01	H4520_002_0	10	1	011111111111111111111001100100000111111111001101		1	20	20	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	9	5	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	9	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	003	0	1	04	01	H4520_003_0	9	1	011111111111111111111000000100000111111111101101		1	30	30	6	2			2	
H4520	003	0	1	04	01	H4520_003_0	9	4	000000000000000000000001110000000000000000000000		1	20	40	3	2			2	
H4520	003	0	1	04	01	H4520_003_0	9	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	003	0	1	04	01	H4520_003_0	9	6	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	1	000000000000000000000000110000000000000000100000		1	20	40	6	2			2	
H4520	005	0	1	04	01	H4520_005_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H4520	005	0	1	04	01	H4520_005_0	5	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	7	6	000000000000000000000000000000001000000000000000		1	50	50	3	2			2	
H4520	006	0	1	04	01	H4520_006_0	7	7	000010010000000000000000000000000000000000000000		1	15	15	3	2			2	
H4520	006	0	1	04	01	H4520_006_0	7	8	000000000000000000000000000000000000000000011000		1	50	55	2	2			2	
H4520	006	0	1	04	01	H4520_006_0	7	5	000000000000000000000000110000000000000000100000		1	15	40	3	2			2	
H4520	006	0	1	04	01	H4520_006_0	7	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	006	0	1	04	01	H4520_006_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	006	0	1	04	01	H4520_006_0	7	1	011101101111111111111001000100001111111111001101		1	15	20	6	2			2	
H4520	006	0	1	04	01	H4520_006_0	7	4	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H4520	016	0	1	04	01	H4520_016_0	5	6	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4520	016	0	1	04	01	H4520_016_0	5	5	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4520	016	0	1	04	01	H4520_016_0	5	4	000000000000000000000000010000000000000000100000		1	15	40	3	2			2	
H4520	016	0	1	04	01	H4520_016_0	5	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	016	0	1	04	01	H4520_016_0	5	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	016	0	1	04	01	H4520_016_0	5	1	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H4520	018	0	1	04	01	H4520_018_0	7	5	000000000000000000000000000000001000000000000000		1	50	50	3	2			2	
H4520	018	0	1	04	01	H4520_018_0	7	6	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H4520	018	0	1	04	01	H4520_018_0	7	1	011111111111111111111001100100000111111111001111		1	20	20	6	2			2	
H4520	018	0	1	04	01	H4520_018_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4520	018	0	1	04	01	H4520_018_0	7	4	000000000000000000000000010000000000000000100000		1	20	40	3	2			2	
H4520	018	0	1	04	01	H4520_018_0	7	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H4520	801	0	1	04	01	H4520_801_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4520	801	0	1	04	01	H4520_801_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4520	801	0	1	04	01	H4520_801_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4520	804	0	1	04	01	H4520_804_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4520	804	0	1	04	01	H4520_804_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4520	804	0	1	04	01	H4520_804_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4520	805	0	1	04	01	H4520_805_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4520	805	0	1	04	01	H4520_805_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4520	805	0	1	04	01	H4520_805_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4520	806	0	1	04	01	H4520_806_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	10	000000000000010000000000000000000000000000000000	Group 10	1	40	40	6	1	7.00	7.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	11	000000000000000000000010000000000000000000000000	Group 11	1	50	50	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	12	000000000000000000000000000000000000000000000010	Group 12	1	30	50	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	9	100000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	6	000000000000000000000000001000000000000000000000	Group 6	1	20	20	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	8	000000000000000000000001110000000000000000100000	Group 8	1	30	30	6	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	6	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	3	000000000000000000000000000000001000000000001000	Group 3	1	0	30	6	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	4	100000000000000000000000000000000000000000010010	Group 4	2				1	0.00	0.00	2	
H4522	007	0	1	04	01	H4522_007_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	1	011101111111111111111111110101000111111111100101	Group 1	1	30	30	6	2			2	
H4522	008	0	1	04	01	H4522_008_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H4522	008	0	1	04	01	H4522_008_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H4522	008	0	1	04	01	H4522_008_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H4522	008	0	1	04	01	H4522_008_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H4522	008	0	1	04	01	H4522_008_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H4522	801	0	1	04	01	H4522_801_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H4522	801	0	1	04	01	H4522_801_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H4522	801	0	1	04	01	H4522_801_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H4522	801	0	1	04	01	H4522_801_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H4522	801	0	1	04	01	H4522_801_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H4522	801	0	1	04	01	H4522_801_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H4522	801	0	1	04	01	H4522_801_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H4522	801	0	1	04	01	H4522_801_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H4522	801	0	1	04	01	H4522_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H4522	801	0	1	04	01	H4522_801_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H4522	803	0	1	04	01	H4522_803_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H4522	803	0	1	04	01	H4522_803_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H4522	803	0	1	04	01	H4522_803_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H4522	804	0	1	04	01	H4522_804_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H4522	804	0	1	04	01	H4522_804_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H4522	804	0	1	04	01	H4522_804_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H4522	804	0	1	04	01	H4522_804_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H4522	805	0	1	04	01	H4522_805_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H4522	805	0	1	04	01	H4522_805_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H4522	805	0	1	04	01	H4522_805_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H4522	805	0	1	04	01	H4522_805_0	2	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H4522	805	0	1	04	01	H4522_805_0	2	5	000000000000010000000000000000000000000000000000	Group 5	1	40	40	2	1	7.00	7.00	2	
H4522	805	0	1	04	01	H4522_805_0	2	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H4522	805	0	1	04	01	H4522_805_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H4522	805	0	1	04	01	H4522_805_0	2	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
H4522	805	0	1	04	01	H4522_805_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H4522	805	0	1	04	01	H4522_805_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H4524	001	0	1	04	01	H4524_001_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	001	0	1	04	01	H4524_001_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	001	0	1	04	01	H4524_001_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	001	0	1	04	01	H4524_001_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	001	0	1	04	01	H4524_001_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	002	0	1	04	01	H4524_002_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	002	0	1	04	01	H4524_002_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	002	0	1	04	01	H4524_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	002	0	1	04	01	H4524_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	002	0	1	04	01	H4524_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	003	0	1	04	01	H4524_003_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	003	0	1	04	01	H4524_003_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	003	0	1	04	01	H4524_003_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	003	0	1	04	01	H4524_003_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	003	0	1	04	01	H4524_003_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	005	0	1	04	01	H4524_005_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	005	0	1	04	01	H4524_005_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	005	0	1	04	01	H4524_005_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	005	0	1	04	01	H4524_005_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	005	0	1	04	01	H4524_005_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	007	0	1	04	01	H4524_007_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	007	0	1	04	01	H4524_007_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	007	0	1	04	01	H4524_007_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	007	0	1	04	01	H4524_007_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	007	0	1	04	01	H4524_007_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	008	0	1	04	01	H4524_008_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	008	0	1	04	01	H4524_008_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	008	0	1	04	01	H4524_008_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	008	0	1	04	01	H4524_008_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	008	0	1	04	01	H4524_008_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	009	0	1	04	01	H4524_009_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	009	0	1	04	01	H4524_009_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	009	0	1	04	01	H4524_009_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	009	0	1	04	01	H4524_009_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	009	0	1	04	01	H4524_009_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	011	0	1	04	01	H4524_011_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	011	0	1	04	01	H4524_011_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	011	0	1	04	01	H4524_011_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	011	0	1	04	01	H4524_011_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	011	0	1	04	01	H4524_011_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H4524	012	0	1	04	01	H4524_012_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	012	0	1	04	01	H4524_012_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	012	0	1	04	01	H4524_012_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	012	0	1	04	01	H4524_012_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	012	0	1	04	01	H4524_012_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H4524	013	0	1	04	01	H4524_013_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	013	0	1	04	01	H4524_013_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	013	0	1	04	01	H4524_013_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	013	0	1	04	01	H4524_013_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	013	0	1	04	01	H4524_013_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	014	0	1	04	01	H4524_014_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4524	014	0	1	04	01	H4524_014_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4524	014	0	1	04	01	H4524_014_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4524	014	0	1	04	01	H4524_014_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4524	014	0	1	04	01	H4524_014_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4524	801	0	1	04	01	H4524_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4524	801	0	1	04	01	H4524_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4524	801	0	1	04	01	H4524_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4524	802	0	1	04	01	H4524_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4524	802	0	1	04	01	H4524_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4524	802	0	1	04	01	H4524_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4524	804	0	1	04	01	H4524_804_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4524	804	0	1	04	01	H4524_804_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4524	804	0	1	04	01	H4524_804_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	001	0	1	04	01	H4531_001_0	9	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	001	0	1	04	01	H4531_001_0	9	10	100000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	001	0	1	04	01	H4531_001_0	9	9	000000000000000000000000000010000000000000000000	OON:  50% coinsurance	1	50	50	1	2			2	
H4531	001	0	1	04	01	H4531_001_0	9	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	001	0	1	04	01	H4531_001_0	9	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	001	0	1	04	01	H4531_001_0	9	5	000000000000000000010000000000000000000000001000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	003	0	1	04	01	H4531_003_0	7	1	011111111111101101111001100100001011111101101000	OON: 30% coinsurance	1	30	30	1	2			2	
H4531	003	0	1	04	01	H4531_003_0	7	2	000000000000000000000000011000000000000010000000	OON: 20% copay	1	20	20	1	2			2	
H4531	003	0	1	04	01	H4531_003_0	7	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	003	0	1	04	01	H4531_003_0	7	4	000000000000000000000100000000000000000000000000	OON:  $150 copay	2				1	150.00	150.00	2	
H4531	003	0	1	04	01	H4531_003_0	7	5	100000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	003	0	1	04	01	H4531_003_0	7	6	000000000000000000000000000010000000000000000000		1	50	50	1	2			2	
H4531	003	0	1	04	01	H4531_003_0	7	7	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	30	1	2			2	
H4531	003	0	1	04	01	H4531_003_0	7	8	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	30	1	2			2	
H4531	004	0	1	04	01	H4531_004_0	8	1	011001100100101101101001101100000001111101100000	OON:  20% coinsurance	1	20	20	1	2			2	
H4531	004	0	1	04	01	H4531_004_0	8	10	100000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	004	0	1	04	01	H4531_004_0	8	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	004	0	1	04	01	H4531_004_0	8	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	004	0	1	04	01	H4531_004_0	8	2	000110000000000000000000000000000000000000000000	OON: $20 copay	2				1	20.00	20.00	2	
H4531	004	0	1	04	01	H4531_004_0	8	9	000000000000000000000000000010000000000000000000	OON:  50% coinsurance	1	50	50	1	2			2	
H4531	004	0	1	04	01	H4531_004_0	8	4	000000011011000000000000000000000000000000000000	OON: $40 copay	2				1	40.00	40.00	2	
H4531	004	0	1	04	01	H4531_004_0	8	5	000000000000000000010000000000000000000000001000	OON: Outpatient Substance Abuse Services	2				1	40.00	100.00	2	
H4531	004	0	1	04	01	H4531_004_0	8	6	000000000000000000000000010000000000000010000000	OON: 10% copay	1	10	10	1	2			2	
H4531	004	0	1	04	01	H4531_004_0	8	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	40.00	2	
H4531	004	0	1	04	01	H4531_004_0	8	8	000000000000000000000100000000000000000000000000	OON: $100 copay	2				1	100.00	100.00	2	
H4531	004	0	1	04	01	H4531_004_0	8	3	000000000000000000000000000000000000000000000101	OON: $50 copay	2				1	50.00	50.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	802	0	1	04	01	H4531_802_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	802	0	1	04	01	H4531_802_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	802	0	1	04	01	H4531_802_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	802	0	1	04	01	H4531_802_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	802	0	1	04	01	H4531_802_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	803	0	1	04	01	H4531_803_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	803	0	1	04	01	H4531_803_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	803	0	1	04	01	H4531_803_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	803	0	1	04	01	H4531_803_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	804	0	1	04	01	H4531_804_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	804	0	1	04	01	H4531_804_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	804	0	1	04	01	H4531_804_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	804	0	1	04	01	H4531_804_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	804	0	1	04	01	H4531_804_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	804	0	1	04	01	H4531_804_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	805	0	1	04	01	H4531_805_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	805	0	1	04	01	H4531_805_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	805	0	1	04	01	H4531_805_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	805	0	1	04	01	H4531_805_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	805	0	1	04	01	H4531_805_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	806	0	1	04	01	H4531_806_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	806	0	1	04	01	H4531_806_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	806	0	1	04	01	H4531_806_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	806	0	1	04	01	H4531_806_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	806	0	1	04	01	H4531_806_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	807	0	1	04	01	H4531_807_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	807	0	1	04	01	H4531_807_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	807	0	1	04	01	H4531_807_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	807	0	1	04	01	H4531_807_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	807	0	1	04	01	H4531_807_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	1	011001100100101101101001101100000001111101100000	OON: 20% coinsurance	1	20	20	1	2			2	
H4531	808	0	1	04	01	H4531_808_0	5	10	000000000000000000000000000000000000000000000010	OON:  Remainder	2				1	0.00	0.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	11	000000000000010010000000000000000000000000000000	OON:  X-Rays  Lab	1	0	20	1	2			2	
H4531	808	0	1	04	01	H4531_808_0	5	12	000000000000000000000000000000000100000000000000	OON:  Immunizations	1	0	20	1	2			2	
H4531	808	0	1	04	01	H4531_808_0	5	2	000110000000000000000000000000000000000000000000	OON $20 Copay	2				1	20.00	20.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	9	000000000000000000000000000000000000000000001000	OON:	2				1	60.00	100.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	7	000000000000000000000000000000001010000000000000	OON: Routine Physical Exams	2				1	20.00	60.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	6	000000000000000000000000010000000000000010000000	OON:  10% copay	1	10	10	1	2			2	
H4531	808	0	1	04	01	H4531_808_0	5	5	000000000000000000010000000000000000000000000000	OON: Outpatient Substance Abuse Services	2				1	60.00	100.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	4	000000011011000000000000000000000000000000000000	OON:  $60 copay	2				1	60.00	60.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	3	000000000000000000000000000000000000000000000101	OON:  $50 copay	2				1	50.00	50.00	2	
H4531	808	0	1	04	01	H4531_808_0	5	8	000000000000000000000100000000000000000000000000	OON:  $100 copay	2				1	100.00	100.00	2	
H4605	001	0	1	04	01	H4605_001_0	4	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	4	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H4605	001	0	1	04	01	H4605_001_0	4	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H4605	001	0	1	04	01	H4605_001_0	4	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H4605	001	0	1	04	01	H4605_001_0	4	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H4605	001	0	1	04	01	H4605_001_0	4	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	4	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H4605	002	0	1	04	01	H4605_002_0	6	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H4605	002	0	1	04	01	H4605_002_0	6	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H4605	004	0	1	04	01	H4605_004_0	7	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H4605	004	0	1	04	01	H4605_004_0	7	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H4605	004	0	1	04	01	H4605_004_0	7	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H4605	004	0	1	04	01	H4605_004_0	7	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H4605	004	0	1	04	01	H4605_004_0	7	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H4605	004	0	1	04	01	H4605_004_0	7	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H4605	004	0	1	04	01	H4605_004_0	7	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	7	000000000000000000000000000000000000000000000010	$0 copay	2				1	0.00	0.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	6	011000000000000000001000010100000101111111000000	$0 copay	2				1	0.00	0.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	5	000100000000001110000001100000000000000000000000	40% coinsurance	1	40	40	2	2			2	
H4605	006	0	1	04	01	H4605_006_0	5	4	000000000000000000000000001000000000000000100000	20% coinsurance	1	20	20	2	2			2	
H4605	006	0	1	04	01	H4605_006_0	5	9	000000000000000000000000000000001000000000000000	$0 copay	2				1	0.00	0.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	2	000000000000000000000100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	10	000000000000000001000000000000000000000000000000	$0 to $500	2				1	0.00	500.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	1	000011111111100000010000000000000010000000001101	$35.00 copay	2				1	35.00	35.00	2	
H4605	006	0	1	04	01	H4605_006_0	5	8	000000000000010000000000000000000000000000000000	0to 40% coinsurance	1	0	40	2	2			2	
H4605	006	0	1	04	01	H4605_006_0	5	3	000000000000000000100000000000000000000000000000	$500	2				1	500.00	500.00	2	
H4606	001	0	1	04	01	H4606_001_0	7	7	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	8	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	9	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	1	011011111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	10	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4606	001	0	1	04	01	H4606_001_0	7	3	000100000000000000000000000000000000000000000000		1	25	25	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	4	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4606	001	0	1	04	01	H4606_001_0	7	6	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H4606	001	0	1	04	01	H4606_001_0	7	5	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H4606	004	0	1	04	01	H4606_004_0	5	5	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	5	6	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	5	7	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H4606	004	0	1	04	01	H4606_004_0	5	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	5	9	011100000000000001100000000000000000000000000000		1	20	20	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	5	4	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	5	10	000011011101000000000000000000000111100000001101		1	25	25	6	2			2	
H4606	004	0	1	04	01	H4606_004_0	5	2	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H4606	004	0	1	04	01	H4606_004_0	5	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4606	004	0	1	04	01	H4606_004_0	5	1	000000100010111110011000000100000000011111100000		1	20	25	6	2			2	
H4606	801	0	1	04	01	H4606_801_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4606	801	0	1	04	01	H4606_801_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4606	801	0	1	04	01	H4606_801_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4606	802	0	1	04	01	H4606_802_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4606	802	0	1	04	01	H4606_802_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4606	802	0	1	04	01	H4606_802_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4606	803	0	1	04	01	H4606_803_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4606	804	0	1	04	01	H4606_804_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H4606	804	0	1	04	01	H4606_804_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H4606	804	0	1	04	01	H4606_804_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H4781	001	0	1	04	01	H4781_001_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4781	001	0	1	04	01	H4781_001_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	25	25	6	2			2	
H4781	001	0	1	04	01	H4781_001_0	7	3	000000000000000000000000000000001000000000010010	Tier 3	2				2			2	
H4781	001	0	1	04	01	H4781_001_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4781	001	0	1	04	01	H4781_001_0	7	5	100000000000000000000000000000000000000000000000	Tier 5	2				1	0.00	0.00	2	
H4781	002	0	1	04	01	H4781_002_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4781	002	0	1	04	01	H4781_002_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H4781	002	0	1	04	01	H4781_002_0	7	3	000000000000000000000000000000001000000000010010	Tier 3	2				2			2	
H4781	002	0	1	04	01	H4781_002_0	7	5	100000000000000000000000000000000000000000000000	Tier 5	2				1	0.00	0.00	2	
H4781	002	0	1	04	01	H4781_002_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4781	801	0	1	04	01	H4781_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4781	801	0	1	04	01	H4781_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4781	801	0	1	04	01	H4781_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4781	802	0	1	04	01	H4781_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4781	802	0	1	04	01	H4781_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4781	802	0	1	04	01	H4781_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	1	010000000000000000000000000000000000000000000000	150.00	2				1	150.00	150.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	10	000000000000000000000000001000000000000000000000	$10 Copay	2				1	10.00	10.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	11	000000000000000000000000000000001000000000001000	100% Coinsurance	1	100	100	1	2			2	
H4908	001	0	1	04	01	H4908_001_0	3	9	000000000000000000000000010000000000000000000000	15% Coinsurance	1	15	15	1	2			2	
H4908	001	0	1	04	01	H4908_001_0	3	8	100000000000000010000010000011110000000000010000	Not Covered OON	2				2			2	
H4908	001	0	1	04	01	H4908_001_0	3	2	000000000000000001100000000000000000000000000000	250.00 copay	2				1	250.00	250.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	6	000000000000000000000001100000000000000000100110	20% coinsurance	1	20	20	1	2			2	
H4908	001	0	1	04	01	H4908_001_0	3	5	000000000000001000000000000000000000000000000000	$15-$100	2				1	15.00	100.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	4	001111111111110110011000000100000010000001000000	15.00 copay	2				1	15.00	15.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	3	000000000000000000000100000000000000000000000000	50.00 copay	2				1	50.00	50.00	2	
H4908	001	0	1	04	01	H4908_001_0	3	7	000000000000000000000000000000000101111110000001	$0 copay	2				1	0.00	0.00	2	
H4908	002	0	1	04	01	H4908_002_0	4	1	010000000000000001100000000000000000000000000000	$250 copay	2				1	250.00	250.00	2	
H4908	002	0	1	04	01	H4908_002_0	4	10	000000000000000000000000000000001000000000001000	100% Coinsurance	1	100	100	1	2			2	
H4908	002	0	1	04	01	H4908_002_0	4	3	001111111111110110011000000100000010000001000000	$15 copay	2				1	15.00	15.00	2	
H4908	002	0	1	04	01	H4908_002_0	4	2	000000000000000000000100000000000000000000000000	$50 copay	2				1	50.00	50.00	2	
H4908	002	0	1	04	01	H4908_002_0	4	4	000000000000001000000000000000000000000000000000	$15-$100	2				1	15.00	100.00	2	
H4908	002	0	1	04	01	H4908_002_0	4	5	000000000000000000000001100000000000000000100110	20% coinsurance	1	20	20	1	2			2	
H4908	002	0	1	04	01	H4908_002_0	4	6	000000000000000000000000000000000101111110000001	$0 copay	2				1	0.00	0.00	2	
H4908	002	0	1	04	01	H4908_002_0	4	7	100000000000000000000010000011110000000000010000	Not Covered OON	2				2			2	
H4908	002	0	1	04	01	H4908_002_0	4	8	000000000000000000000000010000000000000000000000	15% Coinsurance	1	15	15	1	2			2	
H4908	002	0	1	04	01	H4908_002_0	4	9	000000000000000000000000001000000000000000000000	$10 Copay	2				1	10.00	10.00	2	
H4908	005	0	1	04	01	H4908_005_0	3	2	011011111111111111111101111100000010000001100111	20% Coinsurance	1	20	20	1	2			2	
H4908	005	0	1	04	01	H4908_005_0	3	5	000000000000000000000000000000001000000000001000	100% Coinsurance	1	100	100	1	2			2	
H4908	005	0	1	04	01	H4908_005_0	3	4	100000000000000000000010000011110000000000010000	Not Covered OON	2				2			2	
H4908	005	0	1	04	01	H4908_005_0	3	3	000000000000000000000000000000000101111110000000	$0 Copay	2				1	0.00	0.00	2	
H4908	005	0	1	04	01	H4908_005_0	3	1	000100000000000000000000000000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
H4908	006	0	1	04	01	H4908_006_0	5	1	000100000000000000000000000000000000000000000000	$15 copay	2				1	15.00	15.00	2	
H4908	006	0	1	04	01	H4908_006_0	5	2	011011111111111111111101110100000010000001100111	30%	1	30	30	1	2			2	
H4908	006	0	1	04	01	H4908_006_0	5	3	000000000000000000000000000000000101111110000000	$0	2				1	0.00	0.00	2	
H4908	006	0	1	04	01	H4908_006_0	5	4	000000000000000000000010000011110000000000010000	Not Covered OON	2				2			2	
H4908	006	0	1	04	01	H4908_006_0	5	6	000000000000000000000000000000001000000000001000	100% Coinsurance	1	100	100	1	2			2	
H4908	006	0	1	04	01	H4908_006_0	5	5	000000000000000000000000001000000000000000000000	20%	1	20	20	1	2			2	
H4909	001	0	1	04	01	H4909_001_0	12	9	000000000000000000000000000000000000000000000010	$0 to $40 Copayment Group	2				1	0.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	12	8	000000000000010000000000000000000000000000000000	0% to 20% Coinsurance Group	1	0	20	3	2			2	
H4909	001	0	1	04	01	H4909_001_0	12	5	000000000000000000000100000000000000000000000000	$100 Copayment Group	2				1	100.00	100.00	2	
H4909	001	0	1	04	01	H4909_001_0	12	6	000000000000000000100000000000000000000000000000	$250 Copayment Group	2				1	250.00	250.00	2	
H4909	001	0	1	04	01	H4909_001_0	12	7	000100000010000001001000000100001111110100001000	$0 Copayment Group	2				1	0.00	0.00	2	
H4909	001	0	1	04	01	H4909_001_0	12	4	011001111101100000010000000000000000001000000101	$40 Copayment Group	2				1	40.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	12	3	000010000000000000000000000000000000000000000000	$25 Copayment Group	2				1	25.00	25.00	2	
H4909	001	0	1	04	01	H4909_001_0	12	2	000000000000000000000001110000000000000000000000	30% OON Coinsurance Group	1	30	30	3	2			2	
H4909	001	0	1	04	01	H4909_001_0	12	1	000000000000001110000000001000000000000011100000	20% OON Coinsurance Group	1	20	20	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	13	9	000000000000010000000000000000000000000000000000	0% to 20% Coinsurance Group	1	0	20	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	13	1	000000000000001110000000001000000000000011100000	20% OON Coinsurance Group	1	20	20	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	13	10	000000000000000000000000000000000000000000000010	$0 to $35 Copayment Group	2				1	0.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	13	11	000000000000000000000000000000000000000000010000	OON Preventive Dental	1	50	50	6	2			2	
H4909	004	0	1	04	01	H4909_004_0	13	2	000000000000000000000001110000000000000000000000	30% OON Coinsurance Group	1	30	30	3	2			2	
H4909	004	0	1	04	01	H4909_004_0	13	3	000010000000000000000000000000000000000000000000	$20 Copayment Group	2				1	20.00	20.00	2	
H4909	004	0	1	04	01	H4909_004_0	13	8	000000000000000000000000000000000000001000000000	$40 Copayment Group	2				1	40.00	40.00	2	
H4909	004	0	1	04	01	H4909_004_0	13	7	000100000010000001001000000100001111110100001000	$0 Copayment Group	2				1	0.00	0.00	2	
H4909	004	0	1	04	01	H4909_004_0	13	6	000000000000000000100000000000000000000000000000	$250 Copayment Group	2				1	250.00	250.00	2	
H4909	004	0	1	04	01	H4909_004_0	13	5	000000000000000000000100000000000000000000000000	$100 Copayment Group	2				1	100.00	100.00	2	
H4909	004	0	1	04	01	H4909_004_0	13	4	011001111101100000010000000000000000000000000101	$35 Copayment Group	2				1	35.00	35.00	2	
H4909	804	0	1	04	01	H4909_804_0	3	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H4909	804	0	1	04	01	H4909_804_0	3	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H4909	805	0	1	04	01	H4909_805_0	3	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H4909	805	0	1	04	01	H4909_805_0	3	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H4909	806	0	1	04	01	H4909_806_0	3	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
H4909	806	0	1	04	01	H4909_806_0	3	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
H4911	002	0	1	04	01	H4911_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4911	002	0	1	04	01	H4911_002_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4911	002	0	1	04	01	H4911_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4911	002	0	1	04	01	H4911_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H4911	002	0	1	04	01	H4911_002_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4911	003	0	1	04	01	H4911_003_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H4911	003	0	1	04	01	H4911_003_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H4911	003	0	1	04	01	H4911_003_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H4911	003	0	1	04	01	H4911_003_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H4911	003	0	1	04	01	H4911_003_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H4911	801	0	1	04	01	H4911_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4911	801	0	1	04	01	H4911_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4911	801	0	1	04	01	H4911_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4911	802	0	1	04	01	H4911_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4911	802	0	1	04	01	H4911_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4911	802	0	1	04	01	H4911_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4911	804	0	1	04	01	H4911_804_0	2	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H4911	804	0	1	04	01	H4911_804_0	2	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H4911	804	0	1	04	01	H4911_804_0	2	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H4956	001	0	1	04	01	H4956_001_0	5	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	2	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4956	001	0	1	04	01	H4956_001_0	5	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4956	001	0	1	04	01	H4956_001_0	5	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H4956	001	0	1	04	01	H4956_001_0	5	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	2	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H4956	002	0	1	04	01	H4956_002_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H4956	002	0	1	04	01	H4956_002_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H4956	002	0	1	04	01	H4956_002_0	4	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H4956	801	0	1	04	01	H4956_801_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H4956	801	0	1	04	01	H4956_801_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H4956	801	0	1	04	01	H4956_801_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H4956	802	0	1	04	01	H4956_802_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H4956	802	0	1	04	01	H4956_802_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H4956	802	0	1	04	01	H4956_802_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H4956	803	0	1	04	01	H4956_803_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H4956	803	0	1	04	01	H4956_803_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H4956	803	0	1	04	01	H4956_803_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H4956	804	0	1	04	01	H4956_804_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H4956	804	0	1	04	01	H4956_804_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H4956	804	0	1	04	01	H4956_804_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5009	004	0	1	04	01	H5009_004_0	6	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H5009	004	0	1	04	01	H5009_004_0	6	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5009	004	0	1	04	01	H5009_004_0	6	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H5009	004	0	1	04	01	H5009_004_0	6	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H5009	004	0	1	04	01	H5009_004_0	6	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H5009	004	0	1	04	01	H5009_004_0	6	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H5009	004	0	1	04	01	H5009_004_0	6	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	8	000000000000010000000000000000000000000000000000	0to 40% coinsurance	1	0	40	2	2			2	
H5009	006	0	1	04	01	H5009_006_0	5	9	000000000000000000000000000000001000000000000000	$0 copay	2				1	0.00	0.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	7	000000000000000000000000000000000000000000000010	$0 copay	2				1	0.00	0.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	6	011000000000000000001000010100000101111111000000	$0 copay	2				1	0.00	0.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	5	000100000000001110000001100000000000000000000000	40% coinsurance	1	40	40	2	2			2	
H5009	006	0	1	04	01	H5009_006_0	5	4	000000000000000000000000001000000000000000100000	20% coinsurance	1	20	20	2	2			2	
H5009	006	0	1	04	01	H5009_006_0	5	3	000000000000000000100000000000000000000000000000	$500	2				1	500.00	500.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	2	000000000000000000000100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	1	000011111111100000010000000000000010000000001101	$35.00 copay	2				1	35.00	35.00	2	
H5009	006	0	1	04	01	H5009_006_0	5	10	000000000000000001000000000000000000000000000000	$0 to $500	2				1	0.00	500.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H5010	001	0	1	04	01	H5010_001_0	4	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H5010	001	0	1	04	01	H5010_001_0	4	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H5010	004	0	1	04	01	H5010_004_0	8	7	000000000000000001000000000000000000000000000000	$0 to $100 copayment	2				1	0.00	100.00	2	
H5010	004	0	1	04	01	H5010_004_0	8	6	000000000000000000000000000000001000000000010010	Misc.	2				1	0.00	0.00	2	
H5010	004	0	1	04	01	H5010_004_0	8	5	011000000000011110001000011100000101111111000000	$0 cost sharing	2				1	0.00	0.00	2	
H5010	004	0	1	04	01	H5010_004_0	8	4	000000000000000000000000000000000000000000100000	10% coinsurance	1	10	10	2	2			2	
H5010	004	0	1	04	01	H5010_004_0	8	3	000100000000000000000001100000000000000000000000	20% coinsurance	1	20	20	2	2			2	
H5010	004	0	1	04	01	H5010_004_0	8	2	000000000000000000100100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5010	004	0	1	04	01	H5010_004_0	8	1	000011111111100000010000000000000010000000001101	$25 copay	2				1	25.00	25.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	8	000000000000010000000000000000000000000000000000	0to 40% coinsurance	1	0	40	2	2			2	
H5010	006	0	1	04	01	H5010_006_0	5	7	000000000000000000000000000000000000000000000010	$0 copay	2				1	0.00	0.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	6	011000000000000000001000010100000101111111000000	$0 copay	2				1	0.00	0.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	5	000100000000001110000001100000000000000000000000	40% coinsurance	1	40	40	2	2			2	
H5010	006	0	1	04	01	H5010_006_0	5	9	000000000000000000000000000000001000000000000000	$0 copay	2				1	0.00	0.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	3	000000000000000000100000000000000000000000000000	$500	2				1	500.00	500.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	2	000000000000000000000100000000000000000000000000	$100 copay	2				1	100.00	100.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	10	000000000000000001000000000000000000000000000000	$0 to $500	2				1	0.00	500.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	1	000011111111100000010000000000000010000000001101	$35.00 copay	2				1	35.00	35.00	2	
H5010	006	0	1	04	01	H5010_006_0	5	4	000000000000000000000000001000000000000000100000	20% coinsurance	1	20	20	2	2			2	
H5041	001	0	1	04	01	H5041_001_0	6	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H5041	001	0	1	04	01	H5041_001_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5041	001	0	1	04	01	H5041_001_0	6	1	000000000000000000000000010000000000000000100000		1	20	40	6	2			2	
H5041	001	0	1	04	01	H5041_001_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5041	001	0	1	04	01	H5041_001_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H5041	001	0	1	04	01	H5041_001_0	6	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H5041	801	0	1	04	01	H5041_801_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5041	801	0	1	04	01	H5041_801_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5041	801	0	1	04	01	H5041_801_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5041	802	0	1	04	01	H5041_802_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5041	802	0	1	04	01	H5041_802_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5041	802	0	1	04	01	H5041_802_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5041	803	0	1	04	01	H5041_803_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5041	803	0	1	04	01	H5041_803_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5041	803	0	1	04	01	H5041_803_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5041	804	0	1	04	01	H5041_804_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5041	804	0	1	04	01	H5041_804_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5041	804	0	1	04	01	H5041_804_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5042	001	0	1	04	01	H5042_001_0	8	6	000000000000000000000000000000001000000000000000	$0-$10 Copayment	2				1	0.00	10.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	5	000000000000000001100000000000000000000000000000	$100 Copayment	2				1	100.00	100.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	4	000000000000000000000100000000000000000000000000	$50 Copayment	2				1	50.00	50.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	3	000001110110111110001000001000000000000001000101	$10 Copayment	2				1	10.00	10.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	2	000010000000000000000000000000000000000000000000	$5 Copayment	2				1	5.00	5.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	9	000000000000000000000000010000000000000000000000	$10-$20% Copayment	1	20	20	1	1	10.00	10.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	10	000000000000000000000001100000000000000000000000	$200-20% Copayment	1	20	20	2	1	200.00	200.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	1	111000000000000000000010000100000111111110111000	$0 Copayment	2				1	0.00	0.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	7	000100000000000000000000000000000000000000000000	$0-$25 Copayment	2				1	0.00	25.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	8	000000001001000000010000000000000000000000000000	$5-$25 Copayment	2				1	5.00	25.00	2	
H5042	001	0	1	04	01	H5042_001_0	8	11	000000000000000000000000000000000000000000000010	$0-20% Copayment	1	20	20	2	2			2	
H5042	002	0	1	04	01	H5042_002_0	6	1	111000000000000000000010000100000111111110111000	$0 Copay Group	2				1	0.00	0.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	10	000000000000000000000000000000000000000000000010	$0/20% Group	1	20	20	1	2			2	
H5042	002	0	1	04	01	H5042_002_0	6	2	000010000000000000000000000000000000000000000000	$10 Copay Group	2				1	10.00	10.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	3	000001110110111110001000001000000000000001000101	$25 Copay Group	2				1	25.00	25.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	4	000000000000000000000100000000000000000000000000	$100 Copay Group	2				1	100.00	100.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	5	000000000000000001100000000000000000000000000000	$125 Copay Group	2				1	125.00	125.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	6	000100000000000000000000000000001000000000000000	$0-$25 Copay Group	2				1	0.00	25.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	7	000000001001000000010000000000000000000000000000	$20-$25 Copay Group	2				1	20.00	25.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	8	000000000000000000000000010000000000000000000000	$10/20% Group	1	20	20	1	1	10.00	10.00	2	
H5042	002	0	1	04	01	H5042_002_0	6	9	000000000000000000000001100000000000000000000000	$200/20% Group	1	20	20	1	1	200.00	200.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	1	111000000000000000000010000100000111111110111000	$0 Copay Group	2				1	0.00	0.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	8	000000001001000000010000000000000000000000000000	$5-$25 Copay Group	2				1	5.00	25.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	7	000100000000000000000000000000000000000000000000	$0-$25 Copay Group	2				1	0.00	25.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	6	000000000000000000000000000000001000000000000000	$0-$10 Copay Group	2				1	0.00	10.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	5	000000000000000001100000000000000000000000000000	$100 Copay Group	2				1	100.00	100.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	10	000000000000000000000001100000000000000000000000	20%/$200 Copay Group	1	20	20	2	1	200.00	200.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	3	000001110110111110001000001000000000000001000101	$10 Copay Group	2				1	10.00	10.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	2	000010000000000000000000000000000000000000000000	$5 Copay Group	2				1	5.00	5.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	11	000000000000000000000000000000000000000000000010	20%/$0 Copay Group	1	20	20	2	2			2	
H5042	004	0	1	04	01	H5042_004_0	6	9	000000000000000000000000010000000000000000000000	20%/$10 Copay Group	1	20	20	1	1	10.00	10.00	2	
H5042	004	0	1	04	01	H5042_004_0	6	4	000000000000000000000100000000000000000000000000	$50 Copay Group	2				1	50.00	50.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	8	000000000000000000000000010000000000000000000000	$10/20% Group	1	20	20	1	1	10.00	10.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	7	000000001001000000010000000000000000000000000000	$20-$25 Copay Group	2				1	20.00	25.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	6	000100000000000000000000000000001000000000000000	$0-$25 Copay Group	2				1	0.00	25.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	5	000000000000000001100000000000000000000000000000	$125 Copay Group	2				1	125.00	125.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	4	000000000000000000000100000000000000000000000000	$100 Copay Group	2				1	100.00	100.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	3	000001110110111110001000001000000000000001000101	$25 Copay Group	2				1	25.00	25.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	2	000010000000000000000000000000000000000000000000	$10 Copay Group	2				1	10.00	10.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	10	000000000000000000000000000000000000000000000010	$0/20% Group	1	20	20	1	2			2	
H5042	005	0	1	04	01	H5042_005_0	8	1	111000000000000000000010000100000111111110111000	$0 Copay Group	2				1	0.00	0.00	2	
H5042	005	0	1	04	01	H5042_005_0	8	9	000000000000000000000001100000000000000000000000	$200/20% Group	1	20	20	1	1	200.00	200.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	8	000000000000000000000000000000000000000000000010	20%/$0 Copay Group	1	20	20	2	2			2	
H5042	006	0	1	04	01	H5042_006_0	6	7	000000000000000000000001100000000000000000000000	20%/$200 Copay Group	1	20	20	2	1	200.00	200.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	6	000000000000000000000000010000000000000000000000	20%/$10 Copay Group	1	20	20	2	1	10.00	10.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	5	000000001001000000010000000000000000000000000000	$20-$25 Copay Group	2				1	20.00	25.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	4	000100000000000000000000000000001000000000000000	$0-$10 Copay Group	2				1	0.00	10.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	1	111010000000011110000010000100000111111110111000	$0 Copay Group	2				1	0.00	0.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	3	000000000000000001100100000000000000000000000000	$50 Copay Group	2				1	50.00	50.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	2	000001110110100000001000001000000000000001000101	$10 Copay Group	2				1	10.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	8	000000000000000000000000000000000000000000000010	20%/$0 Copay Group	1	20	20	2	2			2	
H5042	007	0	1	04	01	H5042_007_0	8	7	000000000000000000000001100000000000000000000000	20%/$200 Copay Group	1	20	20	2	1	200.00	200.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	6	000000000000000000000000010000000000000000000000	20%/$10 Copay Group	1	20	20	2	1	10.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	5	000000001001000000010000000000000000000000000000	$20-$25 Copay Group	2				1	20.00	25.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	4	000100000000000000000000000000001000000000000000	$0-$10 Copay Group	2				1	0.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	2	000001110110100000001000001000000000000001000101	$10 Copay Group	2				1	10.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	1	111010000000011110000010000100000111111110111000	$0 Copay Group	2				1	0.00	0.00	2	
H5042	007	0	1	04	01	H5042_007_0	8	3	000000000000000001100100000000000000000000000000	$50 Copay Group	2				1	50.00	50.00	2	
H5042	801	0	1	04	01	H5042_801_0	6	1	011111111111111111111101111100001111111111101111	0%-50% Coninsurance	1	0	50	2	2			2	
H5042	802	0	1	04	01	H5042_802_0	6	1	011111111111111111111101111100001111111111101111	0%-50% Coninsurance	1	0	50	2	2			2	
H5042	803	0	1	04	01	H5042_803_0	6	1	011111111111111111111101111100001111111111101111	0%-50% Coninsurance	1	0	50	2	2			2	
H5106	013	0	1	04	01	H5106_013_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H5106	013	0	1	04	01	H5106_013_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H5106	013	0	1	04	01	H5106_013_0	7	7	100000000000000000000000000000000000000000000000	Hearing Aids	2				1	0.00	0.00	2	
H5106	013	0	1	04	01	H5106_013_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H5106	013	0	1	04	01	H5106_013_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	1	2			1	250.00
H5106	013	0	1	04	01	H5106_013_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H5106	013	0	1	04	01	H5106_013_0	7	2	000000000000000000000100000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H5106	014	0	1	04	01	H5106_014_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H5106	014	0	1	04	01	H5106_014_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	1	2			1	250.00
H5106	014	0	1	04	01	H5106_014_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H5106	014	0	1	04	01	H5106_014_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H5106	014	0	1	04	01	H5106_014_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H5106	014	0	1	04	01	H5106_014_0	7	2	000000000000000000000100000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H5106	014	0	1	04	01	H5106_014_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H5106	014	0	1	04	01	H5106_014_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H5106	015	0	1	04	01	H5106_015_0	7	2	000000000000000000000100000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H5106	015	0	1	04	01	H5106_015_0	7	7	100000000000000000000000000000000000000000000000	Hearing Aids	2				1	0.00	0.00	2	
H5106	015	0	1	04	01	H5106_015_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H5106	015	0	1	04	01	H5106_015_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	1	2			1	250.00
H5106	015	0	1	04	01	H5106_015_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H5106	015	0	1	04	01	H5106_015_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H5106	015	0	1	04	01	H5106_015_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H5106	016	0	1	04	01	H5106_016_0	7	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H5106	016	0	1	04	01	H5106_016_0	7	7	100000000000000000000000000000000000000000000000	Group 7	2				1	0.00	0.00	2	
H5106	016	0	1	04	01	H5106_016_0	7	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H5106	016	0	1	04	01	H5106_016_0	7	8	000000000000000000000000000000000000000000010000	Group 8	1	50	50	2	2			2	
H5106	016	0	1	04	01	H5106_016_0	7	2	000000000000000000000100000000000000000000000000	Group 2	1	20	20	1	1	50.00	50.00	2	
H5106	016	0	1	04	01	H5106_016_0	7	1	011111111111111111111000001100000010000000001111	Group 1	1	20	20	1	2			2	
H5106	016	0	1	04	01	H5106_016_0	7	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	1	2			1	250.00
H5106	016	0	1	04	01	H5106_016_0	7	6	000000000000000000000000000000000000000000100000	Group 6	1	20	20	1	1	2.00	25.00	2	
H5106	017	0	1	04	01	H5106_017_0	6	7	100000000000000000000000000000000000000000000000	Hearing Aids	2				1	0.00	0.00	2	
H5106	017	0	1	04	01	H5106_017_0	6	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	1	2			1	250.00
H5106	017	0	1	04	01	H5106_017_0	6	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H5106	017	0	1	04	01	H5106_017_0	6	2	000000000000000000000100000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H5106	017	0	1	04	01	H5106_017_0	6	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H5106	017	0	1	04	01	H5106_017_0	6	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H5106	017	0	1	04	01	H5106_017_0	6	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	6	4	000000000000000000000000000000000101111111000000	Group 4	2				1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	6	3	000000000000000000000001110000000000000000000000	Group 3	1	50	50	1	2			1	500.00
H5106	018	0	1	04	01	H5106_018_0	6	2	000000000000000000000100000000000000000000000000	Group 2	1	30	30	1	1	50.00	50.00	2	
H5106	018	0	1	04	01	H5106_018_0	6	1	011111111111111111111000001100000010000000001111	Group 1	1	30	30	1	2			2	
H5106	018	0	1	04	01	H5106_018_0	6	5	000000000000000000000000000000001000000000000000	Group 5	1	50	50	1	2			1	250.00
H5106	018	0	1	04	01	H5106_018_0	6	7	100000000000000000000000000000000000000000000000	Hearing Aids	2				1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	6	6	000000000000000000000000000000000000000000100000	Group 6	1	30	30	1	1	2.00	25.00	2	
H5106	806	0	1	04	01	H5106_806_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	20	20	1	2			2	
H5106	806	0	1	04	01	H5106_806_0	5	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H5106	806	0	1	04	01	H5106_806_0	5	1	011111110110111111111101111100000111111111101111	Group 1	1	20	20	1	2			2	
H5106	807	0	1	04	01	H5106_807_0	5	1	011111110110111111111101111100000111111111101111	Group 1	1	20	20	1	2			2	
H5106	807	0	1	04	01	H5106_807_0	5	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H5106	807	0	1	04	01	H5106_807_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	20	20	1	2			2	
H5106	808	0	1	04	01	H5106_808_0	5	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H5106	808	0	1	04	01	H5106_808_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	20	20	1	2			2	
H5106	808	0	1	04	01	H5106_808_0	5	1	011111110110111111111101111100000111111111101111	Group 1	1	20	20	1	2			2	
H5144	001	0	1	04	01	H5144_001_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5144	001	0	1	04	01	H5144_001_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5144	001	0	1	04	01	H5144_001_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5144	001	0	1	04	01	H5144_001_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5144	001	0	1	04	01	H5144_001_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5144	801	0	1	04	01	H5144_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5144	801	0	1	04	01	H5144_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5144	801	0	1	04	01	H5144_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5144	802	0	1	04	01	H5144_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5144	802	0	1	04	01	H5144_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5144	802	0	1	04	01	H5144_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5214	003	0	1	04	01	H5214_003_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	4	5	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	4	7	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5214	003	0	1	04	01	H5214_003_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	4	2	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H5214	003	0	1	04	01	H5214_003_0	4	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5214	003	0	1	04	01	H5214_003_0	4	4	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H5214	004	0	1	04	01	H5214_004_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H5214	004	0	1	04	01	H5214_004_0	4	7	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H5214	004	0	1	04	01	H5214_004_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H5214	004	0	1	04	01	H5214_004_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H5214	004	0	1	04	01	H5214_004_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5214	004	0	1	04	01	H5214_004_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H5214	004	0	1	04	01	H5214_004_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H5214	004	0	1	04	01	H5214_004_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H5214	801	0	1	04	01	H5214_801_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5214	801	0	1	04	01	H5214_801_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5214	801	0	1	04	01	H5214_801_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5214	803	0	1	04	01	H5214_803_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5214	803	0	1	04	01	H5214_803_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5214	803	0	1	04	01	H5214_803_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5214	804	0	1	04	01	H5214_804_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5214	805	0	1	04	01	H5214_805_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5214	805	0	1	04	01	H5214_805_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5214	805	0	1	04	01	H5214_805_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5215	001	0	1	04	01	H5215_001_0	6	8	000000000000001000000000000000000000000000000000	$100 Copay Group	2				1	100.00	100.00	2	
H5215	001	0	1	04	01	H5215_001_0	6	7	000000000000000001100000000000000000000000000000	$75 Copay Group	2				1	75.00	75.00	2	
H5215	001	0	1	04	01	H5215_001_0	6	6	000000000000000000000000000000001000000000000000	35% Coinsurance Group	1	35	35	1	2			2	
H5215	001	0	1	04	01	H5215_001_0	6	5	000000000000000000000100000000000000000000000000	$25 Copay Group	2				1	25.00	25.00	2	
H5215	001	0	1	04	01	H5215_001_0	6	4	011100000000000000011000001000000000000001000010	$15 Copay Group	2				1	15.00	15.00	2	
H5215	001	0	1	04	01	H5215_001_0	6	3	000010000000010010000000000101000011111100000000	$10 Copay Group	2				1	10.00	10.00	2	
H5215	001	0	1	04	01	H5215_001_0	6	2	000000000000000000000000000000000100000010000000	$0 Copay Group	2				1	0.00	0.00	2	
H5215	001	0	1	04	01	H5215_001_0	6	9	000000000000000100000000000000000000000000000000	10%	1	10	10	1	2			2	
H5215	001	0	1	04	01	H5215_001_0	6	1	000000000000000000000001110000000000000000100000	20% Coinsurance Group	1	20	20	1	2			2	
H5215	001	0	1	04	01	H5215_001_0	6	10	000001111111100000000000000000000000000000001101	$20 Copay Group	2				1	20.00	20.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	4	011100000000000000011000001000000000000001000010	$15 Copay Group	2				1	15.00	15.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	5	000000000000000000000100000000000000000000000000	$25 Copay Group	2				1	25.00	25.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	6	000000000000000000000000000000001000000000000000	35% Coinsurance Group	1	35	35	1	2			2	
H5215	002	0	1	04	01	H5215_002_0	8	7	000000000000000001100000000000000000000000000000	$75 Copay Group	2				1	75.00	75.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	8	000000000000001000000000000000000000000000000000	$100 Copay Group	2				1	100.00	100.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	9	000000000000000100000000000000000000000000000000	10%	1	10	10	1	2			2	
H5215	002	0	1	04	01	H5215_002_0	8	1	000000000000000000000001110000000000000000100000	20% Coinsurance Group	1	20	20	1	2			2	
H5215	002	0	1	04	01	H5215_002_0	8	10	000001111111100000000000000000000000000000001101	$20 Copay Group	2				1	20.00	20.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	2	000000000000000000000000000000000100000010000000	$0 Copay Group	2				1	0.00	0.00	2	
H5215	002	0	1	04	01	H5215_002_0	8	3	000010000000010010000000000101000011111100000000	$10 Copay Group	2				1	10.00	10.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	6	000000000000000001100000000000000000000000000000	$75 Copay Group	2				1	75.00	75.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	5	000000000000001000000100000000000000000000000000	$25 Copay Group	2				1	25.00	25.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	4	000100000000000000000000000000000000000000000000	$15 Copay Group	2				1	15.00	15.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	3	111001111111100100011000001101000011111111000111	$10 Copay Group	2				1	10.00	10.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	2	000010000000011010000000000000000000000000001000	$5 Copay Group	2				1	5.00	5.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	1	000000000000000000000000000000000100000000000000	$0 Copay Group	2				1	0.00	0.00	2	
H5215	005	0	1	04	01	H5215_005_0	8	7	000000000000000000000001110000000000000000100000	10% Coinsurance Group	1	10	10	1	2			2	
H5215	005	0	1	04	01	H5215_005_0	8	8	000000000000000000000000000000001000000000000000	35% Coinsurance Group	1	35	35	1	2			2	
H5215	006	0	1	04	01	H5215_006_0	6	6	000000000000000001100000000000000000000000000000	$75 Copay Group	2				1	75.00	75.00	2	
H5215	006	0	1	04	01	H5215_006_0	6	5	000000000000001000000100000000000000000000000000	$25 Copay Group	2				1	25.00	25.00	2	
H5215	006	0	1	04	01	H5215_006_0	6	4	000100000000000000000000000000000000000000000000	$15 Copay Group	2				1	15.00	15.00	2	
H5215	006	0	1	04	01	H5215_006_0	6	3	111001111111100100011000001101000011111111000111	$10 Copay Group	2				1	10.00	10.00	2	
H5215	006	0	1	04	01	H5215_006_0	6	2	000010000000011010000000000000000000000000001000	$5 Copay Group	2				1	5.00	5.00	2	
H5215	006	0	1	04	01	H5215_006_0	6	1	000000000000000000000000000000000100000000000000	$0 Copay Group	2				1	0.00	0.00	2	
H5215	006	0	1	04	01	H5215_006_0	6	7	000000000000000000000001110000000000000000100000	10% Coinsurance Group	1	10	10	1	2			2	
H5215	006	0	1	04	01	H5215_006_0	6	8	000000000000000000000000000000001000000000000000	35% Coinsurance Group	1	35	35	1	2			2	
H5215	007	0	1	04	01	H5215_007_0	6	2	000000001001000000010000000000000000000000001000	50% Coins Group	1	0	50	2	2			2	
H5215	007	0	1	04	01	H5215_007_0	6	1	011111110110111111101111111101101111111111110111	20% Coins Group	1	0	20	1	2			2	
H5215	008	0	1	04	01	H5215_008_0	7	11	000000000000000001100000000000000000000000000000	$200 Copay Group	2				1	200.00	200.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	2	000000000000000000000000000000000000000010000000	$0 Copay Group	2				1	0.00	0.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	9	000000000000001110000000000000000000000000000000	10% Coinsurance Group	1	10	10	1	2			2	
H5215	008	0	1	04	01	H5215_008_0	7	4	000010000000000000000000000000000010000000000000	$15 Copay Group	2				1	15.00	15.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	5	000100000000000000000000000000000000000000000000	$25 Copay Group	2				1	25.00	25.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	6	011001111111100000011000011101000000000000001111	$35 Copay Group	2				1	35.00	35.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	7	000000000000000000000100000000000000000000000000	$75 Copay Group	2				1	75.00	75.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	8	000000000000001000000000000000000000000000000000	$110 Copay Group	2				1	110.00	110.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	10	000000000000000000000000000000001101111101000000	$5 Copay Group	2				1	5.00	5.00	2	
H5215	008	0	1	04	01	H5215_008_0	7	1	000000000000000000000001100000000000000000100000	30% Coinsurance Group	1	30	30	1	2			2	
H5215	008	0	1	04	01	H5215_008_0	7	3	000000000000010000000000000000000000000000000000	$10 Copay Group	2				1	10.00	10.00	2	
H5215	801	0	1	04	01	H5215_801_0	4	1	011111110110111111101101111100001111111111111111	20% Coinsurance Group	1	0	20	1	2			2	
H5215	801	0	1	04	01	H5215_801_0	4	2	000000001001000000010000000000000000000000000000	50% Coinsurance Group	1	0	50	1	2			2	
H5215	804	0	1	04	01	H5215_804_0	5	1	011111110110111111101101111100001111111111111111	20% Coinsurance Group	1	0	20	1	2			2	
H5215	804	0	1	04	01	H5215_804_0	5	2	000000001001000000010000000000000000000000000000	50% Coinsurance Group	1	0	50	1	2			2	
H5215	805	0	1	04	01	H5215_805_0	5	2	000000001001000000010000000000000000000000000000	50% Coinsurance Group	1	0	50	1	2			2	
H5215	805	0	1	04	01	H5215_805_0	5	1	011111110110111111101101111100001111111111111111	20% Coinsurance Group	1	0	20	1	2			2	
H5216	001	0	1	04	01	H5216_001_0	4	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	4	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	4	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	4	8	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H5216	001	0	1	04	01	H5216_001_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5216	001	0	1	04	01	H5216_001_0	4	9	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	4	2	000011010111000000000000000000000111100000001101		2				1	40.00	40.00	2	
H5216	001	0	1	04	01	H5216_001_0	4	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5216	001	0	1	04	01	H5216_001_0	4	3	000000101000111110011000000100000000011111000100		1	30	30	6	1	40.00	40.00	2	
H5216	003	0	1	04	01	H5216_003_0	5	2	000011010111000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5216	003	0	1	04	01	H5216_003_0	5	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5216	003	0	1	04	01	H5216_003_0	5	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	40.00	40.00	2	
H5216	003	0	1	04	01	H5216_003_0	5	9	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H5216	003	0	1	04	01	H5216_003_0	5	8	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H5216	003	0	1	04	01	H5216_003_0	5	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H5216	003	0	1	04	01	H5216_003_0	5	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H5216	003	0	1	04	01	H5216_003_0	5	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5216	003	0	1	04	01	H5216_003_0	5	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5216	801	0	1	04	01	H5216_801_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5216	801	0	1	04	01	H5216_801_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5216	801	0	1	04	01	H5216_801_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5216	802	0	1	04	01	H5216_802_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5216	803	0	1	04	01	H5216_803_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5216	803	0	1	04	01	H5216_803_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5216	803	0	1	04	01	H5216_803_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5216	804	0	1	04	01	H5216_804_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5216	804	0	1	04	01	H5216_804_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5216	804	0	1	04	01	H5216_804_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5301	002	0	1	38	05	H5301_002_0	3	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5301	003	0	1	38	05	H5301_003_0	2	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5301	004	0	1	38	05	H5301_004_0	2	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5301	005	0	1	38	05	H5301_005_0	2	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5301	007	0	1	38	05	H5301_007_0	2	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H5378	001	0	1	04	01	H5378_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H5378	001	0	1	04	01	H5378_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H5378	002	0	1	04	01	H5378_002_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5378	002	0	1	04	01	H5378_002_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H5378	003	0	1	04	01	H5378_003_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H5378	003	0	1	04	01	H5378_003_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H5378	004	0	1	04	01	H5378_004_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H5378	004	0	1	04	01	H5378_004_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H5378	005	0	1	04	01	H5378_005_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H5378	005	0	1	04	01	H5378_005_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H5378	005	0	1	04	01	H5378_005_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5378	005	0	1	04	01	H5378_005_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H5378	005	0	1	04	01	H5378_005_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5378	005	0	1	04	01	H5378_005_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H5378	005	0	1	04	01	H5378_005_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H5378	006	0	1	04	01	H5378_006_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H5378	006	0	1	04	01	H5378_006_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H5378	801	0	1	04	01	H5378_801_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H5378	801	0	1	04	01	H5378_801_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H5378	801	0	1	04	01	H5378_801_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H5378	802	0	1	04	01	H5378_802_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H5378	802	0	1	04	01	H5378_802_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H5378	802	0	1	04	01	H5378_802_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H5378	803	0	1	04	01	H5378_803_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H5378	803	0	1	04	01	H5378_803_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H5378	803	0	1	04	01	H5378_803_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H5415	039	0	1	04	01	H5415_039_0	3	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5415	039	0	1	04	01	H5415_039_0	3	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5415	039	0	1	04	01	H5415_039_0	3	2	000011010111000000000000000000000111100000001101		2				1	40.00	40.00	2	
H5415	039	0	1	04	01	H5415_039_0	3	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5415	039	0	1	04	01	H5415_039_0	3	7	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H5415	039	0	1	04	01	H5415_039_0	3	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H5415	039	0	1	04	01	H5415_039_0	3	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5415	039	0	1	04	01	H5415_039_0	3	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	40.00	40.00	2	
H5415	801	0	1	04	01	H5415_801_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5415	801	0	1	04	01	H5415_801_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5415	801	0	1	04	01	H5415_801_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5415	803	0	1	04	01	H5415_803_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5415	803	0	1	04	01	H5415_803_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5415	803	0	1	04	01	H5415_803_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5415	804	0	1	04	01	H5415_804_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5415	805	0	1	04	01	H5415_805_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5415	805	0	1	04	01	H5415_805_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5415	805	0	1	04	01	H5415_805_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5417	001	0	1	04	01	H5417_001_0	3	4	000000000000000000000000000000001000000000000000	Group 4	1	0	30	6	2			2	
H5417	001	0	1	04	01	H5417_001_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H5417	001	0	1	04	01	H5417_001_0	3	3	000000000000000000000000001000000000000000000010	Group 3	2				1	0.00	0.00	2	
H5417	001	0	1	04	01	H5417_001_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	35.00	2	
H5417	005	0	1	04	01	H5417_005_0	3	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
H5417	005	0	1	04	01	H5417_005_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
H5417	005	0	1	04	01	H5417_005_0	3	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
H5417	005	0	1	04	01	H5417_005_0	3	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
H5417	005	0	1	04	01	H5417_005_0	3	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
H5417	006	0	1	04	01	H5417_006_0	5	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
H5417	006	0	1	04	01	H5417_006_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H5417	006	0	1	04	01	H5417_006_0	5	1	010011110110100000001000000000000010000000011101	Group 1	2				1	40.00	40.00	2	
H5417	006	0	1	04	01	H5417_006_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5417	006	0	1	04	01	H5417_006_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H5417	006	0	1	04	01	H5417_006_0	5	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H5417	006	0	1	04	01	H5417_006_0	5	5	000000000000010000000000000000000000000000000000	Group 5	1	0	30	6	1	0.00	7.00	2	
H5417	006	0	1	04	01	H5417_006_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
H5417	006	0	1	04	01	H5417_006_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	046	0	1	09	04	H5421_046_0	2	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	046	0	1	09	04	H5421_046_0	2	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	046	0	1	09	04	H5421_046_0	2	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	046	0	1	09	04	H5421_046_0	2	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	046	0	1	09	04	H5421_046_0	2	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	046	0	1	09	04	H5421_046_0	2	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	046	0	1	09	04	H5421_046_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	047	0	1	09	04	H5421_047_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	047	0	1	09	04	H5421_047_0	2	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	047	0	1	09	04	H5421_047_0	2	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	047	0	1	09	04	H5421_047_0	2	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	047	0	1	09	04	H5421_047_0	2	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	047	0	1	09	04	H5421_047_0	2	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	047	0	1	09	04	H5421_047_0	2	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	048	0	1	09	04	H5421_048_0	2	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	048	0	1	09	04	H5421_048_0	2	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	048	0	1	09	04	H5421_048_0	2	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	048	0	1	09	04	H5421_048_0	2	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	048	0	1	09	04	H5421_048_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	048	0	1	09	04	H5421_048_0	2	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	048	0	1	09	04	H5421_048_0	2	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	049	0	1	09	04	H5421_049_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	049	0	1	09	04	H5421_049_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	049	0	1	09	04	H5421_049_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	049	0	1	09	04	H5421_049_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	049	0	1	09	04	H5421_049_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	049	0	1	09	04	H5421_049_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	049	0	1	09	04	H5421_049_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	050	0	1	09	04	H5421_050_0	2	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	050	0	1	09	04	H5421_050_0	2	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	050	0	1	09	04	H5421_050_0	2	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	050	0	1	09	04	H5421_050_0	2	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	050	0	1	09	04	H5421_050_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	050	0	1	09	04	H5421_050_0	2	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	051	0	1	09	04	H5421_051_0	2	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	051	0	1	09	04	H5421_051_0	2	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	051	0	1	09	04	H5421_051_0	2	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	051	0	1	09	04	H5421_051_0	2	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	051	0	1	09	04	H5421_051_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	051	0	1	09	04	H5421_051_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	051	0	1	09	04	H5421_051_0	2	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	051	0	1	09	04	H5421_051_0	2	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	052	0	1	09	04	H5421_052_0	2	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	052	0	1	09	04	H5421_052_0	2	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	052	0	1	09	04	H5421_052_0	2	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	052	0	1	09	04	H5421_052_0	2	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	052	0	1	09	04	H5421_052_0	2	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	052	0	1	09	04	H5421_052_0	2	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	053	0	1	09	04	H5421_053_0	2	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	053	0	1	09	04	H5421_053_0	2	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	053	0	1	09	04	H5421_053_0	2	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	053	0	1	09	04	H5421_053_0	2	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	053	0	1	09	04	H5421_053_0	2	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	053	0	1	09	04	H5421_053_0	2	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	053	0	1	09	04	H5421_053_0	2	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	053	0	1	09	04	H5421_053_0	2	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	054	0	1	09	04	H5421_054_0	2	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	054	0	1	09	04	H5421_054_0	2	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	054	0	1	09	04	H5421_054_0	2	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	054	0	1	09	04	H5421_054_0	2	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	054	0	1	09	04	H5421_054_0	2	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	054	0	1	09	04	H5421_054_0	2	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	054	0	1	09	04	H5421_054_0	2	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	055	0	1	09	04	H5421_055_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	055	0	1	09	04	H5421_055_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	055	0	1	09	04	H5421_055_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	055	0	1	09	04	H5421_055_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	055	0	1	09	04	H5421_055_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	055	0	1	09	04	H5421_055_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	055	0	1	09	04	H5421_055_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	056	0	1	09	04	H5421_056_0	2	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	056	0	1	09	04	H5421_056_0	2	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	056	0	1	09	04	H5421_056_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	056	0	1	09	04	H5421_056_0	2	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	056	0	1	09	04	H5421_056_0	2	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	056	0	1	09	04	H5421_056_0	2	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	057	0	1	09	04	H5421_057_0	2	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	057	0	1	09	04	H5421_057_0	2	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	057	0	1	09	04	H5421_057_0	2	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	057	0	1	09	04	H5421_057_0	2	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	057	0	1	09	04	H5421_057_0	2	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	057	0	1	09	04	H5421_057_0	2	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	057	0	1	09	04	H5421_057_0	2	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	064	0	1	09	04	H5421_064_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	064	0	1	09	04	H5421_064_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	064	0	1	09	04	H5421_064_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	064	0	1	09	04	H5421_064_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	064	0	1	09	04	H5421_064_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	064	0	1	09	04	H5421_064_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	064	0	1	09	04	H5421_064_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	065	0	1	09	04	H5421_065_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	065	0	1	09	04	H5421_065_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	065	0	1	09	04	H5421_065_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	065	0	1	09	04	H5421_065_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	065	0	1	09	04	H5421_065_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	065	0	1	09	04	H5421_065_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	065	0	1	09	04	H5421_065_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	065	0	1	09	04	H5421_065_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	066	0	1	09	04	H5421_066_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	066	0	1	09	04	H5421_066_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	066	0	1	09	04	H5421_066_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	066	0	1	09	04	H5421_066_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	066	0	1	09	04	H5421_066_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	066	0	1	09	04	H5421_066_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	066	0	1	09	04	H5421_066_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	067	0	1	09	04	H5421_067_0	6	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	067	0	1	09	04	H5421_067_0	6	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	067	0	1	09	04	H5421_067_0	6	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	067	0	1	09	04	H5421_067_0	6	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	067	0	1	09	04	H5421_067_0	6	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	067	0	1	09	04	H5421_067_0	6	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	067	0	1	09	04	H5421_067_0	6	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	068	0	1	09	04	H5421_068_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	068	0	1	09	04	H5421_068_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	068	0	1	09	04	H5421_068_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	068	0	1	09	04	H5421_068_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	068	0	1	09	04	H5421_068_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	068	0	1	09	04	H5421_068_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	068	0	1	09	04	H5421_068_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	069	0	1	09	04	H5421_069_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	069	0	1	09	04	H5421_069_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	069	0	1	09	04	H5421_069_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	069	0	1	09	04	H5421_069_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	069	0	1	09	04	H5421_069_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	069	0	1	09	04	H5421_069_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	069	0	1	09	04	H5421_069_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	070	0	1	09	04	H5421_070_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	070	0	1	09	04	H5421_070_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	070	0	1	09	04	H5421_070_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	070	0	1	09	04	H5421_070_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	070	0	1	09	04	H5421_070_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	070	0	1	09	04	H5421_070_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	070	0	1	09	04	H5421_070_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	071	0	1	09	04	H5421_071_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	071	0	1	09	04	H5421_071_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	071	0	1	09	04	H5421_071_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	071	0	1	09	04	H5421_071_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	071	0	1	09	04	H5421_071_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	071	0	1	09	04	H5421_071_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	072	0	1	09	04	H5421_072_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	072	0	1	09	04	H5421_072_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	072	0	1	09	04	H5421_072_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	072	0	1	09	04	H5421_072_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	072	0	1	09	04	H5421_072_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	072	0	1	09	04	H5421_072_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	072	0	1	09	04	H5421_072_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	072	0	1	09	04	H5421_072_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	073	0	1	09	04	H5421_073_0	6	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	073	0	1	09	04	H5421_073_0	6	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	073	0	1	09	04	H5421_073_0	6	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	073	0	1	09	04	H5421_073_0	6	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	073	0	1	09	04	H5421_073_0	6	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	073	0	1	09	04	H5421_073_0	6	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	073	0	1	09	04	H5421_073_0	6	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	074	0	1	09	04	H5421_074_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	074	0	1	09	04	H5421_074_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	074	0	1	09	04	H5421_074_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	074	0	1	09	04	H5421_074_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	074	0	1	09	04	H5421_074_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	074	0	1	09	04	H5421_074_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	074	0	1	09	04	H5421_074_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	075	0	1	09	04	H5421_075_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	075	0	1	09	04	H5421_075_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	075	0	1	09	04	H5421_075_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	075	0	1	09	04	H5421_075_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	075	0	1	09	04	H5421_075_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	075	0	1	09	04	H5421_075_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	100	0	1	09	04	H5421_100_0	3	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	100	0	1	09	04	H5421_100_0	3	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	100	0	1	09	04	H5421_100_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	100	0	1	09	04	H5421_100_0	3	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	100	0	1	09	04	H5421_100_0	3	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	100	0	1	09	04	H5421_100_0	3	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	100	0	1	09	04	H5421_100_0	3	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	100	0	1	09	04	H5421_100_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	101	0	1	09	04	H5421_101_0	3	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	101	0	1	09	04	H5421_101_0	3	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	101	0	1	09	04	H5421_101_0	3	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	101	0	1	09	04	H5421_101_0	3	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	101	0	1	09	04	H5421_101_0	3	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	101	0	1	09	04	H5421_101_0	3	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	103	0	1	09	04	H5421_103_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	103	0	1	09	04	H5421_103_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	103	0	1	09	04	H5421_103_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	103	0	1	09	04	H5421_103_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	103	0	1	09	04	H5421_103_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	103	0	1	09	04	H5421_103_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	103	0	1	09	04	H5421_103_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	103	0	1	09	04	H5421_103_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	104	0	1	09	04	H5421_104_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	104	0	1	09	04	H5421_104_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	104	0	1	09	04	H5421_104_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	104	0	1	09	04	H5421_104_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	104	0	1	09	04	H5421_104_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	104	0	1	09	04	H5421_104_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	104	0	1	09	04	H5421_104_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	106	0	1	09	04	H5421_106_0	5	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	106	0	1	09	04	H5421_106_0	5	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	106	0	1	09	04	H5421_106_0	5	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	106	0	1	09	04	H5421_106_0	5	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	106	0	1	09	04	H5421_106_0	5	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	106	0	1	09	04	H5421_106_0	5	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	107	0	1	09	04	H5421_107_0	5	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	107	0	1	09	04	H5421_107_0	5	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	107	0	1	09	04	H5421_107_0	5	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	107	0	1	09	04	H5421_107_0	5	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	107	0	1	09	04	H5421_107_0	5	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	107	0	1	09	04	H5421_107_0	5	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	107	0	1	09	04	H5421_107_0	5	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	107	0	1	09	04	H5421_107_0	5	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	109	0	1	09	04	H5421_109_0	6	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	109	0	1	09	04	H5421_109_0	6	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	109	0	1	09	04	H5421_109_0	6	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	109	0	1	09	04	H5421_109_0	6	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	109	0	1	09	04	H5421_109_0	6	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	109	0	1	09	04	H5421_109_0	6	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	109	0	1	09	04	H5421_109_0	6	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	110	0	1	09	04	H5421_110_0	6	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	110	0	1	09	04	H5421_110_0	6	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	110	0	1	09	04	H5421_110_0	6	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	110	0	1	09	04	H5421_110_0	6	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	110	0	1	09	04	H5421_110_0	6	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	110	0	1	09	04	H5421_110_0	6	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	112	0	1	09	04	H5421_112_0	3	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	112	0	1	09	04	H5421_112_0	3	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	112	0	1	09	04	H5421_112_0	3	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	112	0	1	09	04	H5421_112_0	3	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	112	0	1	09	04	H5421_112_0	3	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	112	0	1	09	04	H5421_112_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	112	0	1	09	04	H5421_112_0	3	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	112	0	1	09	04	H5421_112_0	3	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	113	0	1	09	04	H5421_113_0	3	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	113	0	1	09	04	H5421_113_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	113	0	1	09	04	H5421_113_0	3	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	113	0	1	09	04	H5421_113_0	3	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	113	0	1	09	04	H5421_113_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	113	0	1	09	04	H5421_113_0	3	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	115	0	1	09	04	H5421_115_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	115	0	1	09	04	H5421_115_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	115	0	1	09	04	H5421_115_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	115	0	1	09	04	H5421_115_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	115	0	1	09	04	H5421_115_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	115	0	1	09	04	H5421_115_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	115	0	1	09	04	H5421_115_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	116	0	1	09	04	H5421_116_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	116	0	1	09	04	H5421_116_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	116	0	1	09	04	H5421_116_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	116	0	1	09	04	H5421_116_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	116	0	1	09	04	H5421_116_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	116	0	1	09	04	H5421_116_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	116	0	1	09	04	H5421_116_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	116	0	1	09	04	H5421_116_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	124	0	1	09	04	H5421_124_0	3	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	124	0	1	09	04	H5421_124_0	3	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	124	0	1	09	04	H5421_124_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	124	0	1	09	04	H5421_124_0	3	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	124	0	1	09	04	H5421_124_0	3	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	124	0	1	09	04	H5421_124_0	3	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	124	0	1	09	04	H5421_124_0	3	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	125	0	1	09	04	H5421_125_0	3	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	125	0	1	09	04	H5421_125_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	125	0	1	09	04	H5421_125_0	3	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	125	0	1	09	04	H5421_125_0	3	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	125	0	1	09	04	H5421_125_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	125	0	1	09	04	H5421_125_0	3	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	125	0	1	09	04	H5421_125_0	3	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	127	0	1	09	04	H5421_127_0	4	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	127	0	1	09	04	H5421_127_0	4	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	127	0	1	09	04	H5421_127_0	4	7	000000000000000001000100000000000000000000000000	Outpatient Hospital and Ambulance	2				1	100.00	100.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	127	0	1	09	04	H5421_127_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	127	0	1	09	04	H5421_127_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	13	000000000000000000100000000000000000000000000000	ASC	2				1	75.00	75.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	127	0	1	09	04	H5421_127_0	4	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	127	0	1	09	04	H5421_127_0	4	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	200.00	200.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	128	0	1	09	04	H5421_128_0	4	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	128	0	1	09	04	H5421_128_0	4	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	128	0	1	09	04	H5421_128_0	4	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	128	0	1	09	04	H5421_128_0	4	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	128	0	1	09	04	H5421_128_0	4	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	128	0	1	09	04	H5421_128_0	4	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	128	0	1	09	04	H5421_128_0	4	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	130	0	1	09	04	H5421_130_0	3	13	000000000000000001100000000000000000000000000000	ASC and Outpatient Hospital	2				1	75.00	75.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	130	0	1	09	04	H5421_130_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	130	0	1	09	04	H5421_130_0	3	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	130	0	1	09	04	H5421_130_0	3	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	130	0	1	09	04	H5421_130_0	3	7	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5421	130	0	1	09	04	H5421_130_0	3	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	130	0	1	09	04	H5421_130_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	131	0	1	09	04	H5421_131_0	3	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	131	0	1	09	04	H5421_131_0	3	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	131	0	1	09	04	H5421_131_0	3	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	100.00	100.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	131	0	1	09	04	H5421_131_0	3	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	131	0	1	09	04	H5421_131_0	3	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	131	0	1	09	04	H5421_131_0	3	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	131	0	1	09	04	H5421_131_0	3	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	175.00	175.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	9	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	133	0	1	09	04	H5421_133_0	5	8	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	133	0	1	09	04	H5421_133_0	5	7	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	6	000000000000011110000000000000000000000000000000	Diagnostics	1	0	10	3	2			2	
H5421	133	0	1	09	04	H5421_133_0	5	5	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	133	0	1	09	04	H5421_133_0	5	14	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	3	000100000000000000000000000000000000000000000000	Home Health Services	1	15	15	3	2			2	
H5421	133	0	1	09	04	H5421_133_0	5	1	010000100000100000001000000000000000000000000000	CORF and Rehab	2				1	15.00	15.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	10	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	15.00	15.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	11	000010000000000000000000000000000000000000000000	PCP	2				1	10.00	10.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	12	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	133	0	1	09	04	H5421_133_0	5	13	000000000000000001100000000000000000000000000000	ASC and Outpatient Hospital	2				1	75.00	75.00	2	
H5421	133	0	1	09	04	H5421_133_0	5	4	000001010110000000000000000000000000000000000000	Physician Services	2				1	25.00	25.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	9	000000000000000000100000000000000000000000000000	Ambulatory Surgical Centers	2				1	100.00	100.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	7	000000000000011110000000000000000000000000000000	Outpatient Diagnostics/X-rays	1	0	20	3	2			2	
H5421	134	0	1	09	04	H5421_134_0	5	8	000000000000000001000000000000000000000000000000	Outpatient Hospital	2				1	100.00	100.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	6	000000001001000000010000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	134	0	1	09	04	H5421_134_0	5	5	000001010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	4	000010000000000000000000000000000000000000000000	PCP	2				1	20.00	20.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	3	000100000000000000000000000000000000000000000000	Home Health Services	1	20	20	3	2			2	
H5421	134	0	1	09	04	H5421_134_0	5	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	195.00	195.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	1	010000100000100000001000000000000000000000000000	CORF, Rehab, Therapy	2				1	35.00	35.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	11	000000000000000000000001110000000000000000100000	DME, Medical Supplies, Part B Drugs	1	0	20	3	2			2	
H5421	134	0	1	09	04	H5421_134_0	5	12	000000000000000000000000001000000000000000000000	ESRD	2				1	50.00	50.00	2	
H5421	134	0	1	09	04	H5421_134_0	5	13	000000000000000000000000000100001111111111000000	Preventative Services	2				2			2	
H5421	134	0	1	09	04	H5421_134_0	5	14	000000000000000000000000000000000000000000001000	Dental	2				2			2	
H5421	134	0	1	09	04	H5421_134_0	5	15	000000000000000000000000000000000000000000000111	Vision and Hearing	2				1	35.00	35.00	2	
H5421	136	0	1	09	04	H5421_136_0	4	1	011011110110111111111101101100000101111111100000	Out-of-Network Benefits	1	20	20	3	2			2	
H5421	136	0	1	09	04	H5421_136_0	4	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H5421	136	0	1	09	04	H5421_136_0	4	3	000100000000000000000000000000000000000000000000	Home Heath Services	2				2			2	
H5421	136	0	1	09	04	H5421_136_0	4	4	000000001001000000000000000000000000000000000000	Mental Health and Substance Abuse	1	50	50	3	2			2	
H5421	136	0	1	09	04	H5421_136_0	4	5	000000000000000000000000000000001010000000000000	Routine Physical Exam	2				2			2	
H5421	136	0	1	09	04	H5421_136_0	4	6	100000000000000000000000000000000000000000011111	Dental, Vision, Hearing	1	0	100	3	2			2	
H5421	136	0	1	09	04	H5421_136_0	4	7	000000000000000000000000000001000000000000000000	OTC Benefit	2				2			2	
H5421	801	0	1	09	04	H5421_801_0	6	1	011111110110111111101111111100001111111111101111	OON Benefits	1	20	20	3	2			2	
H5421	801	0	1	09	04	H5421_801_0	6	2	000000001001000000010000000000000000000000000000	Mental Health  Substance Abuse	1	50	50	3	2			2	
H5421	804	0	1	09	04	H5421_804_0	6	1	011111110110111111101111111100001111111111101111	OON Benefits	1	20	20	3	2			2	
H5421	804	0	1	09	04	H5421_804_0	6	2	000000001001000000010000000000000000000000000000	Mental Health  Substance Abuse	1	50	50	3	2			2	
H5421	805	0	1	09	04	H5421_805_0	6	1	011111110110111111101111111100001111111111101111	OON Benefits	1	20	20	3	2			2	
H5421	805	0	1	09	04	H5421_805_0	6	2	000000001001000000010000000000000000000000000000	Mental Health  Substance Abuse	1	50	50	3	2			2	
H5421	806	0	1	09	04	H5421_806_0	6	1	011111110110111111101111111100001111111111101111	OON Benefits	1	20	20	3	2			2	
H5421	806	0	1	09	04	H5421_806_0	6	2	000000001001000000010000000000000000000000000000	Mental Health  Substance Abuse	1	50	50	3	2			2	
H5421	807	0	1	09	04	H5421_807_0	6	1	011111110110111111101111111100001111111111101111	OON Benefits	1	20	20	3	2			2	
H5421	807	0	1	09	04	H5421_807_0	6	2	000000001001000000010000000000000000000000000000	Mental Health  Substance Abuse	1	50	50	3	2			2	
H5421	808	0	1	09	04	H5421_808_0	6	1	011111110110111111101111111100001111111111101111	OON Benefits	1	20	20	3	2			2	
H5421	808	0	1	09	04	H5421_808_0	6	2	000000001001000000010000000000000000000000000000	Mental Health  Substance Abuse	1	50	50	3	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	11	000000000000000000000010000010000000000000010000	Group 11	1	50	50	6	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	12	000001000000000000000000000000000000000000000000	Group 12	1	50	50	6	1	35.00	35.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	13	000000000000000000000000000000000000000000000010	Group 13	1	0	30	6	1	0.00	0.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	3	000000000000001101100001110001000001111111100000	Group 3	1	30	30	6	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	6	1	7.00	7.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	6	000010000010000010000000000000000010000000000000	Group 6	2				1	20.00	20.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	9	100000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	1	010000110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	10	000100000000000000000000000000000000000000000000	Group 10	1	30	50	6	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	12	000001000000000000000000000000000000000000000000	Group 12	1	50	50	2	1	35.00	35.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	8	000000000000000000000010000010000000000000010000	Group 8	1	50	50	2	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	10	100000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	1	010000110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	11	000100000000000000000000000000000000000000000000	Group 11	1	30	50	2	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	13	000000000000000000000000000000000000000000000010	Group 13	1	0	30	6	1	0.00	0.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5424	003	0	1	04	01	H5424_003_0	4	3	000000000000001101100001110001000001111111100000	Group 3	1	30	30	2	2			2	
H5424	003	0	1	04	01	H5424_003_0	4	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H5424	005	0	1	04	01	H5424_005_0	3	1	011101111111111111111111110101000111111111100101	Group 1	1	30	30	6	2			2	
H5424	005	0	1	04	01	H5424_005_0	3	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	35.00	2	
H5424	005	0	1	04	01	H5424_005_0	3	3	000000000000000000000000000000001000000000001000	Group 3	1	0	30	6	2			2	
H5424	005	0	1	04	01	H5424_005_0	3	4	100000000000000000000000001000000000000000010010	Group 4	2				1	0.00	0.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H5424	801	0	1	04	01	H5424_801_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H5424	801	0	1	04	01	H5424_801_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	8	000000000000000000000001110000000000000000100010	Group 8	1	30	30	2	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H5429	001	0	1	04	01	H5429_001_0	11	1	011111111111111111111101111100001111111111111111	Out of Network Services 1	1	20	20	3	2			2	
H5429	005	0	1	04	01	H5429_005_0	10	1	011111111111111111111101111100001111111111111111	Out of Network Services 1	1	20	20	3	2			2	
H5429	015	0	1	04	01	H5429_015_0	10	1	011111111111111111111101111100001111111111111111	Out of Network Services 1	1	20	20	3	2			2	
H5429	020	0	1	04	01	H5429_020_0	11	1	011111111111111111111101111100001111111111111111	Out of Network Services 1	1	20	20	3	2			2	
H5429	053	0	1	04	01	H5429_053_0	8	1	011111111111111111111101111100001111111111111111	Out of Network Services 1	1	20	20	3	2			2	
H5434	001	0	1	04	01	H5434_001_0	7	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5434	001	0	1	04	01	H5434_001_0	7	1	010111110110111111101001110100000111111111100111	30% coinsurance	1	30	30	1	2			2	
H5434	001	0	1	04	01	H5434_001_0	7	6	000000000000000000000000000000000000000000011000	Dental Member Cost Share	1	25	25	1	2			2	
H5434	001	0	1	04	01	H5434_001_0	7	5	000000000000000000000000000000001000000000000000	No Copayment	2				1	0.00	0.00	2	
H5434	001	0	1	04	01	H5434_001_0	7	4	001000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H5434	001	0	1	04	01	H5434_001_0	7	3	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5434	002	0	1	04	01	H5434_002_0	5	5	000000000000000000000000000000001000000000000000	No Copayment	2				1	0.00	0.00	2	
H5434	002	0	1	04	01	H5434_002_0	5	6	000000000000000000000000000000000000000000011000	Dental Member Cost Share	1	25	25	1	2			2	
H5434	002	0	1	04	01	H5434_002_0	5	4	001000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H5434	002	0	1	04	01	H5434_002_0	5	3	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	30.00	30.00	2	
H5434	002	0	1	04	01	H5434_002_0	5	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5434	002	0	1	04	01	H5434_002_0	5	1	010111110110111111101001110100000111111111100111	30% coinsurance	1	30	30	1	2			2	
H5434	014	0	1	04	01	H5434_014_0	6	10	000000000000011111000000000000000000000000000000	Outpatient Hospital	2				1	0.00	150.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	1	000000000000000000000000000000000000000000100000	30% coinsurance	1	30	30	1	2			2	
H5434	014	0	1	04	01	H5434_014_0	6	7	011101111101100000011000010000000111111011000111	$50 Copayment	2				1	50.00	50.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	8	000000000010000000000000000000000000000000000000	Allergy  e-Medicine	2				1	5.00	5.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	6	000000000000000000000000001000000000000000000000	Dialysis	2				1	30.00	30.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	2	000000000000000000000000000000000000000000011000	Dental Member Cost Share	1	25	25	1	2			2	
H5434	014	0	1	04	01	H5434_014_0	6	3	000000000000000000000000100100001000000100000000	No Copayment	2				1	0.00	0.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	4	000000000000000000000001000000000000000000000000	Durable Medical Equipment	2				1	0.00	500.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	5	000010000000000000000000000000000000000000000000	PCP Copayment	2				1	15.00	15.00	2	
H5434	014	0	1	04	01	H5434_014_0	6	9	000000000000000000100100000000000000000000000000	Ambulance  ASC	2				1	100.00	100.00	2	
H5434	015	0	1	04	01	H5434_015_0	5	5	000000000000000000000000000000001000000000000000	No Copayment	2				1	0.00	0.00	2	
H5434	015	0	1	04	01	H5434_015_0	5	6	000000000000000000000000000000000000000000011000	Dental Member Cost Share	1	25	25	1	2			2	
H5434	015	0	1	04	01	H5434_015_0	5	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5434	015	0	1	04	01	H5434_015_0	5	4	001000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H5434	015	0	1	04	01	H5434_015_0	5	1	010111110110111111101001110100000111111111100111	30% coinsurance	1	30	30	1	2			2	
H5434	015	0	1	04	01	H5434_015_0	5	3	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	25.00	25.00	2	
H5434	016	0	1	04	01	H5434_016_0	5	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5434	016	0	1	04	01	H5434_016_0	5	1	010111110110111111101001110100000111111111100111	30% coinsurance	1	30	30	1	2			2	
H5434	016	0	1	04	01	H5434_016_0	5	6	000000000000000000000000000000000000000000011000	Dental Member Cost Share	1	25	25	1	2			2	
H5434	016	0	1	04	01	H5434_016_0	5	3	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	25.00	25.00	2	
H5434	016	0	1	04	01	H5434_016_0	5	4	001000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H5434	016	0	1	04	01	H5434_016_0	5	5	000000000000000000000000000000001000000000000000	No Copayment	2				1	0.00	0.00	2	
H5434	018	0	1	04	01	H5434_018_0	5	6	000000000000000000000000000000000000000000011000	Dental Member Cost Share	1	25	25	1	2			2	
H5434	018	0	1	04	01	H5434_018_0	5	4	001000001001000000010000000000000000000000000000	Mental Health	1	50	50	1	2			2	
H5434	018	0	1	04	01	H5434_018_0	5	5	000000000000000000000000000000001000000000000000	No Copayment	2				1	0.00	0.00	2	
H5434	018	0	1	04	01	H5434_018_0	5	1	010111110110111111101001110100000111111111100111	30% coinsurance	1	30	30	1	2			2	
H5434	018	0	1	04	01	H5434_018_0	5	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5434	018	0	1	04	01	H5434_018_0	5	3	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	35.00	35.00	2	
H5434	801	0	1	04	01	H5434_801_0	5	2	011011111111111111111101111100001111111111101111	All Others	1	23	23	2	2			2	
H5434	801	0	1	04	01	H5434_801_0	5	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H5434	802	0	1	04	01	H5434_802_0	5	2	011011111111111111111101111100001111111111101111	All Others	1	23	23	2	2			2	
H5434	802	0	1	04	01	H5434_802_0	5	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H5434	803	0	1	04	01	H5434_803_0	5	2	011011111111111111111101111100001111111111101111	All Others	1	23	23	2	2			2	
H5434	803	0	1	04	01	H5434_803_0	5	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H5434	804	0	1	04	01	H5434_804_0	6	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H5434	804	0	1	04	01	H5434_804_0	6	2	011011111111111111111101111100001111111111101111	All Others	1	23	23	2	2			2	
H5434	805	0	1	04	01	H5434_805_0	6	2	011011111111111111111101111100001111111111101111	All Others	1	23	23	2	2			2	
H5434	805	0	1	04	01	H5434_805_0	6	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H5436	001	0	1	04	01	H5436_001_0	8	1	010111110110111111101001101100001111111111001111	Group 1	1	20	20	3	2			2	
H5436	001	0	1	04	01	H5436_001_0	8	2	001000001001000000010000000000000000000000000000	Group 2	1	10	10	3	2			2	
H5436	001	0	1	04	01	H5436_001_0	8	3	000000000000000000000100000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H5436	001	0	1	04	01	H5436_001_0	8	4	000000000000000000000000010000000000000000100000	Group 4	2				1	5.00	50.00	2	
H5436	002	0	1	04	01	H5436_002_0	8	2	001000001001000000010000000000000000000000000000	Group 2	1	10	10	3	2			2	
H5436	002	0	1	04	01	H5436_002_0	8	3	000000000000000000000100000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H5436	002	0	1	04	01	H5436_002_0	8	4	000000000000000000000000010000000000000000100000	Group 4	2				1	5.00	50.00	2	
H5436	002	0	1	04	01	H5436_002_0	8	1	010111110110111111101011101100001111111111001111	Group 1	1	20	20	3	2			2	
H5437	001	0	1	04	01	H5437_001_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	001	0	1	04	01	H5437_001_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5437	001	0	1	04	01	H5437_001_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5437	001	0	1	04	01	H5437_001_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5437	001	0	1	04	01	H5437_001_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5437	003	0	1	04	01	H5437_003_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	003	0	1	04	01	H5437_003_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5437	003	0	1	04	01	H5437_003_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5437	003	0	1	04	01	H5437_003_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5437	003	0	1	04	01	H5437_003_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5437	004	0	1	04	01	H5437_004_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5437	004	0	1	04	01	H5437_004_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	004	0	1	04	01	H5437_004_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5437	004	0	1	04	01	H5437_004_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5437	004	0	1	04	01	H5437_004_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5437	005	0	1	04	01	H5437_005_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	005	0	1	04	01	H5437_005_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5437	005	0	1	04	01	H5437_005_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5437	005	0	1	04	01	H5437_005_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5437	005	0	1	04	01	H5437_005_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5437	006	0	1	04	01	H5437_006_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5437	006	0	1	04	01	H5437_006_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5437	006	0	1	04	01	H5437_006_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5437	006	0	1	04	01	H5437_006_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5437	006	0	1	04	01	H5437_006_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	007	0	1	04	01	H5437_007_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5437	007	0	1	04	01	H5437_007_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5437	007	0	1	04	01	H5437_007_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5437	007	0	1	04	01	H5437_007_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5437	007	0	1	04	01	H5437_007_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5437	801	0	1	04	01	H5437_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5437	801	0	1	04	01	H5437_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5437	801	0	1	04	01	H5437_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5437	802	0	1	04	01	H5437_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5437	802	0	1	04	01	H5437_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5437	802	0	1	04	01	H5437_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5437	804	0	1	04	01	H5437_804_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5437	804	0	1	04	01	H5437_804_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5437	804	0	1	04	01	H5437_804_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5439	001	0	1	04	01	H5439_001_0	5	6	000000000000000000000000001000000000000000000000	Copayment $10	2				1	10.00	10.00	2	
H5439	001	0	1	04	01	H5439_001_0	5	5	000100000000000000000000000000001000000000000010	No Cost	2				1	0.00	0.00	2	
H5439	001	0	1	04	01	H5439_001_0	5	4	001001001001000000010000000000000000000000000000	Copayment $50	2				1	50.00	50.00	2	
H5439	001	0	1	04	01	H5439_001_0	5	1	000010010010011111100001110100000111111111101101	Coinsurance 10%	1	10	10	6	2			2	
H5439	001	0	1	04	01	H5439_001_0	5	3	010000100100100000001000000000000000000000000000	Copayment $35	2				1	35.00	35.00	2	
H5439	001	0	1	04	01	H5439_001_0	5	2	000000000000000000000100000000000000000000000000	Copay $25	2				1	25.00	25.00	2	
H5470	002	0	1	04	01	H5470_002_0	4	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5470	002	0	1	04	01	H5470_002_0	4	2	000011010111000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5470	002	0	1	04	01	H5470_002_0	4	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5470	002	0	1	04	01	H5470_002_0	4	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H5470	002	0	1	04	01	H5470_002_0	4	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H5470	002	0	1	04	01	H5470_002_0	4	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5470	002	0	1	04	01	H5470_002_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5470	002	0	1	04	01	H5470_002_0	4	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H5470	801	0	1	04	01	H5470_801_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5470	801	0	1	04	01	H5470_801_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5470	801	0	1	04	01	H5470_801_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5470	802	0	1	04	01	H5470_802_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5470	802	0	1	04	01	H5470_802_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5470	802	0	1	04	01	H5470_802_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5470	803	0	1	04	01	H5470_803_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5470	803	0	1	04	01	H5470_803_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5470	803	0	1	04	01	H5470_803_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5470	804	0	1	04	01	H5470_804_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5470	804	0	1	04	01	H5470_804_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5470	804	0	1	04	01	H5470_804_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5501	001	0	1	04	01	H5501_001_0	11	2	000000000000000000000000000000000000000000011000	Non-Participating Providers Dental	2				1	0.00	140.00	1	50.00
H5501	001	0	1	04	01	H5501_001_0	11	1	011111111111111111111101111100001111111111100111	Non-Participating Providers Medical	1	20	20	1	2			2	
H5501	001	0	1	04	01	H5501_001_0	11	3	000000000000000000000000000000001000000000000000	Health  Wellness	1	0	100	6	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	7	000000000000000000000000001000000000000000000000	Group 7	1	20	20	6	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	8	000000000000000000000000000100001100000000000000	Group 8	2				1	0.00	0.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	1	010111110110101101101001110001000011111111101111	Group 1	1	30	30	6	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	6	000000000000000000000100000000000000000000000000	Group 6	2				1	150.00	150.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	5	000000000000000010000000000000000000000000000000	Group 5	2				1	20.00	20.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	3	000000001001000000010000000000000000000000000000	Group 3	2				1	35.00	45.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	4	000000000000010000000000000000000000000000000000	Group 4	1	30	30	6	1	10.00	10.00	2	
H5508	001	0	1	04	01	H5508_001_0	4	1	111011110111111111111101111100000000000011101111	Group 1	1	20	20	1	2			2	
H5508	001	0	1	04	01	H5508_001_0	4	2	000100000000000000000000000000001111111100000000	Group 2	2				1	0.00	0.00	2	
H5508	001	0	1	04	01	H5508_001_0	4	3	000000001000000000000000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5508	002	0	1	04	01	H5508_002_0	2	1	111011110111111111111101111100000000000011101111	Group 1	1	20	20	1	2			2	
H5508	002	0	1	04	01	H5508_002_0	2	2	000100000000000000000000000000001111111100000000	Group 2	2				1	0.00	0.00	2	
H5508	002	0	1	04	01	H5508_002_0	2	3	000000001000000000000000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5508	003	0	1	04	01	H5508_003_0	4	1	111011110111111111111101111100000000000011101111	Group 1	1	20	20	1	2			2	
H5508	003	0	1	04	01	H5508_003_0	4	3	000000001000000000000000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5508	003	0	1	04	01	H5508_003_0	4	2	000100000000000000000000000000001111111100000000	Group 2	2				1	0.00	0.00	2	
H5508	801	0	1	04	01	H5508_801_0	3	1	111011110111111111111101111100000000000011101111	Group 1	1	20	20	1	2			2	
H5508	801	0	1	04	01	H5508_801_0	3	2	000100000000000000000000000000001111111100000000	Group 2	2				1	0.00	0.00	2	
H5508	801	0	1	04	01	H5508_801_0	3	3	000000001000000000000000000000000000000000000000	Group 3	1	50	50	1	2			2	
H5509	001	0	1	04	01	H5509_001_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	001	0	1	04	01	H5509_001_0	7	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	001	0	1	04	01	H5509_001_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	003	0	1	04	01	H5509_003_0	6	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	003	0	1	04	01	H5509_003_0	6	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	003	0	1	04	01	H5509_003_0	6	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	004	0	1	04	01	H5509_004_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	004	0	1	04	01	H5509_004_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5509	004	0	1	04	01	H5509_004_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	005	0	1	04	01	H5509_005_0	6	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	005	0	1	04	01	H5509_005_0	6	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	005	0	1	04	01	H5509_005_0	6	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	006	0	1	04	01	H5509_006_0	8	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5509	006	0	1	04	01	H5509_006_0	8	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	006	0	1	04	01	H5509_006_0	8	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	007	0	1	04	01	H5509_007_0	7	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	007	0	1	04	01	H5509_007_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	007	0	1	04	01	H5509_007_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	008	0	1	04	01	H5509_008_0	7	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	008	0	1	04	01	H5509_008_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	008	0	1	04	01	H5509_008_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	009	0	1	04	01	H5509_009_0	9	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	009	0	1	04	01	H5509_009_0	9	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	009	0	1	04	01	H5509_009_0	9	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	010	0	1	04	01	H5509_010_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	010	0	1	04	01	H5509_010_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5509	010	0	1	04	01	H5509_010_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	011	0	1	04	01	H5509_011_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	011	0	1	04	01	H5509_011_0	7	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5509	011	0	1	04	01	H5509_011_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	012	0	1	04	01	H5509_012_0	7	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5509	012	0	1	04	01	H5509_012_0	7	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	012	0	1	04	01	H5509_012_0	7	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	013	0	1	04	01	H5509_013_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5509	013	0	1	04	01	H5509_013_0	6	1	011111111111111111111001111100001111111111101111		1	20	20	2	2			2	
H5509	013	0	1	04	01	H5509_013_0	6	3	100000000000000000000000000000000000000000010010		1	0	0	3	2			2	
H5509	801	0	1	04	01	H5509_801_0	6	1	011011111111111111111101111100001111111111101111		1	23	23	2	2			2	
H5509	801	0	1	04	01	H5509_801_0	6	2	000100000000000000000000000000000000000000000000		1	0	0	3	2			2	
H5509	802	0	1	04	01	H5509_802_0	6	1	011011111111111111111101111100001111111111101111		1	23	23	2	2			2	
H5509	802	0	1	04	01	H5509_802_0	6	2	000100000000000000000000000000000000000000000000		1	0	0	3	2			2	
H5509	803	0	1	04	01	H5509_803_0	6	1	011011111111111111111101111100001111111111101111		1	23	23	2	2			2	
H5509	803	0	1	04	01	H5509_803_0	6	2	000100000000000000000000000000000000000000000000		1	0	0	3	2			2	
H5510	002	0	1	04	01	H5510_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	002	0	1	04	01	H5510_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H5510	002	0	1	04	01	H5510_002_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5510	002	0	1	04	01	H5510_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5510	002	0	1	04	01	H5510_002_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5510	003	0	1	04	01	H5510_003_0	8	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5510	003	0	1	04	01	H5510_003_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	003	0	1	04	01	H5510_003_0	8	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5510	003	0	1	04	01	H5510_003_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5510	003	0	1	04	01	H5510_003_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5510	005	0	1	04	01	H5510_005_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5510	005	0	1	04	01	H5510_005_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5510	005	0	1	04	01	H5510_005_0	8	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5510	005	0	1	04	01	H5510_005_0	8	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5510	005	0	1	04	01	H5510_005_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	006	0	1	04	01	H5510_006_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5510	006	0	1	04	01	H5510_006_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H5510	006	0	1	04	01	H5510_006_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5510	006	0	1	04	01	H5510_006_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5510	006	0	1	04	01	H5510_006_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5510	801	0	1	04	01	H5510_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5510	801	0	1	04	01	H5510_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5510	801	0	1	04	01	H5510_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5510	802	0	1	04	01	H5510_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5510	802	0	1	04	01	H5510_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5510	802	0	1	04	01	H5510_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5510	804	0	1	04	01	H5510_804_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5510	804	0	1	04	01	H5510_804_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5510	804	0	1	04	01	H5510_804_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5512	001	0	1	04	01	H5512_001_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5512	001	0	1	04	01	H5512_001_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5512	001	0	1	04	01	H5512_001_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	001	0	1	04	01	H5512_001_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5512	001	0	1	04	01	H5512_001_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5512	002	0	1	04	01	H5512_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	002	0	1	04	01	H5512_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5512	002	0	1	04	01	H5512_002_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5512	002	0	1	04	01	H5512_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5512	002	0	1	04	01	H5512_002_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5512	008	0	1	04	01	H5512_008_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	008	0	1	04	01	H5512_008_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5512	008	0	1	04	01	H5512_008_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5512	008	0	1	04	01	H5512_008_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5512	008	0	1	04	01	H5512_008_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5512	009	0	1	04	01	H5512_009_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H5512	009	0	1	04	01	H5512_009_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5512	009	0	1	04	01	H5512_009_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5512	009	0	1	04	01	H5512_009_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5512	009	0	1	04	01	H5512_009_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5512	801	0	1	04	01	H5512_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5512	801	0	1	04	01	H5512_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5512	801	0	1	04	01	H5512_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5512	802	0	1	04	01	H5512_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5512	802	0	1	04	01	H5512_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5512	802	0	1	04	01	H5512_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H5516	001	0	1	04	01	H5516_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
H5516	001	0	1	04	01	H5516_001_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H5517	002	0	1	04	01	H5517_002_0	6	1	111111111111111111111101111100001111111111111111	OON Services	1	30	30	2	2			2	
H5517	003	0	1	04	01	H5517_003_0	4	1	111111111111111111111101111100001111111111111111		1	30	30	2	2			2	
H5517	004	0	1	04	01	H5517_004_0	7	1	011111110110111111111111111101001111111111101000	OON Services	1	20	20	1	2			2	
H5517	004	0	1	04	01	H5517_004_0	7	2	000000001001000000000000000000000000000000000000	OON MH Services	1	50	50	1	2			2	
H5517	004	0	1	04	01	H5517_004_0	7	3	100000000000000000000000000000000000000000010111		2				1	0.00	0.00	2	
H5517	005	0	1	04	01	H5517_005_0	5	1	011100000000001111000001101000001000000000100000		1	30	30	2	2			2	
H5517	005	0	1	04	01	H5517_005_0	5	2	000011111111110000111100000000000100000011011101		2				1	25.00	100.00	2	
H5517	005	0	1	04	01	H5517_005_0	5	3	100000000000000000000000010100000011111100000010		2				1	0.00	0.00	2	
H5517	802	0	1	04	01	H5517_802_0	5	1	011111110110111111111101111100001111111111101111		1	20	20	1	2			2	
H5517	802	0	1	04	01	H5517_802_0	5	2	000000001001000000000000000000000000000000000000	oon mental health services	1	50	50	1	2			2	
H5517	804	0	1	04	01	H5517_804_0	5	1	011111110110111111111101111100001111111111101111		1	20	20	1	2			2	
H5517	804	0	1	04	01	H5517_804_0	5	2	000000001001000000000000000000000000000000000000	oon mental health services	1	50	50	1	2			2	
H5517	805	0	1	04	01	H5517_805_0	5	1	011111110110111111111101111100001111111111101111		1	20	20	1	2			2	
H5517	805	0	1	04	01	H5517_805_0	5	2	000000001001000000000000000000000000000000000000	oon mental health services	1	50	50	1	2			2	
H5520	001	0	1	04	01	H5520_001_0	3	2	010000100100100000001000000000000000000000000000	Group 2	2				1	35.00	35.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	13	000000000000000000000000000000000000000000000100	$10 to $10 Group	2				1	10.00	20.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	4	000000000000001100000001101000000000000000100000	Group 4	2				1	30.00	900.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	5	000000000000000000000000000000000000000000010000	Group 5	1	20	20	2	2			1	35.00
H5520	001	0	1	04	01	H5520_001_0	3	6	000000000000000000000000000000000000000000001000	Group 6	2				1	20.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	7	000000000010000000000100000000000000000000000000	Group 7	2				1	25.00	25.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	8	000001000000000000000000000000000000000000000000	Group 8	2				1	15.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	9	000000000000010000000000000000000000000000000000	Group 9	2				1	20.00	900.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	3	000000001001000000010000000000000000000000000000	Group 3	2				1	50.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	12	000000000000000000000000000010000000000000000000	Group 12	2				1	15.00	15.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	11	001100000000000000000000010100001111111111000010	Group 11	2				1	0.00	0.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	10	000000000000000001100000000000000000000000000000	Group 10	2				1	200.00	200.00	2	
H5520	001	0	1	04	01	H5520_001_0	3	1	000010010000000010000000000000001000000000000001	Group 1	2				1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	14	000000000010000000000000000000000000000000000000	$25 group	2				1	25.00	25.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	1	000000000000000001100000000000000000000000000000	Group 1	2				1	200.00	200.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	3	010000100100100000001000000000000000000000000000		2				1	35.00	35.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	4	000000001001000000010000000000000000000000000000		2				1	50.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	5	000000000000010000000000000000000000000000100000		2				1	20.00	900.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	6	001100000000000000000000010100001111111111000010		2				1	0.00	0.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	7	000000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	002	0	1	04	01	H5520_002_0	6	8	000000000000000000000000000000000000000000001000		2				1	20.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	9	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	2	000010010000000010000000000000001000000000000001	$20 Copay group	2				1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	10	000001000000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	11	000000000000001100000001101000000000000000000000		2				1	30.00	900.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	12	000000000000000000000000000010000000000000000000		2				1	15.00	15.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	13	000000000000000000000000000000000000000000000100	$10 to $20 Group	2				1	10.00	20.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	2	010000100100100000001000000000000000000000000000	Group 2	2				1	35.00	35.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	3	000000001001000000010000000000000000000000000000	Group 3	2				1	50.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	4	000000000000001100000001101000000000000000100000	Group 4	2				1	30.00	900.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	5	000000000000000000000000000000000000000000010000	Group 5	1	20	20	2	2			1	35.00
H5520	003	0	1	04	01	H5520_003_0	3	6	000000000000000000000000000000000000000000001000	Group 6	2				1	25.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	7	000000000000000000000100000000000000000000000000	Group 7	2				1	25.00	25.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	1	000010010010000010000000000000001000000000000001	Group 1	2				1	25.00	25.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	9	000000000000010000000000000000000000000000000000	Group 9	2				1	25.00	900.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	13	000000000000000000000000000000000000000000000100	$10 to $25 Group	2				1	10.00	25.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	12	000000000000000000000000000010000000000000000000	Group 12	2				1	15.00	15.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	11	001100000000000000000000010100001111111111000010	Group 11	2				1	0.00	0.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	10	000000000000000001100000000000000000000000000000	Group 10	2				1	200.00	200.00	2	
H5520	003	0	1	04	01	H5520_003_0	3	8	000001000000000000000000000000000000000000000000	Group 8	2				1	15.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	1	000000000000000001100000000000000000000000000000	Group 1	2				1	200.00	200.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	10	000001000000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	11	000000000000010000000000000000000000000000000000		2				1	25.00	900.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	12	000000000000000000000000000010000000000000000000		2				1	15.00	15.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	13	000000000000000000000000000000000000000000000100	$10 to $25 Group	2				1	10.00	25.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	2	000010010010000010000000000000001000000000000001	$25 Copay group	2				1	25.00	25.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	3	010000100100100000001000000000000000000000000000		2				1	35.00	35.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	4	000000001001000000010000000000000000000000000000		2				1	50.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	5	000000000000001100000001101000000000000000100000		2				1	30.00	900.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	6	001100000000000000000000010100001111111111000010		2				1	0.00	0.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	7	000000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	004	0	1	04	01	H5520_004_0	5	8	000000000000000000000000000000000000000000001000		2				1	25.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	5	9	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	10	000000000000000000000000000010000000000000000000		2				1	15.00	15.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	1	000000000000000000000001110000000000000000000000		1	30	30	2	2			2	
H5520	005	0	1	04	01	H5520_005_0	5	9	001000000000000000000000000100001111111111000000		2				1	0.00	0.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	8	000010010000000010000000000000001000000000000001		2				1	30.00	30.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	7	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	12	000000000000000000000000000000000000000000000100	$20 to $30 Group	2				1	20.00	30.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	5	000000000000011100000000001000000000000000100000		2				1	30.00	900.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	4	000000001011000000010000000000000000000000000000		2				1	40.00	40.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	3	010000000100000000001000000000000000000000000000		2				1	35.00	35.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	2	000001000000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	11	000000000000000000000000000000000000000000001000		2				1	30.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	5	6	000100100000100001100000000000000000000000000010		1	40	40	2	2			2	
H5520	006	0	1	04	01	H5520_006_0	4	10	000000000000000000000000000010000000000000000000		2				1	15.00	15.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	1	000000000000000000000001110000000000000000000000		1	30	30	2	2			2	
H5520	006	0	1	04	01	H5520_006_0	4	3	010000000100000000001000000000000000000000000000		2				1	35.00	35.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	9	001000000000000000000000000100001111111111000000		2				1	0.00	0.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	8	000010010000000010000000000000001000000000000101		2				1	30.00	30.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	7	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	6	000100100000100001100000000000000000000000000010		1	40	40	2	2			2	
H5520	006	0	1	04	01	H5520_006_0	4	5	000000000000011100000000001000000000000000100000		2				1	30.00	900.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	11	000000000000000000000000000000000000000000001000		2				1	30.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	2	000001000000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	4	4	000000001011000000010000000000000000000000000000		2				1	40.00	40.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	1	000000000000000001100000000000000000000000000000	Group 1	2				1	200.00	200.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	10	000001000000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	9	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	8	000000000000000000000000000000000000000000001000		2				1	20.00	50.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	7	000000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	007	0	1	04	01	H5520_007_0	5	6	001100000000000000000000010100001111111111000010		2				1	0.00	0.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	5	000000000000001100000001101000000000000000100000		2				1	30.00	900.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	4	000000001001000000010000000000000000000000000000		2				1	50.00	50.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	3	010000100100100000001000000000000000000000000000		2				1	35.00	35.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	2	000010010000000010000000000000001000000000000001	$20 Copay group	2				1	20.00	20.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	14	000000000000010000000000000000000000000000000000		2				1	0.00	900.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	13	000000000000000000000000000000000000000000000100	$10 to $20 Group	2				1	10.00	20.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	12	000000000000000000000000000010000000000000000000		2				1	15.00	15.00	2	
H5520	007	0	1	04	01	H5520_007_0	5	11	000000000010000000000000000000000000000000000000		2				1	25.00	25.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	8	000000000000000000000000000000000000000000001000		2				1	25.00	50.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	7	000000000000000000000000000000000000000000010000		1	20	20	2	2			1	35.00
H5520	008	0	1	04	01	H5520_008_0	5	6	001100000000000000000000010100001111111111000010		2				1	0.00	0.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	5	000000000000001100000001101000000000000000100000		2				1	30.00	900.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	4	000000001001000000010000000000000000000000000000		2				1	50.00	50.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	3	010000100100100000001000000000000000000000000000		2				1	35.00	35.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	9	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	13	000000000000000000000000000000000000000000000100	$10 to $25 Group	2				1	10.00	25.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	12	000000000000000000000000000010000000000000000000		2				1	15.00	15.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	11	000000000000010000000000000000000000000000000000		2				1	0.00	900.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	10	000001000000000000000000000000000000000000000000		2				1	15.00	50.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	1	000000000000000001100000000000000000000000000000	Group 1	2				1	200.00	200.00	2	
H5520	008	0	1	04	01	H5520_008_0	5	2	000010010010000010000000000000001000000000000001	$25 Copay group	2				1	25.00	25.00	2	
H5521	005	0	1	04	01	H5521_005_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	005	0	1	04	01	H5521_005_0	8	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5521	005	0	1	04	01	H5521_005_0	8	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5521	005	0	1	04	01	H5521_005_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5521	005	0	1	04	01	H5521_005_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5521	006	0	1	04	01	H5521_006_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H5521	006	0	1	04	01	H5521_006_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	006	0	1	04	01	H5521_006_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5521	006	0	1	04	01	H5521_006_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5521	006	0	1	04	01	H5521_006_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5521	008	0	1	04	01	H5521_008_0	7	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	008	0	1	04	01	H5521_008_0	7	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5521	008	0	1	04	01	H5521_008_0	7	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5521	008	0	1	04	01	H5521_008_0	7	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5521	008	0	1	04	01	H5521_008_0	7	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5521	009	0	1	04	01	H5521_009_0	8	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H5521	009	0	1	04	01	H5521_009_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	009	0	1	04	01	H5521_009_0	8	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5521	009	0	1	04	01	H5521_009_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5521	009	0	1	04	01	H5521_009_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5521	011	0	1	04	01	H5521_011_0	9	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5521	011	0	1	04	01	H5521_011_0	9	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	011	0	1	04	01	H5521_011_0	9	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5521	011	0	1	04	01	H5521_011_0	9	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5521	011	0	1	04	01	H5521_011_0	9	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5521	012	0	1	04	01	H5521_012_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5521	012	0	1	04	01	H5521_012_0	8	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5521	012	0	1	04	01	H5521_012_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5521	012	0	1	04	01	H5521_012_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5521	012	0	1	04	01	H5521_012_0	8	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
H5521	801	0	1	04	01	H5521_801_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5521	801	0	1	04	01	H5521_801_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5521	801	0	1	04	01	H5521_801_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5521	802	0	1	04	01	H5521_802_0	3	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5521	802	0	1	04	01	H5521_802_0	3	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5521	802	0	1	04	01	H5521_802_0	3	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5521	804	0	1	04	01	H5521_804_0	2	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5521	804	0	1	04	01	H5521_804_0	2	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5521	804	0	1	04	01	H5521_804_0	2	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5522	001	0	1	04	01	H5522_001_0	8	1	010111110110111111101101111100000111111111101111	20% Coinsurance OON	1	20	20	1	2			2	
H5522	001	0	1	04	01	H5522_001_0	8	2	101000001001000000010000000000001000000000000000	50% Coinsurance OON	1	50	50	1	2			2	
H5522	002	0	1	04	01	H5522_002_0	7	1	010111110110111111101101111100000111111111101111	20% OON Services	1	20	20	1	2			2	
H5522	002	0	1	04	01	H5522_002_0	7	2	101000001001000000010000000000001000000000000000	50%  OON SERVICES	1	50	50	1	2			2	
H5522	003	0	1	04	01	H5522_003_0	7	1	010111110110111111101101111100000111111111101111	20% Coinsurance OON	1	20	20	1	2			2	
H5522	003	0	1	04	01	H5522_003_0	7	2	101000001001000000010000000000001000000000000000	50% Coinsurance OON	1	50	50	1	2			2	
H5522	004	0	1	04	01	H5522_004_0	5	1	010111110110111111101101111100000111111111101111	20% Coinsurance	1	20	20	1	2			2	
H5522	004	0	1	04	01	H5522_004_0	5	2	101000001001000000010000000000001000000000000000	50% Coinsurance	1	50	50	1	2			2	
H5522	005	0	1	04	01	H5522_005_0	5	1	010111110110111111101101111100000111111111101111	20% Coinsurance OON	1	20	20	1	2			2	
H5522	005	0	1	04	01	H5522_005_0	5	2	101000001001000000010000000000001000000000000000	50% Coinsurance OON	1	50	50	1	2			2	
H5522	006	0	1	04	01	H5522_006_0	7	1	010111110110111111101101111100000111111111101111	20% OON Services	1	20	20	1	2			2	
H5522	006	0	1	04	01	H5522_006_0	7	2	101000001001000000010000000000001000000000000000	50%  OON SERVICES	1	50	50	1	2			2	
H5522	006	0	1	04	01	H5522_006_0	7	3	000000000000000000000000000000000000000000010000	Non Medicare Covered Dental	1	0	50	1	2			1	25.00
H5522	006	0	1	04	01	H5522_006_0	7	4	000000000000000000000000000001000000000000000000	Non Medicare Covered Services	1	0	0	1	2			2	
H5522	802	0	1	04	01	H5522_802_0	4	1	011111111111111111111101111100001111111111101111	OON Services	1	23	23	1	2			2	
H5522	803	0	1	04	01	H5522_803_0	4	1	011111111111111111111101111100001111111111101111	OON Services	1	23	23	1	2			2	
H5522	805	0	1	04	01	H5522_805_0	3	1	011111111111111111111101111100001111111111101111	OON Services	1	23	23	1	2			2	
H5523	001	0	1	04	01	H5523_001_0	20	1	001111010110011111101111110100001111111111101010	30% Coinsurance	1	30	30	1	2			2	
H5523	001	0	1	04	01	H5523_001_0	20	2	000000001001000000010000000000000000000000000000	50% Coinsurance	1	50	50	1	2			2	
H5523	001	0	1	04	01	H5523_001_0	20	5	000000000000000000000000000000000000000000000001	$10 co-pay	2				1	10.00	10.00	2	
H5523	001	0	1	04	01	H5523_001_0	20	4	000000000000000000000000001000000000000000000000	100% Covered	2				2			2	
H5523	001	0	1	04	01	H5523_001_0	20	3	010000100000100000000000000000000000000000000100	$15 co-payment	2				1	15.00	15.00	2	
H5525	001	0	1	04	01	H5525_001_0	4	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5525	001	0	1	04	01	H5525_001_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H5525	001	0	1	04	01	H5525_001_0	4	8	000000100010111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H5525	001	0	1	04	01	H5525_001_0	4	7	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H5525	001	0	1	04	01	H5525_001_0	4	6	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5525	001	0	1	04	01	H5525_001_0	4	5	000011011101000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5525	001	0	1	04	01	H5525_001_0	4	4	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H5525	001	0	1	04	01	H5525_001_0	4	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5525	002	0	1	04	01	H5525_002_0	3	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5525	002	0	1	04	01	H5525_002_0	3	7	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H5525	002	0	1	04	01	H5525_002_0	3	6	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5525	002	0	1	04	01	H5525_002_0	3	5	000011011101000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5525	002	0	1	04	01	H5525_002_0	3	4	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H5525	002	0	1	04	01	H5525_002_0	3	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5525	002	0	1	04	01	H5525_002_0	3	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H5525	002	0	1	04	01	H5525_002_0	3	8	000000100010111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5525	004	0	1	04	01	H5525_004_0	5	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	8	000000100010111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	7	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H5525	004	0	1	04	01	H5525_004_0	5	6	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5525	004	0	1	04	01	H5525_004_0	5	5	000011011101000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	4	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H5525	004	0	1	04	01	H5525_004_0	5	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5525	801	0	1	04	01	H5525_801_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H5525	801	0	1	04	01	H5525_801_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H5525	801	0	1	04	01	H5525_801_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H5525	802	0	1	04	01	H5525_802_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H5525	802	0	1	04	01	H5525_802_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H5525	802	0	1	04	01	H5525_802_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H5525	805	0	1	04	01	H5525_805_0	4	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H5525	805	0	1	04	01	H5525_805_0	4	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H5525	805	0	1	04	01	H5525_805_0	4	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H5525	808	0	1	04	01	H5525_808_0	3	1	011011110110101111101101111100001111111111101111	Group #1	1	20	20	6	2			2	
H5525	808	0	1	04	01	H5525_808_0	3	3	000100000000010000000000000000000000000000000000	Group #3	1	0	20	6	2			2	
H5525	808	0	1	04	01	H5525_808_0	3	2	000000001001000000010000000000000000000000000000	Group #2	1	50	50	6	2			2	
H5526	001	0	1	04	01	H5526_001_0	8	1	000000000000000001100000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	20	20	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	8	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	8	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	001	0	1	04	01	H5526_001_0	8	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	001	0	1	04	01	H5526_001_0	8	5	010111110110111110001000001100000111111111000101	Primary Care/Specialist Services	2				1	25.00	25.00	2	
H5526	001	0	1	04	01	H5526_001_0	8	6	000000000000000000000010000010001000000000001010	Comp Dental/Health Ed/Eye Wear	2				2			2	
H5526	001	0	1	04	01	H5526_001_0	8	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	7	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	7	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	7	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	002	0	1	04	01	H5526_002_0	7	1	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	7	9	000000000000000001100000000000000000000000000000	Outpatient Surgery/ASC Services	2				1	75.00	75.00	2	
H5526	002	0	1	04	01	H5526_002_0	7	6	000000000000000000000010000000101000000000011010	Comp Dental/HealthEd/EyeWear	2				2			2	
H5526	002	0	1	04	01	H5526_002_0	7	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	002	0	1	04	01	H5526_002_0	7	8	000010000000000000000000000000000010000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	002	0	1	04	01	H5526_002_0	7	5	010101110110111110001000001100000101111111000101	Specialist Services	2				1	25.00	25.00	2	
H5526	003	0	1	04	01	H5526_003_0	10	5	010111110110111110001000001100000111111111000101	Primary Care/Specialist Services	2				1	25.00	25.00	2	
H5526	003	0	1	04	01	H5526_003_0	10	6	000000000000000000000010000000101000000000011010	Comp Dental/Health Ed/Eye Wear	2				2			2	
H5526	003	0	1	04	01	H5526_003_0	10	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	003	0	1	04	01	H5526_003_0	10	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	003	0	1	04	01	H5526_003_0	10	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	003	0	1	04	01	H5526_003_0	10	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	003	0	1	04	01	H5526_003_0	10	1	000000000000000001100000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	20	20	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	1	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	6	000000000000000000000010000000101000000000011010	Comp Dental/HealthEd/EyeWear	2				2			2	
H5526	004	0	1	04	01	H5526_004_0	9	8	000010000000000000000000000000000010000000000000	Primary Care Services	2				1	15.00	15.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	5	010101110110111110001000001100000101111111000101	Specialist Services	2				1	20.00	20.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	9	000000000000000001100000000000000000000000000000	Outpatient Surgery/ASC Services	2				1	75.00	75.00	2	
H5526	007	0	1	04	01	H5526_007_0	7	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	7	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	7	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	007	0	1	04	01	H5526_007_0	7	1	000000000000000001100000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	20	20	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	7	8	000010000000000000000000000000000110000000000000	Primary	2				1	20.00	20.00	2	
H5526	007	0	1	04	01	H5526_007_0	7	5	010101110110111110001000001100000001111111000101	Primary Care/Specialist Services	2				1	30.00	30.00	2	
H5526	007	0	1	04	01	H5526_007_0	7	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	007	0	1	04	01	H5526_007_0	7	6	000000000000000000000010000000101000000000011010	Comp Dental/Health Ed/Eye Wear	2				2			2	
H5526	008	0	1	04	01	H5526_008_0	9	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	35	35	1	2			2	
H5526	008	0	1	04	01	H5526_008_0	9	5	010111110110111110001000001100000111111111000101	Primary Care/Specialist Services	2				1	10.00	10.00	2	
H5526	008	0	1	04	01	H5526_008_0	9	6	000000000000000000000010000000101000000000001010	Comp Dental/Health Ed/Eye Wear	2				2			2	
H5526	008	0	1	04	01	H5526_008_0	9	1	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	1	2			2	
H5526	008	0	1	04	01	H5526_008_0	9	2	000000000000000001100100000000000000000000000000	Ambulance/Outpatient Surgery/ASC	2				1	50.00	50.00	2	
H5526	008	0	1	04	01	H5526_008_0	9	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	008	0	1	04	01	H5526_008_0	9	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	010	0	1	04	01	H5526_010_0	7	5	010101110110111110001000001000000101111111001101	Specialist Services	2				1	25.00	25.00	2	
H5526	010	0	1	04	01	H5526_010_0	7	6	100000000000000000000010000110101000000000011010	Outpatient Blood/Comprehensive Dental	2				2			2	
H5526	010	0	1	04	01	H5526_010_0	7	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	30	30	1	2			2	
H5526	010	0	1	04	01	H5526_010_0	7	8	000010000000000000000000000000000010000000000000	Primary Care	2				1	15.00	15.00	2	
H5526	010	0	1	04	01	H5526_010_0	7	1	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	1	2			2	
H5526	010	0	1	04	01	H5526_010_0	7	2	000000000000000001100100000000000000000000000000	Ambulance	2				1	50.00	50.00	2	
H5526	010	0	1	04	01	H5526_010_0	7	3	001000001000000000010000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	010	0	1	04	01	H5526_010_0	7	4	000000000001000000000000000000000000000000000000	Mental Health Psychiatric	1	50	50	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	8	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	8	6	000000000000000000000000000000001000000000001010	Comprehensive Dental	2				2			2	
H5526	801	0	1	04	01	H5526_801_0	8	5	000001110110111110000000000100000001111111000101	Specialist Services	2				1	45.00	45.00	2	
H5526	801	0	1	04	01	H5526_801_0	8	4	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	25	25	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	8	1	000000000000000000000000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	30	30	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	8	8	000110000000000000000000001000000110000000000000	Primary Care	2				1	30.00	30.00	2	
H5526	801	0	1	04	01	H5526_801_0	8	3	011000001001000000011000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	801	0	1	04	01	H5526_801_0	8	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5526	802	0	1	04	01	H5526_802_0	8	1	000000000000000000000000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	30	30	1	2			2	
H5526	802	0	1	04	01	H5526_802_0	8	4	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	25	25	1	2			2	
H5526	802	0	1	04	01	H5526_802_0	8	5	000001110110111110000000000100000001111111000101	Specialist Services	2				1	45.00	45.00	2	
H5526	802	0	1	04	01	H5526_802_0	8	6	000000000000000000000000000000001000000000001010	Comprehensive Dental	2				2			2	
H5526	802	0	1	04	01	H5526_802_0	8	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	802	0	1	04	01	H5526_802_0	8	8	000110000000000000000000001000000110000000000000	Primary Care	2				1	30.00	30.00	2	
H5526	802	0	1	04	01	H5526_802_0	8	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5526	802	0	1	04	01	H5526_802_0	8	3	011000001001000000011000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	8	4	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	25	25	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	8	3	011000001001000000011000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	8	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5526	803	0	1	04	01	H5526_803_0	8	1	000000000000000000000000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	30	30	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	8	5	000001110110111110000000000100000001111111000101	Specialist Services	2				1	45.00	45.00	2	
H5526	803	0	1	04	01	H5526_803_0	8	6	000000000000000000000000000000001000000000001010	Comprehensive Dental	2				2			2	
H5526	803	0	1	04	01	H5526_803_0	8	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	803	0	1	04	01	H5526_803_0	8	8	000110000000000000000000001000000110000000000000	Primary Care	2				1	30.00	30.00	2	
H5526	804	0	1	04	01	H5526_804_0	8	4	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	25	25	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	8	3	011000001001000000011000000000000000000000000000	Mental Health/Substance Abuse	1	55	55	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	8	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H5526	804	0	1	04	01	H5526_804_0	8	1	000000000000000000000000000000000000000000100000	Part B Drugs/Outpatient Surgery	1	30	30	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	8	5	000001110110111110000000000100000001111111000101	Specialist Services	2				1	45.00	45.00	2	
H5526	804	0	1	04	01	H5526_804_0	8	8	000110000000000000000000001000000110000000000000	Primary Care	2				1	30.00	30.00	2	
H5526	804	0	1	04	01	H5526_804_0	8	7	000000000000000000000001110000000000000000000000	DME/Prosthetics	1	50	50	1	2			2	
H5526	804	0	1	04	01	H5526_804_0	8	6	000000000000000000000000000000001000000000001010	Comprehensive Dental	2				2			2	
H5528	001	0	1	04	01	H5528_001_0	2	1	000010010010011111100100000100000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	001	0	1	04	01	H5528_001_0	2	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	001	0	1	04	01	H5528_001_0	2	3	011000101001100000011001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	001	0	1	04	01	H5528_001_0	2	4	000000000000000000000000001000001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	001	0	1	04	01	H5528_001_0	2	5	000000000000000000000000000001000000000000000000	OTC Benefit	2				1	0.00	0.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	1	000010010010011111100100000100000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	002	0	1	04	01	H5528_002_0	4	4	000000000000000000000000001000001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	3	011000101001100000011001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	002	0	1	04	01	H5528_002_0	4	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	5	100000000000000000000000000000000000000000000000	$600 Maximum Benefit	2				1	0.00	0.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	4	000000000000000000000000001000001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	1	000010010010011111100100000100000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	003	0	1	04	01	H5528_003_0	4	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	3	011000101001100000011001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	004	0	1	04	01	H5528_004_0	2	1	000010010010011111100100000100000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	004	0	1	04	01	H5528_004_0	2	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	004	0	1	04	01	H5528_004_0	2	3	011000101001100000011001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	004	0	1	04	01	H5528_004_0	2	4	000000000000000000000000001000001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	004	0	1	04	01	H5528_004_0	2	5	100000000000000000000000000000000000000000000000	$500 Maximum Benefit	2				1	0.00	0.00	2	
H5528	005	0	1	04	01	H5528_005_0	3	1	000010010010011111100100000100000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	005	0	1	04	01	H5528_005_0	3	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	005	0	1	04	01	H5528_005_0	3	4	000000000000000000000000001000001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	005	0	1	04	01	H5528_005_0	3	3	011000101001100000011001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	008	0	1	04	01	H5528_008_0	4	1	000010010010011111100100000100000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	008	0	1	04	01	H5528_008_0	4	3	011000101001100000011001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	008	0	1	04	01	H5528_008_0	4	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	008	0	1	04	01	H5528_008_0	4	4	000000000000000000000000001000001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	1	000010010010000000000100000000000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	6	000000000000000100000000000000000000000000000000	$20 Cost Sharing	2				1	20.00	20.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	5	000000000000011011100000001100001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	4	011000100000100000001000000000000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	3	000000001001000000010001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	010	0	1	04	01	H5528_010_0	3	1	000010010010000000000100000000000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	010	0	1	04	01	H5528_010_0	3	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	010	0	1	04	01	H5528_010_0	3	3	000000001001000000010001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	010	0	1	04	01	H5528_010_0	3	4	011000100000100100001000000000000000000000000000	$20 Cost Sharing	2				1	20.00	20.00	2	
H5528	010	0	1	04	01	H5528_010_0	3	5	000000000000011011100000001100001000000000000000	$0 - $50 Cost Sharing	2				1	0.00	50.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	4	011000100000100100001000000000000000000000000000	$20 Cost Sharing	2				1	20.00	20.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	3	000000001001000000010001110000000000000000110110	50% Cost Sharing	1	50	50	1	2			2	
H5528	011	0	1	04	01	H5528_011_0	4	2	000101000100000000000000000000000000000000000001	$40 Cost Sharing	2				1	40.00	40.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	1	000010010010000000000100000000000111111111001000	25% Cost Sharing	1	25	25	1	2			2	
H5528	011	0	1	04	01	H5528_011_0	4	5	000000000000011011100000001100001000000000000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	012	0	1	04	01	H5528_012_0	4	1	100110000000011111100101111100001111111111101111	$0 Cost Sharing Group	2				1	0.00	0.00	2	
H5528	012	0	1	04	01	H5528_012_0	4	2	010000110110100000001000000000000000000000000000	$0 - $10 Cost Sharing	2				1	0.00	10.00	2	
H5528	012	0	1	04	01	H5528_012_0	4	4	000001000000000000000000000000000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	012	0	1	04	01	H5528_012_0	4	3	001000001001000000010000000000000000000000000000	$0 - $20 Cost Sharing	2				1	0.00	20.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	1	100110000000011111100101111100001111111111101111	$0 Cost Sharing Group	2				1	0.00	0.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	2	010000110110100000001000000000000000000000000000	$0 - $10 Cost Sharing	2				1	0.00	10.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	3	001000001001000000010000000000000000000000000000	$0 - $20 Cost Sharing	2				1	0.00	20.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	4	000001000000000000000000000000000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	4	000001000000000000000000000000000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	3	001000001001000000010000000000000000000000000000	$0 - $20 Cost Sharing	2				1	0.00	20.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	1	100110000000011111100101111100001111111111101111	$0 Cost Sharing Group	2				1	0.00	0.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	2	010000110110100000001000000000000000000000000000	$0 - $10 Cost Sharing	2				1	0.00	10.00	2	
H5528	015	0	1	04	01	H5528_015_0	4	5	000010000000011010000000000100000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	015	0	1	04	01	H5528_015_0	4	4	000000000000000001100000001000001010000001000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	015	0	1	04	01	H5528_015_0	4	3	000000000000000000000000000000000000000000010110	50% Cost Sharing	1	50	50	1	2			2	
H5528	015	0	1	04	01	H5528_015_0	4	2	000000010010000000000000000000000000000000001001	$20 Cost Sharing	2				1	20.00	20.00	2	
H5528	015	0	1	04	01	H5528_015_0	4	1	011101101101100100011101110000000101111110100000	20% Cost Sharing	1	20	20	1	2			2	
H5528	016	0	1	04	01	H5528_016_0	4	5	000000010010000000000000000000000000000000001001	$20 Cost Sharing	2				1	20.00	20.00	2	
H5528	016	0	1	04	01	H5528_016_0	4	4	000000000000000001100000001000001010000001000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	016	0	1	04	01	H5528_016_0	4	1	011101101101100100011101110000000101111110100000	20% Cost Sharing	1	20	20	1	2			2	
H5528	016	0	1	04	01	H5528_016_0	4	2	000010000000011010000000000100000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	016	0	1	04	01	H5528_016_0	4	3	000000000000000000000000000000000000000000010110	50% Cost Sharing	1	50	50	1	2			2	
H5528	017	0	1	04	01	H5528_017_0	4	3	011010100000100000001000000000000000000000000000	$10 Cost Sharing	2				1	10.00	10.00	2	
H5528	017	0	1	04	01	H5528_017_0	4	1	000000000000011011100000001100001010000001000000	$0 Cost Sharing	2				1	0.00	0.00	2	
H5528	017	0	1	04	01	H5528_017_0	4	5	000000000000000000000000000000000000000000010110	50% Cost Sharing	1	50	50	1	2			2	
H5528	017	0	1	04	01	H5528_017_0	4	4	000000010010000100000000000000000000000000001001	$20 Cost Sharing	2				1	20.00	20.00	2	
H5528	017	0	1	04	01	H5528_017_0	4	2	000101001101000000010101110000000101111110100000	20% Cost Sharing	1	20	20	1	2			2	
H5528	802	0	1	04	01	H5528_802_0	3	1	011011110110101111111101111100001111111111101111	20% Coinsurance Group	1	20	20	1	2			2	
H5528	802	0	1	04	01	H5528_802_0	3	2	000000001001000000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	802	0	1	04	01	H5528_802_0	3	3	000100000000010000000000000000000000000000000000	0% Coinsurance Group	1	0	0	1	2			2	
H5528	804	0	1	04	01	H5528_804_0	3	2	000000001001000000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	804	0	1	04	01	H5528_804_0	3	1	011011110110101111111101111100001111111111101111	20% Coinsurance Group	1	20	20	1	2			2	
H5528	804	0	1	04	01	H5528_804_0	3	3	000100000000010000000000000000000000000000000000	0% Coinsurance Group	1	0	0	1	2			2	
H5528	806	0	1	04	01	H5528_806_0	3	3	000100000000010000000000000000000000000000000000	0% Coinsurance Group	1	0	0	1	2			2	
H5528	806	0	1	04	01	H5528_806_0	3	1	011011110110101111111101111100001111111111101111	20% Coinsurance Group	1	20	20	1	2			2	
H5528	806	0	1	04	01	H5528_806_0	3	2	000000001001000000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	807	0	1	04	01	H5528_807_0	3	1	011011110110101111111101111100001111111111101111	20% Coinsurance Group	1	20	20	1	2			2	
H5528	807	0	1	04	01	H5528_807_0	3	2	000000001001000000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	807	0	1	04	01	H5528_807_0	3	3	000100000000010000000000000000000000000000000000	0% Coinsurance Group	1	0	0	1	2			2	
H5528	809	0	1	04	01	H5528_809_0	2	1	011011110110101111111101111100001111111111101111	20% Coinsurance Group	1	20	20	1	2			2	
H5528	809	0	1	04	01	H5528_809_0	2	2	000000001001000000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	809	0	1	04	01	H5528_809_0	2	3	000100000000010000000000000000000000000000000000	0% Coinsurance Group	1	0	0	1	2			2	
H5528	810	0	1	04	01	H5528_810_0	2	1	011011110110101111111101111100001111111111101111	20% Coinsurance Group	1	20	20	1	2			2	
H5528	810	0	1	04	01	H5528_810_0	2	2	000000001001000000000000000000000000000000000000	50% Coinsurance Group	1	50	50	1	2			2	
H5528	810	0	1	04	01	H5528_810_0	2	3	000100000000010000000000000000000000000000000000	0% Coinsurance Group	1	0	0	1	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	10	000100000010000001001000000100001111110100000000	OON No Copayment	2				1	0.00	0.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	11	000000000000000000000000000000000000000000001000	OON $0 Copayment Comprehensive Dental	2				1	0.00	0.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	13	000000000000000000000000000000000000000000010000	OON Preventive Dental	1	50	50	6	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	9	000000000000000000000100000000000000000000000000	OON Ambulance	2				1	100.00	100.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	10	000100000010000001001000000100001111110100000000	OON No Copayment	2				1	0.00	0.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	11	000000000000000000000000000000000000000000001000	OON $0 Copayment Comprehensive Dental	2				1	0.00	0.00	2	
H5531	001	0	1	04	01	H5531_001_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	001	0	1	04	01	H5531_001_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	35	35	6	2			2	
H5531	001	0	1	04	01	H5531_001_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	001	0	1	04	01	H5531_001_0	6	5	100000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5531	001	0	1	04	01	H5531_001_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5531	002	0	1	04	01	H5531_002_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	002	0	1	04	01	H5531_002_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	002	0	1	04	01	H5531_002_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	002	0	1	04	01	H5531_002_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5531	002	0	1	04	01	H5531_002_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	003	0	1	04	01	H5531_003_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	003	0	1	04	01	H5531_003_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	003	0	1	04	01	H5531_003_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	10.00	10.00	2	
H5531	003	0	1	04	01	H5531_003_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	003	0	1	04	01	H5531_003_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	004	0	1	04	01	H5531_004_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	004	0	1	04	01	H5531_004_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	10.00	10.00	2	
H5531	004	0	1	04	01	H5531_004_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	004	0	1	04	01	H5531_004_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	004	0	1	04	01	H5531_004_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	005	0	1	04	01	H5531_005_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	005	0	1	04	01	H5531_005_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	005	0	1	04	01	H5531_005_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	005	0	1	04	01	H5531_005_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5531	005	0	1	04	01	H5531_005_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	006	0	1	04	01	H5531_006_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	006	0	1	04	01	H5531_006_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	006	0	1	04	01	H5531_006_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	006	0	1	04	01	H5531_006_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	006	0	1	04	01	H5531_006_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5531	007	0	1	04	01	H5531_007_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	007	0	1	04	01	H5531_007_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	007	0	1	04	01	H5531_007_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5531	007	0	1	04	01	H5531_007_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	007	0	1	04	01	H5531_007_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	008	0	1	04	01	H5531_008_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	008	0	1	04	01	H5531_008_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	008	0	1	04	01	H5531_008_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	008	0	1	04	01	H5531_008_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	20.00	20.00	2	
H5531	008	0	1	04	01	H5531_008_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	009	0	1	04	01	H5531_009_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	009	0	1	04	01	H5531_009_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	009	0	1	04	01	H5531_009_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	009	0	1	04	01	H5531_009_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5531	009	0	1	04	01	H5531_009_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	010	0	1	04	01	H5531_010_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H5531	010	0	1	04	01	H5531_010_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H5531	010	0	1	04	01	H5531_010_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
H5531	010	0	1	04	01	H5531_010_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H5531	010	0	1	04	01	H5531_010_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H5531	801	0	1	04	01	H5531_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5531	801	0	1	04	01	H5531_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5531	801	0	1	04	01	H5531_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5531	802	0	1	04	01	H5531_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H5531	802	0	1	04	01	H5531_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H5531	802	0	1	04	01	H5531_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	4	000010000010000010000000000000000010000000000000	Group 4	2				1	20.00	20.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
H5533	002	0	1	04	01	H5533_002_0	5	2	011111111111111111111100011100000011111111101001	20% Coinsurance	1	20	20	2	2			2	
H5533	002	0	1	04	01	H5533_002_0	5	3	100000000000000000000001100000001000000000000110	50% Coinsurance	1	50	50	2	2			2	
H5533	002	0	1	04	01	H5533_002_0	5	1	000000000000000000000000000000000100000000000000	No OON Cost Sharing Group	2				1	0.00	0.00	2	
H5533	801	0	1	04	01	H5533_801_0	3	2	011111111111111111111100011100000011111111101001	20% Group	1	20	20	2	2			2	
H5533	801	0	1	04	01	H5533_801_0	3	1	000000000000000000000000000000000100000000000000	No OON Cost Share Group	2				1	0.00	0.00	2	
H5533	801	0	1	04	01	H5533_801_0	3	3	100000000000000000000001100000001000000000010110	50% Group	1	50	50	2	2			2	
H5533	802	0	1	04	01	H5533_802_0	3	3	100000000000000000000001100000001000000000010110	50% Group	1	50	50	2	2			2	
H5533	802	0	1	04	01	H5533_802_0	3	2	011111111111111111111100011100000011111111101001	20% Group	1	20	20	2	2			2	
H5533	802	0	1	04	01	H5533_802_0	3	1	000000000000000000000000000000000100000000000000	No OON Cost Share Group	2				1	0.00	0.00	2	
H5533	803	0	1	04	01	H5533_803_0	3	1	000000000000000000000000000000000100000000000000	No OON Cost Share Group	2				1	0.00	0.00	2	
H5533	803	0	1	04	01	H5533_803_0	3	2	011111111111111111111100011100000011111111101001	20% Group	1	20	20	2	2			2	
H5533	803	0	1	04	01	H5533_803_0	3	3	100000000000000000000001100000001000000000010110	50% Group	1	50	50	2	2			2	
H5606	001	0	1	38	05	H5606_001_0	3	1	000000000000000000000000001000000000000000000000	Renal Dialysis	1	20	35	1	2			2	
H5839	001	0	1	09	04	H5839_001_0	4	1	000000000000000001000000000000000000000000000000	Outpatient Hospital	1	20	20	6	2			2	
H5839	001	0	1	09	04	H5839_001_0	4	2	111111111111111110111111111111111111111111111111	All Other Services	2				2			2	
H5868	001	0	1	04	01	H5868_001_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5868	001	0	1	04	01	H5868_001_0	4	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5868	001	0	1	04	01	H5868_001_0	4	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H5868	001	0	1	04	01	H5868_001_0	4	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H5868	001	0	1	04	01	H5868_001_0	4	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5868	001	0	1	04	01	H5868_001_0	4	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H5868	001	0	1	04	01	H5868_001_0	4	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5868	001	0	1	04	01	H5868_001_0	4	2	000011010111000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5868	003	0	1	04	01	H5868_003_0	3	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
H5868	003	0	1	04	01	H5868_003_0	3	2	000011010111000000000000000000000111100000001101		2				1	35.00	35.00	2	
H5868	003	0	1	04	01	H5868_003_0	3	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H5868	003	0	1	04	01	H5868_003_0	3	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H5868	003	0	1	04	01	H5868_003_0	3	7	000000000000000000000000001000000000000000000000		1	0	20	6	2			2	
H5868	003	0	1	04	01	H5868_003_0	3	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H5868	003	0	1	04	01	H5868_003_0	3	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H5868	003	0	1	04	01	H5868_003_0	3	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
H5868	801	0	1	04	01	H5868_801_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5868	801	0	1	04	01	H5868_801_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5868	801	0	1	04	01	H5868_801_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5868	802	0	1	04	01	H5868_802_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5868	802	0	1	04	01	H5868_802_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5868	802	0	1	04	01	H5868_802_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5868	803	0	1	04	01	H5868_803_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5868	803	0	1	04	01	H5868_803_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5868	803	0	1	04	01	H5868_803_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5868	804	0	1	04	01	H5868_804_0	4	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H5868	804	0	1	04	01	H5868_804_0	4	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H5868	804	0	1	04	01	H5868_804_0	4	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H5909	001	0	1	38	05	H5909_001_0	2	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5909	005	0	1	38	05	H5909_005_0	2	1	000000000000000000000000001000000000000000000000	End-Stage Renal Disease	1	20	35	6	2			2	
H5962	001	0	1	38	05	H5962_001_0	3	1	000000000000000000000000001000000000000000000000	Renal Dialysis	1	20	35	1	2			2	
H6328	001	0	1	04	01	H6328_001_0	10	3	000000001001000000010000001000000000000000000000	$50 Copayment	2				1	50.00	50.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	2	010101110100100000001000000000000111111100000101	$30 Copayment	2				1	30.00	30.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	11	000000000000000000000000000100000000000000000000	$0 Copayment	2				1	0.00	0.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	10	100000000010000000000010000011111000000000011010	Not Covered	2				2			2	
H6328	001	0	1	04	01	H6328_001_0	10	6	000000000000000100000001100000000000000000100000	30% Coinsurance	1	30	30	1	2			2	
H6328	001	0	1	04	01	H6328_001_0	10	1	000000000000010010000000000000000000000000000000	$10 to $100 Copayment	2				1	10.00	200.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	9	000000000000000000000000010000000000000011000000	20% Coinsurance	1	20	20	1	2			2	
H6328	001	0	1	04	01	H6328_001_0	10	8	000010000000000000000000000000000000000000000000	$15 Copayment	2				1	15.00	15.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	4	000000000000000001000000000000000000000000000000	$150 Copayment	2				1	150.00	150.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	7	000000000000001000000000000000000000000000000000	$200 Copayment	2				1	200.00	200.00	2	
H6328	001	0	1	04	01	H6328_001_0	10	5	001000000000000000100100000000000000000000000000	$100 Copayment	2				1	100.00	100.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	7	000000100000100000000000000000000000000000000000	$30 Copayment	2				1	30.00	30.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	8	000000000000000000000000001000000000000000000000	$50 Copayment	2				1	50.00	50.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	9	000000001001000000010000000000000000000000000000	$60 Copayment	2				1	60.00	60.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	6	000001000000000000000000000000000000000000000000	$25 Copayment	2				1	25.00	25.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	4	000000000000000000000000000100000000000000000000	$0 Copayment	2				2			2	
H6328	002	0	1	04	01	H6328_002_0	8	5	100000000000000000000010000011111000000000011011	Not Covered	2				2			2	
H6328	002	0	1	04	01	H6328_002_0	8	3	000000000000000000000000000000000010000000000101	$35 Copayment	2				1	35.00	35.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	2	000000000000000100000001100000000000000000100000	30% Coinsurance	1	30	30	1	2			2	
H6328	002	0	1	04	01	H6328_002_0	8	10	000000000000001000000000000000000000000000000000	$200 Copayment	2				1	200.00	200.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	1	011110010110010111101100010100000111111111000000	20% Coinsurance	1	20	20	1	2			2	
H6411	002	0	1	04	01	H6411_002_0	4	5	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H6411	002	0	1	04	01	H6411_002_0	4	4	011111111111111111111001100100000111111111001111		1	30	30	6	2			2	
H6411	002	0	1	04	01	H6411_002_0	4	3	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H6411	002	0	1	04	01	H6411_002_0	4	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H6411	002	0	1	04	01	H6411_002_0	4	1	000000000000000000000000010000000000000000100000		1	15	40	6	2			2	
H6411	002	0	1	04	01	H6411_002_0	4	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H6411	801	0	1	04	01	H6411_801_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6411	801	0	1	04	01	H6411_801_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6411	801	0	1	04	01	H6411_801_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6411	802	0	1	04	01	H6411_802_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6411	802	0	1	04	01	H6411_802_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6411	802	0	1	04	01	H6411_802_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6411	803	0	1	04	01	H6411_803_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6411	803	0	1	04	01	H6411_803_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6411	803	0	1	04	01	H6411_803_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6411	804	0	1	04	01	H6411_804_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6411	804	0	1	04	01	H6411_804_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6411	804	0	1	04	01	H6411_804_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6528	001	0	1	04	01	H6528_001_0	8	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	7	001000000000000000000000000000000000000000000000	$50 Copay	2				1	50.00	50.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	6	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	5	010001110110100000001000001000000000000000000101	$30 Copay	2				1	30.00	30.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	4	000000001001000000010000000000000000000000000000	$15 Copay-Group	2				1	15.00	15.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	3	000010000000000000000000000000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	2	000000000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	1	000100000100000000000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
H6528	001	0	1	04	01	H6528_001_0	8	10	000000000000011110000001100000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
H6900	001	0	1	04	01	H6900_001_0	6	1	000000000000000000000000010000000000000000100000		1	20	40	6	2			2	
H6900	001	0	1	04	01	H6900_001_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H6900	001	0	1	04	01	H6900_001_0	6	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H6900	001	0	1	04	01	H6900_001_0	6	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H6900	001	0	1	04	01	H6900_001_0	6	5	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H6900	001	0	1	04	01	H6900_001_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H6900	001	0	1	04	01	H6900_001_0	6	7	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H6900	002	0	1	04	01	H6900_002_0	6	3	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H6900	002	0	1	04	01	H6900_002_0	6	4	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H6900	002	0	1	04	01	H6900_002_0	6	5	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H6900	002	0	1	04	01	H6900_002_0	6	6	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H6900	002	0	1	04	01	H6900_002_0	6	7	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H6900	002	0	1	04	01	H6900_002_0	6	1	000000000000000000000000010000000000000000100000		1	20	40	6	2			2	
H6900	002	0	1	04	01	H6900_002_0	6	2	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H6900	801	0	1	04	01	H6900_801_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6900	801	0	1	04	01	H6900_801_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6900	801	0	1	04	01	H6900_801_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6900	802	0	1	04	01	H6900_802_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6900	802	0	1	04	01	H6900_802_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6900	802	0	1	04	01	H6900_802_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6900	803	0	1	04	01	H6900_803_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6900	803	0	1	04	01	H6900_803_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6900	803	0	1	04	01	H6900_803_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H6900	804	0	1	04	01	H6900_804_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H6900	804	0	1	04	01	H6900_804_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H6900	804	0	1	04	01	H6900_804_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H7002	001	0	1	04	01	H7002_001_0	5	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H7002	001	0	1	04	01	H7002_001_0	5	2	100000000000000000000000000000000000000000000111		2				1	0.00	0.00	2	
H7002	001	0	1	04	01	H7002_001_0	5	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H7002	001	0	1	04	01	H7002_001_0	5	9	000000000000000000000000000000000000000000011000		1	50	55	6	2			2	
H7002	001	0	1	04	01	H7002_001_0	5	4	000000000000000000000100000000000000000000000000		2				1	50.00	50.00	2	
H7002	001	0	1	04	01	H7002_001_0	5	7	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H7002	001	0	1	04	01	H7002_001_0	5	6	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H7002	001	0	1	04	01	H7002_001_0	5	5	000000000000000000000000001000000000000000000000		2				1	0.00	20.00	2	
H7002	001	0	1	04	01	H7002_001_0	5	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H7188	001	0	1	04	01	H7188_001_0	3	6	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H7188	001	0	1	04	01	H7188_001_0	3	3	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H7188	001	0	1	04	01	H7188_001_0	3	4	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
H7188	001	0	1	04	01	H7188_001_0	3	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H7188	001	0	1	04	01	H7188_001_0	3	2	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H7188	001	0	1	04	01	H7188_001_0	3	1	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H7188	003	0	1	04	01	H7188_003_0	3	2	000000000000000000000000010000000000000000100000		1	20	25	6	2			2	
H7188	003	0	1	04	01	H7188_003_0	3	3	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H7188	003	0	1	04	01	H7188_003_0	3	1	011111111111111111111001100100000111111111001101		1	25	25	6	2			2	
H7188	003	0	1	04	01	H7188_003_0	3	5	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H7188	003	0	1	04	01	H7188_003_0	3	6	000000000000000000000000001000000000000000000000		2				1	0.00	50.00	2	
H7188	003	0	1	04	01	H7188_003_0	3	4	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H7188	801	0	1	04	01	H7188_801_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H7188	801	0	1	04	01	H7188_801_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H7188	801	0	1	04	01	H7188_801_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H7188	802	0	1	04	01	H7188_802_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H7188	802	0	1	04	01	H7188_802_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H7188	802	0	1	04	01	H7188_802_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H7188	803	0	1	04	01	H7188_803_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H7188	803	0	1	04	01	H7188_803_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H7188	803	0	1	04	01	H7188_803_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H7188	804	0	1	04	01	H7188_804_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H7188	804	0	1	04	01	H7188_804_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H7188	804	0	1	04	01	H7188_804_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H7301	001	0	1	04	01	H7301_001_0	4	4	100000000000000000000010000011111000000000000000	Group 4	2				2			2	
H7301	001	0	1	04	01	H7301_001_0	4	3	000000000000000000000000000000000000000000010000	Group 3	1	50	50	1	2			2	
H7301	001	0	1	04	01	H7301_001_0	4	1	000000000000000000000100000000000000000000000000	Group 1	2				1	25.00	25.00	2	
H7301	001	0	1	04	01	H7301_001_0	4	2	011111111111111111111001111100000111111111101111	Group 2	1	20	20	1	2			2	
H7301	002	0	1	04	01	H7301_002_0	3	2	011111111111111111111001111100000111111111101111	Group 2	1	20	20	1	2			2	
H7301	002	0	1	04	01	H7301_002_0	3	1	000000000000000000000100000000000000000000000000	Group 1	2				1	100.00	100.00	2	
H7301	002	0	1	04	01	H7301_002_0	3	4	100000000000000000000010000011111000000000000000	Group 4	2				2			2	
H7301	002	0	1	04	01	H7301_002_0	3	3	000000000000000000000000000000000000000000010000	Group 3	1	50	50	1	2			2	
H7301	801	0	1	04	01	H7301_801_0	4	3	100000000000000000000010000011110000000000010000	Group 3	2				2			2	
H7301	801	0	1	04	01	H7301_801_0	4	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H7301	801	0	1	04	01	H7301_801_0	4	1	011111110110111111111101111100001111111111101111	Group 1	1	20	20	1	2			2	
H7301	802	0	1	04	01	H7301_802_0	4	1	011111110110111111111101111100001111111111101111	Group 1	1	20	20	1	2			2	
H7301	802	0	1	04	01	H7301_802_0	4	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H7301	802	0	1	04	01	H7301_802_0	4	3	100000000000000000000010000011110000000000010000	Group 3	2				2			2	
H7301	803	0	1	04	01	H7301_803_0	4	2	000000001001000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H7301	803	0	1	04	01	H7301_803_0	4	1	011111110110111111111101111100001111111111101111	Group 1	1	20	20	1	2			2	
H7301	803	0	1	04	01	H7301_803_0	4	3	100000000000000000000010000011110000000000010000	Group 3	2				2			2	
H7306	001	0	1	04	01	H7306_001_0	9	6	000000000000000000000000000000000000000000000010	Eyewear	2				1	0.00	0.00	2	
H7306	001	0	1	04	01	H7306_001_0	9	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H7306	001	0	1	04	01	H7306_001_0	9	4	000000000000000000000000000001000000000000000000	100% coinsurance	1	100	100	1	2			2	
H7306	001	0	1	04	01	H7306_001_0	9	2	010000000000000000000001100000000000000000000000	40%	1	40	40	1	2			2	
H7306	001	0	1	04	01	H7306_001_0	9	1	001111111111111111111000011100001111111111101101	20%	1	20	20	1	2			2	
H7306	001	0	1	04	01	H7306_001_0	9	3	000000000000000000000000000000000000000000010000	Dental	1	50	50	2	2			2	
H7306	002	0	1	04	01	H7306_002_0	9	1	001111111111111111111000011100001111111111101101	20%	1	20	20	1	2			2	
H7306	002	0	1	04	01	H7306_002_0	9	2	010000000000000000000001100000000000000000000000	40%	1	40	40	1	2			2	
H7306	002	0	1	04	01	H7306_002_0	9	3	000000000000000000000000000000000000000000010000	Dental	1	50	50	2	2			2	
H7306	002	0	1	04	01	H7306_002_0	9	4	000000000000000000000000000001000000000000000000	100% coinsurance	1	100	100	1	2			2	
H7306	002	0	1	04	01	H7306_002_0	9	5	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H7306	002	0	1	04	01	H7306_002_0	9	6	000000000000000000000000000000000000000000000010	Eyewear	1	0	0	1	1	0.00	0.00	2	
H7306	801	0	1	04	01	H7306_801_0	8	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H7306	801	0	1	04	01	H7306_801_0	8	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H7306	803	0	1	04	01	H7306_803_0	8	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H7306	803	0	1	04	01	H7306_803_0	8	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H7306	804	0	1	04	01	H7306_804_0	8	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H7306	804	0	1	04	01	H7306_804_0	8	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H7692	001	0	1	04	01	H7692_001_0	9	1	001111111111111111111000011100001111111111111101	20% Coinsurance	1	20	20	2	2			2	
H7692	001	0	1	04	01	H7692_001_0	9	2	010000000000000000000001100000000000000000000000	40% Coinsurance	1	40	40	2	2			2	
H7692	001	0	1	04	01	H7692_001_0	9	3	000000000000000000000000000000000000000000010000	Preventive Dental	1	50	50	2	2			2	
H7692	001	0	1	04	01	H7692_001_0	9	4	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	100.00	100.00	2	
H7692	001	0	1	04	01	H7692_001_0	9	5	000000000000000000000000000000000000000000000010	Eyewear	1	0	0	1	1	0.00	0.00	2	
H7692	801	0	1	04	01	H7692_801_0	8	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H7692	801	0	1	04	01	H7692_801_0	8	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H7692	802	0	1	04	01	H7692_802_0	8	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H7692	802	0	1	04	01	H7692_802_0	8	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H7692	803	0	1	04	01	H7692_803_0	8	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H7692	803	0	1	04	01	H7692_803_0	8	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H7787	001	0	1	04	01	H7787_001_0	3	3	000001111111100000010000000000000000000000000101	$40 copayment after deductible	2				1	40.00	40.00	2	
H7787	001	0	1	04	01	H7787_001_0	3	2	000010000000000000000000000000000000000000000000	$20 copayment after deductible	2				1	20.00	20.00	2	
H7787	001	0	1	04	01	H7787_001_0	3	1	000000000000000000000000000000000010000000000000	Routine Physical Exams	2				1	20.00	40.00	2	
H7787	001	0	1	04	01	H7787_001_0	3	4	011100000000011111101101111100000101111111000010	20% coinsurance after deductible	1	20	20	1	2			2	
H7787	001	0	1	04	01	H7787_001_0	3	5	000000000000000000000000000000000000000000100000	40% coinsurance after deductible	2				2			2	
H7787	001	0	1	04	01	H7787_001_0	3	6	100000000000000000000010000011111000000000011000	not covered	2				2			2	
H7787	002	0	1	04	01	H7787_002_0	3	3	000001111111100000010000000000000000000000000101	$40 copayment after deductible	2				1	40.00	40.00	2	
H7787	002	0	1	04	01	H7787_002_0	3	2	000010000000000000000000000000000000000000000000	$20 copayment after deductible	2				1	20.00	20.00	2	
H7787	002	0	1	04	01	H7787_002_0	3	1	000000000000000000000000000000000010000000000000	Routine Physical Exams	2				1	20.00	40.00	2	
H7787	002	0	1	04	01	H7787_002_0	3	4	011100000000011111101101111100000101111111000010	20% coinsurance after deductible	1	20	20	1	2			2	
H7787	002	0	1	04	01	H7787_002_0	3	6	100000000000000000000000000000001000000000011000	not covered	2				2			2	
H7787	002	0	1	04	01	H7787_002_0	3	5	000000000000000000000000000000000000000000100000	40% coinsurance after deductible	2				2			2	
H7787	003	0	1	04	01	H7787_003_0	4	1	000000000000000000000000000000000010000000000000	Routine Physical Exams	2				1	20.00	40.00	2	
H7787	003	0	1	04	01	H7787_003_0	4	2	000010000000000000000000000000000000000000000000	$20 copayment after deductible	2				1	20.00	20.00	2	
H7787	003	0	1	04	01	H7787_003_0	4	3	000001111111100000010000000000000000000000000101	$40 copayment after deductible	2				1	40.00	40.00	2	
H7787	003	0	1	04	01	H7787_003_0	4	4	011100000000011111101101111100001101111111000010	20% coinsurance after deductible	1	20	20	1	2			2	
H7787	003	0	1	04	01	H7787_003_0	4	6	100000000000000000000010000011110000000000000000	not covered	2				2			2	
H7787	003	0	1	04	01	H7787_003_0	4	5	000000000000000000000000000000000000000000100000	40% coinsurance after deductible	2				2			2	
H7787	003	0	1	04	01	H7787_003_0	4	7	000000000000000000000000000000000000000000011000	50% coinsurance	1	50	50	1	2			2	
H7917	004	0	1	04	01	H7917_004_0	7	5	000000000000000000000100000000000000000000000000		2				1	200.00	200.00	2	
H7917	004	0	1	04	01	H7917_004_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	30	6	2			2	
H7917	004	0	1	04	01	H7917_004_0	7	7	000100000000000000000000010100001111111111000000		2				1	0.00	0.00	2	
H7917	004	0	1	04	01	H7917_004_0	7	8	000000000000000000000001100000000000000000000000		1	30	30	2	2			2	
H7917	004	0	1	04	01	H7917_004_0	7	9	000000000000000000000000000000000000000000001111		2				1	30.00	30.00	2	
H7917	004	0	1	04	01	H7917_004_0	7	1	011011111111100000011000000000000000000000000000		2				1	45.00	45.00	2	
H7917	004	0	1	04	01	H7917_004_0	7	2	000000000000000000000000001000000000000000000000		2				1	20.00	20.00	2	
H7917	004	0	1	04	01	H7917_004_0	7	3	000000000000011110000000000000000000000000000000		1	0	30	6	2			2	
H7917	004	0	1	04	01	H7917_004_0	7	4	000000000000000001100000000000000000000000000000		2				1	300.00	300.00	2	
H7917	005	0	1	04	01	H7917_005_0	7	4	000000000000000001100000000000000000000000000000		2				1	300.00	300.00	2	
H7917	005	0	1	04	01	H7917_005_0	7	3	000000000000011110000000000000000000000000000000		1	0	30	6	2			2	
H7917	005	0	1	04	01	H7917_005_0	7	1	011011111111100000011000000000000000000000000000		2				1	45.00	45.00	2	
H7917	005	0	1	04	01	H7917_005_0	7	2	000000000000000000000000001000000000000000000000		2				1	20.00	20.00	2	
H7917	005	0	1	04	01	H7917_005_0	7	9	000000000000000000000000000000000000000000001111		2				1	30.00	30.00	2	
H7917	005	0	1	04	01	H7917_005_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	30	6	2			2	
H7917	005	0	1	04	01	H7917_005_0	7	7	000100000000000000000000010100001111111111000000		2				1	0.00	0.00	2	
H7917	005	0	1	04	01	H7917_005_0	7	8	000000000000000000000001100000000000000000000000		1	30	30	2	2			2	
H7917	005	0	1	04	01	H7917_005_0	7	5	000000000000000000000100000000000000000000000000		2				1	200.00	200.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	4	000000000000000001100000000000000000000000000000		2				1	300.00	300.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	3	000000000000011110000000000000000000000000000000		1	0	30	6	2			2	
H7917	006	0	1	04	01	H7917_006_0	7	2	000000000000000000000000001000000000000000000000		2				1	20.00	20.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	1	011011111111100000011000000000000000000000000000		2				1	45.00	45.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	5	000000000000000000000100000000000000000000000000		2				1	200.00	200.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	9	000000000000000000000000000000000000000000001111		2				1	30.00	30.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	8	000000000000000000000001100000000000000000000000		1	30	30	2	2			2	
H7917	006	0	1	04	01	H7917_006_0	7	7	000100000000000000000000010100001111111111000000		2				1	0.00	0.00	2	
H7917	006	0	1	04	01	H7917_006_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	30	6	2			2	
H7917	007	0	1	04	01	H7917_007_0	6	1	011011111111100000011000000000000000000000000000		2				1	45.00	45.00	2	
H7917	007	0	1	04	01	H7917_007_0	6	2	000000000000000000000000001000000000000000000000		2				1	20.00	20.00	2	
H7917	007	0	1	04	01	H7917_007_0	6	3	000000000000011110000000000000000000000000000000		1	0	30	6	2			2	
H7917	007	0	1	04	01	H7917_007_0	6	4	000000000000000001100000000000000000000000000000		2				1	300.00	300.00	2	
H7917	007	0	1	04	01	H7917_007_0	6	9	000000000000000000000000000000000000000000001111		2				1	30.00	30.00	2	
H7917	007	0	1	04	01	H7917_007_0	6	7	000100000000000000000000010100001111111111000000		2				1	0.00	0.00	2	
H7917	007	0	1	04	01	H7917_007_0	6	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	30	6	2			2	
H7917	007	0	1	04	01	H7917_007_0	6	5	000000000000000000000100000000000000000000000000		2				1	200.00	200.00	2	
H7917	007	0	1	04	01	H7917_007_0	6	8	000000000000000000000001100000000000000000000000		1	30	30	2	2			2	
H7917	008	0	1	04	01	H7917_008_0	7	2	100100000000000000000000011100001111111111000000		2				1	0.00	0.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	1	011011111111100000011000000000000000000000000000		2				1	25.00	25.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	3	000000000000011110000000000000000000000000000000		1	0	10	6	1	0.00	0.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	8	000000000000000000000001100000000000000000000000		1	20	20	2	2			2	
H7917	008	0	1	04	01	H7917_008_0	7	7	000000000000000000000000000000000000000000011111		2				1	10.00	10.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	20	6	2			2	
H7917	008	0	1	04	01	H7917_008_0	7	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	4	000000000000000001100000000000000000000000000000		2				1	50.00	50.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	3	000000000000011110000000000000000000000000000000		1	0	10	6	1	0.00	0.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	2	100100000000000000000000011100001111111111000000		2				1	0.00	0.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	1	011011111111100000011000000000000000000000000000		2				1	25.00	25.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	4	000000000000000001100000000000000000000000000000		2				1	50.00	50.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	20	6	2			2	
H7917	009	0	1	04	01	H7917_009_0	7	7	000000000000000000000000000000000000000000011111		2				1	10.00	10.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	8	000000000000000000000001100000000000000000000000		1	20	20	2	2			2	
H7917	010	0	1	04	01	H7917_010_0	7	3	000000000000011110000000000000000000000000000000		1	0	10	6	1	0.00	0.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	2	100100000000000000000000011100001111111111000000		2				1	0.00	0.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	1	011011111111100000011000000000000000000000000000		2				1	25.00	25.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	4	000000000000000001100000000000000000000000000000		2				1	50.00	50.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	8	000000000000000000000001100000000000000000000000		1	20	20	2	2			2	
H7917	010	0	1	04	01	H7917_010_0	7	7	000000000000000000000000000000000000000000011111		2				1	10.00	10.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	20	6	2			2	
H7917	010	0	1	04	01	H7917_010_0	7	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	1	011011111111100000011000000000000000000000000000		2				1	25.00	25.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	2	100100000000000000000000011100001111111111000000		2				1	0.00	0.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	7	000000000000000000000000000000000000000000011111		2				1	10.00	10.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	3	000000000000011110000000000000000000000000000000		1	0	10	6	1	0.00	0.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	4	000000000000000001100000000000000000000000000000		2				1	50.00	50.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H7917	011	0	1	04	01	H7917_011_0	7	6	000000000000000000000000000000000000000000100000	Part B Drugs and Chemo	1	10	20	6	2			2	
H7917	011	0	1	04	01	H7917_011_0	7	8	000000000000000000000001100000000000000000000000		1	20	20	2	2			2	
H7917	801	0	1	04	01	H7917_801_0	6	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H7917	801	0	1	04	01	H7917_801_0	6	2	010011110110111111111111111111111111111111101111	All Other	1	20	20	2	2			2	
H7917	801	0	1	04	01	H7917_801_0	6	3	001000001001000000000000000000000000000000000000	Mental Health and Partial Hosp	1	50	50	2	2			2	
H7917	802	0	1	04	01	H7917_802_0	8	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H7917	802	0	1	04	01	H7917_802_0	8	2	010011110110111111111111111111111111111111101111	All Other	1	20	20	2	2			2	
H7917	802	0	1	04	01	H7917_802_0	8	3	001000001001000000000000000000000000000000000000	Mental Health and Partial Hosp	1	50	50	2	2			2	
H7917	803	0	1	04	01	H7917_803_0	7	1	000100000000000000000000000000000000000000000000	Home Health	2				1	0.00	0.00	2	
H7917	803	0	1	04	01	H7917_803_0	7	2	010011110110111111111111111111111111111111101111	All Other	1	20	20	2	2			2	
H7917	803	0	1	04	01	H7917_803_0	7	3	001000001001000000000000000000000000000000000000	Mental Health and Partial Hosp	1	50	50	2	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H8172	001	0	1	04	01	H8172_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H8172	001	0	1	04	01	H8172_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H8172	001	0	1	04	01	H8172_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H8172	001	0	1	04	01	H8172_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H8172	001	0	1	04	01	H8172_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H8172	001	0	1	04	01	H8172_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H8172	001	0	1	04	01	H8172_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H8172	002	0	1	04	01	H8172_002_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H8172	002	0	1	04	01	H8172_002_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H8172	003	0	1	04	01	H8172_003_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H8172	003	0	1	04	01	H8172_003_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H8172	004	0	1	04	01	H8172_004_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H8172	004	0	1	04	01	H8172_004_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	12	000000000000000000000000000101001111111100000000	Preventative Services	2				1	0.00	0.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	13	000000000000000000000000000000000000000000000101	Vision / Hearing Exam	2				1	35.00	35.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H8172	005	0	1	04	01	H8172_005_0	6	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H8172	005	0	1	04	01	H8172_005_0	6	3	000000000000000000010000000000000000000000000000	Outpatient Substance Abuse	1	50	50	3	2			2	
H8172	005	0	1	04	01	H8172_005_0	6	4	000011110100100000001000000000000000000000000000	Physician Services and Rehab Therapies	2				1	35.00	35.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	5	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	95.00	95.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	6	000100001001000001100000000000000000000000000000	OP Mental Health, HHC, OP Surgery	1	30	30	3	2			2	
H8172	005	0	1	04	01	H8172_005_0	6	7	000000000000000000000000000000000000000011000000	Diabetes Monitoring, Nutrition Therapy	2				1	10.00	10.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	8	000000000000011110000001100000000000000000000000	Diagnostic and DME	1	30	30	3	2			2	
H8172	005	0	1	04	01	H8172_005_0	6	9	000000000010000000000000000000000000000000000000	Other Health Care	2				1	25.00	25.00	2	
H8172	005	0	1	04	01	H8172_005_0	6	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	12	000000000000000000000000000101001111111100000000	Preventative Services	2				1	0.00	0.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	13	000000000000000000000000000000000000000000000101	Vision / Hearing Exam	2				1	35.00	35.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	2	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	3	000000000000000000010000000000000000000000000000	Outpatient Substance Abuse	1	50	50	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	4	000011110100100000001000000000000000000000000000	Physician Services and Rehab Therapies	2				1	35.00	35.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	5	001000000000000000000000000000000000000000000000	Partial Hospitalization	2				1	95.00	95.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	6	000100001001000001100000000000000000000000000000	OP Mental Health, HHC, OP Surgery	1	30	30	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	7	000000000000000000000000000000000000000011000000	Diabetes Monitoring, Nutrition Therapy	2				1	10.00	10.00	2	
H8172	006	0	1	04	01	H8172_006_0	6	8	000000000000011110000001100000000000000000000000	Diagnostic and DME	1	30	30	3	2			2	
H8172	006	0	1	04	01	H8172_006_0	6	9	000000000010000000000000000000000000000000000000	Other Health Care	2				1	25.00	25.00	2	
H8172	801	0	1	04	01	H8172_801_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H8172	801	0	1	04	01	H8172_801_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H8172	801	0	1	04	01	H8172_801_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H8172	802	0	1	04	01	H8172_802_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H8172	802	0	1	04	01	H8172_802_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H8172	802	0	1	04	01	H8172_802_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H8172	803	0	1	04	01	H8172_803_0	4	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H8172	803	0	1	04	01	H8172_803_0	4	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H8172	803	0	1	04	01	H8172_803_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H8239	001	0	1	04	01	H8239_001_0	11	1	001111111111111111111000011100001111111111101101	20% coinsurance	1	20	20	1	2			2	
H8239	001	0	1	04	01	H8239_001_0	11	2	010000000000000000000001100000000000000000000000	40% Coinsurance	1	40	40	1	2			2	
H8239	001	0	1	04	01	H8239_001_0	11	3	000000000000000000000000000000000000000000010000	Preventive Dental	1	50	50	1	2			2	
H8239	001	0	1	04	01	H8239_001_0	11	4	000000000000000000000100000000000000000000000000	Ambulance Services	2				1	100.00	100.00	2	
H8239	001	0	1	04	01	H8239_001_0	11	5	000000000000000000000000000000000000000000000010	Eyewear	1	0	0	1	1	0.00	0.00	2	
H8239	801	0	1	04	01	H8239_801_0	9	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H8239	801	0	1	04	01	H8239_801_0	9	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H8239	802	0	1	04	01	H8239_802_0	9	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H8239	802	0	1	04	01	H8239_802_0	9	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H8239	803	0	1	04	01	H8239_803_0	9	1	010111110111111111101101111100001111111111101111	20% coinsurance	1	20	20	2	2			2	
H8239	803	0	1	04	01	H8239_803_0	9	2	001000001000000000010000000000000000000000000000	50% coinsurance	1	50	50	1	2			2	
H8393	001	0	1	04	01	H8393_001_0	10	1	011111111111111111111001111100001111111111101101	OON	1	20	20	2	2			2	
H8393	001	0	1	04	01	H8393_001_0	10	2	000000000000000000000100000000000000000000000000	Ambulance	2				1	150.00	150.00	2	
H8393	001	0	1	04	01	H8393_001_0	10	3	000000000000000000000000000000000000000000010000	Preventive Dental	1	50	50	2	2			2	
H8393	001	0	1	04	01	H8393_001_0	10	4	100000000000000000000000000000000000000000000010	Allowance Items	1	0	0	2	1	0.00	0.00	2	
H8393	801	0	1	04	01	H8393_801_0	9	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H8393	801	0	1	04	01	H8393_801_0	9	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H8393	802	0	1	04	01	H8393_802_0	10	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H8393	802	0	1	04	01	H8393_802_0	10	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H8393	803	0	1	04	01	H8393_803_0	10	1	010111110111111111101101111100001111111111101111	Group 1	1	20	20	1	2			2	
H8393	803	0	1	04	01	H8393_803_0	10	2	001000001000000000010000000000000000000000000000	Group 2	1	50	50	1	2			2	
H8604	001	0	1	04	01	H8604_001_0	7	5	000000000000000000000000001000000000000000000000	No Cost Sharing	2				2			2	
H8604	001	0	1	04	01	H8604_001_0	7	4	000001111111100000010000000000000000000000001101	SCP Copays	2				1	35.00	35.00	2	
H8604	001	0	1	04	01	H8604_001_0	7	6	000000000000000000000100000000000000000000000000	$50 Copay / Ambulance	2				1	50.00	50.00	2	
H8604	001	0	1	04	01	H8604_001_0	7	3	000010000000000000000000000000000010000000000000	PCP/Routine Physical Copays	2				1	25.00	25.00	2	
H8604	001	0	1	04	01	H8604_001_0	7	2	000000000000000000000001100000000000000000000000	DME	1	30	30	1	2			2	
H8604	001	0	1	04	01	H8604_001_0	7	1	011100000000011111101000010100001101111111100010	20% Coinsurance	1	20	20	1	2			2	
H8604	002	0	1	04	01	H8604_002_0	5	4	000001111111100000010000000000000000000000001101	SCP Copays	2				1	35.00	35.00	2	
H8604	002	0	1	04	01	H8604_002_0	5	3	000010000000000000000100000000000010000000000000	PCP/Routine Physical/Ambulance Copays	2				1	25.00	25.00	2	
H8604	002	0	1	04	01	H8604_002_0	5	2	000000000000000000000001100000000000000000000000	DME	1	30	30	1	2			2	
H8604	002	0	1	04	01	H8604_002_0	5	5	000000000000000000000000001000000000000000000000	No Cost Sharing	2				2			2	
H8604	002	0	1	04	01	H8604_002_0	5	1	011100000000011111101000010100001101111111100010	20% Coinsurance	1	20	20	1	2			2	
H8604	003	0	1	04	01	H8604_003_0	7	6	000000000000000000000100000000000000000000000000	$50 Copay / Ambulance	2				1	50.00	50.00	2	
H8604	003	0	1	04	01	H8604_003_0	7	5	000000000000000000000000001000000000000000000000	No Cost Sharing	2				2			2	
H8604	003	0	1	04	01	H8604_003_0	7	4	000001111111100000010000000000000000000000001101	SCP Copays	2				1	35.00	35.00	2	
H8604	003	0	1	04	01	H8604_003_0	7	3	000010000000000000000000000000000010000000000000	PCP/Routine Physical Copays	2				1	25.00	25.00	2	
H8604	003	0	1	04	01	H8604_003_0	7	2	000000000000000000000001100000000000000000000000	DME	1	30	30	1	2			2	
H8604	003	0	1	04	01	H8604_003_0	7	1	011100000000011111101000010100001101111111100010	20% Coinsurance	1	20	20	1	2			2	
H8604	004	0	1	04	01	H8604_004_0	5	3	000010000000000000000100000000000010000000000000	PCP/Routine Physical/Ambulance Copays	2				1	25.00	25.00	2	
H8604	004	0	1	04	01	H8604_004_0	5	4	000001111111100000010000000000000000000000001101	SCP Copays	2				1	35.00	35.00	2	
H8604	004	0	1	04	01	H8604_004_0	5	5	000000000000000000000000001000000000000000000000	No Cost Sharing	2				2			2	
H8604	004	0	1	04	01	H8604_004_0	5	1	011100000000011111101000010100001101111111100010	20% Coinsurance	1	20	20	1	2			2	
H8604	004	0	1	04	01	H8604_004_0	5	2	000000000000000000000001100000000000000000000000	DME	1	30	30	1	2			2	
H8604	801	0	1	04	01	H8604_801_0	5	2	000000000000000000000001100000000000000000000000	DME	1	30	30	1	2			2	
H8604	801	0	1	04	01	H8604_801_0	5	1	011100000000011111101000010100001101111111100010	20% Coinsurance	1	20	20	1	2			2	
H8604	801	0	1	04	01	H8604_801_0	5	5	000000000000000000000000001000000000000000000000	No Cost Sharing	2				2			2	
H8604	801	0	1	04	01	H8604_801_0	5	4	000001111111100000010000000000000000000000001101	SCP Copays	2				1	35.00	35.00	2	
H8604	801	0	1	04	01	H8604_801_0	5	3	000010000000000000000100000000000010000000000000	PCP/Routine Physical/Ambulance Copays	2				1	25.00	25.00	2	
H8604	802	0	1	04	01	H8604_802_0	5	1	011100000000011111101000010100001101111111100010	20% Coinsurance	1	20	20	1	2			2	
H8604	802	0	1	04	01	H8604_802_0	5	2	000000000000000000000001100000000000000000000000	DME	1	30	30	1	2			2	
H8604	802	0	1	04	01	H8604_802_0	5	3	000010000000000000000100000000000010000000000000	PCP/Routine Physical/Ambulance Copays	2				1	25.00	25.00	2	
H8604	802	0	1	04	01	H8604_802_0	5	4	000001111111100000010000000000000000000000001101	SCP Copays	2				1	35.00	35.00	2	
H8604	802	0	1	04	01	H8604_802_0	5	5	000000000000000000000000001000000000000000000000	No Cost Sharing	2				2			2	
H8644	001	0	1	04	01	H8644_001_0	3	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H8644	001	0	1	04	01	H8644_001_0	3	3	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H8644	001	0	1	04	01	H8644_001_0	3	4	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H8644	001	0	1	04	01	H8644_001_0	3	6	100000000000000000000000000000000000000000000111		2				1	0.00	0.00	2	
H8644	001	0	1	04	01	H8644_001_0	3	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H8644	001	0	1	04	01	H8644_001_0	3	1	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H8644	003	0	1	04	01	H8644_003_0	3	6	100000000000000000000000000000000000000000000111		2				1	0.00	0.00	2	
H8644	003	0	1	04	01	H8644_003_0	3	3	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
H8644	003	0	1	04	01	H8644_003_0	3	2	000000000000000000000100000000000000000000000000		2				1	150.00	150.00	2	
H8644	003	0	1	04	01	H8644_003_0	3	4	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
H8644	003	0	1	04	01	H8644_003_0	3	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H8644	003	0	1	04	01	H8644_003_0	3	1	011111111111111111111001100100000111111111001101		1	30	30	6	2			2	
H8644	801	0	1	04	01	H8644_801_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8644	801	0	1	04	01	H8644_801_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8644	801	0	1	04	01	H8644_801_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8644	802	0	1	04	01	H8644_802_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8644	802	0	1	04	01	H8644_802_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8644	802	0	1	04	01	H8644_802_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8644	803	0	1	04	01	H8644_803_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8644	803	0	1	04	01	H8644_803_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8644	803	0	1	04	01	H8644_803_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8644	804	0	1	04	01	H8644_804_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8644	804	0	1	04	01	H8644_804_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8644	804	0	1	04	01	H8644_804_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8707	001	0	1	04	01	H8707_001_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H8707	001	0	1	04	01	H8707_001_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H8707	001	0	1	04	01	H8707_001_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H8707	001	0	1	04	01	H8707_001_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H8707	001	0	1	04	01	H8707_001_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H8707	001	0	1	04	01	H8707_001_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H8707	001	0	1	04	01	H8707_001_0	4	7	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H8707	001	0	1	04	01	H8707_001_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H8707	003	0	1	04	01	H8707_003_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H8707	003	0	1	04	01	H8707_003_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H8707	003	0	1	04	01	H8707_003_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H8707	003	0	1	04	01	H8707_003_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H8707	003	0	1	04	01	H8707_003_0	4	5	000000000000000000000000001000000000000000000000		2				1	0.00	75.00	2	
H8707	003	0	1	04	01	H8707_003_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H8707	003	0	1	04	01	H8707_003_0	4	7	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H8707	003	0	1	04	01	H8707_003_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H8707	005	0	1	04	01	H8707_005_0	4	8	000000000000000000000000000000001000000000000000		1	50	50	6	2			2	
H8707	005	0	1	04	01	H8707_005_0	4	7	000000000000000000000001100000000000000000000000		1	40	40	6	2			2	
H8707	005	0	1	04	01	H8707_005_0	4	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H8707	005	0	1	04	01	H8707_005_0	4	5	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
H8707	005	0	1	04	01	H8707_005_0	4	6	000000000000000000000000010000000000000000000000		1	20	40	6	2			2	
H8707	005	0	1	04	01	H8707_005_0	4	3	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H8707	005	0	1	04	01	H8707_005_0	4	2	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H8707	005	0	1	04	01	H8707_005_0	4	1	011111111111111111111000000100000111111111001101		1	30	30	6	2			2	
H8707	801	0	1	04	01	H8707_801_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8707	801	0	1	04	01	H8707_801_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8707	801	0	1	04	01	H8707_801_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8707	802	0	1	04	01	H8707_802_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8707	802	0	1	04	01	H8707_802_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8707	802	0	1	04	01	H8707_802_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8707	803	0	1	04	01	H8707_803_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8707	803	0	1	04	01	H8707_803_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8707	803	0	1	04	01	H8707_803_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8707	804	0	1	04	01	H8707_804_0	2	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H8707	804	0	1	04	01	H8707_804_0	2	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H8707	804	0	1	04	01	H8707_804_0	2	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H8805	001	0	1	04	01	H8805_001_0	9	1	111111111111111111111101111110001111111111111111	outpatient	1	20	20	2	2			2	
H8805	805	0	1	04	01	H8805_805_0	4	2	000000001001000000000000000000000000000000000000	Mental Health related	1	50	50	2	2			2	
H8805	805	0	1	04	01	H8805_805_0	4	1	111111110110111111111101111110001111111111111111	Outpatient	1	20	20	2	2			2	
H8980	001	0	1	04	01	H8980_001_0	7	2	101000001001000000010000000000001000000000000000	50% Coinsurance	1	50	50	1	2			2	
H8980	001	0	1	04	01	H8980_001_0	7	1	010111110110111111101101111100000111111111101111	20% Coinsurance	1	20	20	1	2			2	
H8980	002	0	1	04	01	H8980_002_0	6	1	010111110110111111101101111100000111111111101111	20% Coinsurance	1	20	20	1	2			2	
H8980	002	0	1	04	01	H8980_002_0	6	2	101000001001000000010000000000001000000000000000	50% Coinsurance	1	50	50	1	2			2	
H8980	801	0	1	04	01	H8980_801_0	2	1	011111111111111111111101111100001111111111101111	OON Services	1	23	23	1	2			2	
H8980	802	0	1	04	01	H8980_802_0	2	1	011111111111111111111101111100001111111111101111	OON Services	1	23	23	1	2			2	
H8980	803	0	1	04	01	H8980_803_0	2	1	011111111111111111111101111100001111111111101111	OON Services	1	23	23	1	2			2	
H9503	001	0	1	04	01	H9503_001_0	7	2	000000000000000000000000001000000000000000000000		2				1	0.00	100.00	2	
H9503	001	0	1	04	01	H9503_001_0	7	4	000000000000000000000000100000001000000000000000		1	50	50	6	2			2	
H9503	001	0	1	04	01	H9503_001_0	7	5	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
H9503	001	0	1	04	01	H9503_001_0	7	6	000100000000000000000000000000000000000000000000		1	40	40	6	2			2	
H9503	001	0	1	04	01	H9503_001_0	7	3	000000000000000000000000010000000000000000000000		1	20	50	6	2			2	
H9503	001	0	1	04	01	H9503_001_0	7	8	000000000000000000000000000000000000000000011000		1	50	80	6	2			2	
H9503	001	0	1	04	01	H9503_001_0	7	9	000000000000000000000000000000000000000000000110		2				1	0.00	0.00	2	
H9503	001	0	1	04	01	H9503_001_0	7	1	011011111111111111111001000100000111111111001101		1	30	30	6	2			2	
H9503	001	0	1	04	01	H9503_001_0	7	7	000000000000000000000000000000000000000000100000		1	20	30	6	2			2	
H9503	801	0	1	04	01	H9503_801_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H9503	801	0	1	04	01	H9503_801_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H9503	801	0	1	04	01	H9503_801_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H9503	802	0	1	04	01	H9503_802_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H9503	802	0	1	04	01	H9503_802_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H9503	802	0	1	04	01	H9503_802_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H9503	803	0	1	04	01	H9503_803_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H9503	803	0	1	04	01	H9503_803_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H9503	803	0	1	04	01	H9503_803_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H9503	804	0	1	04	01	H9503_804_0	3	2	000000001001000000010000000000000000000000000000	Group 2	1	50	50	6	2			2	
H9503	804	0	1	04	01	H9503_804_0	3	3	000100000000010000000000000000000000000000000000	Group 3	1	0	20	6	2			2	
H9503	804	0	1	04	01	H9503_804_0	3	1	011011110110101111101101111100001111111111101111	Group 1	1	20	20	6	2			2	
H9615	001	0	1	04	01	H9615_001_0	6	5	000000000000000100000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H9615	001	0	1	04	01	H9615_001_0	6	1	010100100010011001100001111000000000000000100010	20% Coinsurance	1	20	20	2	2			2	
H9615	001	0	1	04	01	H9615_001_0	6	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H9615	001	0	1	04	01	H9615_001_0	6	3	000011010101100010010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H9615	001	0	1	04	01	H9615_001_0	6	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H9615	001	0	1	04	01	H9615_001_0	6	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				2			2	
H9615	001	0	1	04	01	H9615_001_0	6	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				2			2	
H9615	001	0	1	04	01	H9615_001_0	6	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				2			2	
H9615	002	0	1	04	01	H9615_002_0	8	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				2			2	
H9615	002	0	1	04	01	H9615_002_0	8	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H9615	002	0	1	04	01	H9615_002_0	8	1	010100100010011001100001111000000000000000100010	20% Coinsurance	1	20	20	2	2			2	
H9615	002	0	1	04	01	H9615_002_0	8	5	000000000000000100000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H9615	002	0	1	04	01	H9615_002_0	8	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				2			2	
H9615	002	0	1	04	01	H9615_002_0	8	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				2			2	
H9615	002	0	1	04	01	H9615_002_0	8	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H9615	002	0	1	04	01	H9615_002_0	8	3	000011010101100010010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H9615	003	0	1	04	01	H9615_003_0	6	1	010100100010011001100001111000000000000000100010	20% Coinsurance	1	20	20	2	2			2	
H9615	003	0	1	04	01	H9615_003_0	6	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H9615	003	0	1	04	01	H9615_003_0	6	3	000011010101100010010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H9615	003	0	1	04	01	H9615_003_0	6	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H9615	003	0	1	04	01	H9615_003_0	6	5	000000000000000100000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H9615	003	0	1	04	01	H9615_003_0	6	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				2			2	
H9615	003	0	1	04	01	H9615_003_0	6	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				2			2	
H9615	003	0	1	04	01	H9615_003_0	6	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				2			2	
H9615	004	0	1	04	01	H9615_004_0	9	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H9615	004	0	1	04	01	H9615_004_0	9	3	000011010101100010010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H9615	004	0	1	04	01	H9615_004_0	9	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H9615	004	0	1	04	01	H9615_004_0	9	5	000000000000000100000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H9615	004	0	1	04	01	H9615_004_0	9	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				2			2	
H9615	004	0	1	04	01	H9615_004_0	9	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				2			2	
H9615	004	0	1	04	01	H9615_004_0	9	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				2			2	
H9615	004	0	1	04	01	H9615_004_0	9	1	010100100010011001100001111000000000000000100010	20% Coinsurance	1	20	20	2	2			2	
H9615	802	0	1	04	01	H9615_802_0	9	1	010100100010011101100001111000000000000000100010	20% Coinsurance	1	20	20	2	2			2	
H9615	802	0	1	04	01	H9615_802_0	9	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H9615	802	0	1	04	01	H9615_802_0	9	3	000011010101100011010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H9615	802	0	1	04	01	H9615_802_0	9	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H9615	802	0	1	04	01	H9615_802_0	9	5	000000000000000000000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H9615	802	0	1	04	01	H9615_802_0	9	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				2			2	
H9615	802	0	1	04	01	H9615_802_0	9	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				2			2	
H9615	802	0	1	04	01	H9615_802_0	9	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				2			2	
H9615	804	0	1	04	01	H9615_804_0	9	7	000000000000000000000000000000000000000000000010	$100 Allowance	2				2			2	
H9615	804	0	1	04	01	H9615_804_0	9	8	100000000000000000000000000000000000000000000000	$600 Allowance	2				2			2	
H9615	804	0	1	04	01	H9615_804_0	9	6	000000000000000000000000000000000000000000010000	$300 Allowance	2				2			2	
H9615	804	0	1	04	01	H9615_804_0	9	5	000000000000000000000000000100001101111111000000	$0 Copayment	2				1	0.00	0.00	2	
H9615	804	0	1	04	01	H9615_804_0	9	4	000000000000000000000100000000000000000000000000	$35 Copayment	2				1	35.00	35.00	2	
H9615	804	0	1	04	01	H9615_804_0	9	3	000011010101100011010000000000000010000000001101	$25 Copayment	2				1	25.00	25.00	2	
H9615	804	0	1	04	01	H9615_804_0	9	2	001000001000000000001000000010000000000000000000	50% Coinsurance	1	50	50	2	2			2	
H9615	804	0	1	04	01	H9615_804_0	9	1	010100100010011100100001111000000000000000100010	20% Coinsurance	1	20	20	2	2			2	
H9663	001	0	1	04	01	H9663_001_0	6	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H9663	001	0	1	04	01	H9663_001_0	6	1	011111111111111111111001110100000111111111101101	Tier 1	1	35	35	6	2			2	
H9663	001	0	1	04	01	H9663_001_0	6	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H9663	001	0	1	04	01	H9663_001_0	6	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H9663	001	0	1	04	01	H9663_001_0	6	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H9663	002	0	1	04	01	H9663_002_0	5	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
H9663	002	0	1	04	01	H9663_002_0	5	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
H9663	002	0	1	04	01	H9663_002_0	5	1	011111111111111111111001110100000111111111101101	Tier 1	1	35	35	6	2			2	
H9663	002	0	1	04	01	H9663_002_0	5	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
H9663	002	0	1	04	01	H9663_002_0	5	3	000000000000000000000000000000001000000000010000	Tier 3	2				2			2	
H9663	801	0	1	04	01	H9663_801_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H9663	801	0	1	04	01	H9663_801_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H9663	801	0	1	04	01	H9663_801_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H9663	802	0	1	04	01	H9663_802_0	4	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
H9663	802	0	1	04	01	H9663_802_0	4	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
H9663	802	0	1	04	01	H9663_802_0	4	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
H9670	001	0	1	04	01	H9670_001_0	6	1	000000000000000000000000000000000100000000000000	No OON Cost Sharing Group	2				1	0.00	0.00	2	
H9670	001	0	1	04	01	H9670_001_0	6	2	011111111111111111111100011100000011111111101001	20% Coinsurance	1	20	20	2	2			2	
H9670	001	0	1	04	01	H9670_001_0	6	3	100000000000000000000001100000001000000000000110	50% Coinsurance	1	50	50	2	2			2	
H9670	002	0	1	04	01	H9670_002_0	6	1	000000000000000000000000000000000100000000000000	No OON Cost Sharing Group	2				1	0.00	0.00	2	
H9670	002	0	1	04	01	H9670_002_0	6	3	100000000000000000000001100000001000000000000110	50% Coinsurance	1	50	50	2	2			2	
H9670	002	0	1	04	01	H9670_002_0	6	2	011111111111111111111100011100000011111111101001	20% Coinsurance	1	20	20	2	2			2	
H9670	801	0	1	04	01	H9670_801_0	4	2	011111111111111111111100011100000011111111101001	20% Group	1	20	20	2	2			2	
H9670	801	0	1	04	01	H9670_801_0	4	3	100000000000000000000001100000001000000000010110	50% Group	1	50	50	2	2			2	
H9670	801	0	1	04	01	H9670_801_0	4	1	000000000000000000000000000000000100000000000000	No OON Cost Share Group	2				1	0.00	0.00	2	
H9670	802	0	1	04	01	H9670_802_0	4	3	100000000000000000000001100000001000000000010110	50% Group	1	50	50	2	2			2	
H9670	802	0	1	04	01	H9670_802_0	4	2	011111111111111111111100011100000011111111101001	20% Group	1	20	20	2	2			2	
H9670	802	0	1	04	01	H9670_802_0	4	1	000000000000000000000000000000000100000000000000	No OON Cost Share Group	2				1	0.00	0.00	2	
H9670	803	0	1	04	01	H9670_803_0	4	3	100000000000000000000001100000001000000000010110	50% Group	1	50	50	2	2			2	
H9670	803	0	1	04	01	H9670_803_0	4	1	000000000000000000000000000000000100000000000000	No OON Cost Share Group	2				1	0.00	0.00	2	
H9670	803	0	1	04	01	H9670_803_0	4	2	011111111111111111111100011100000011111111101001	20% Group	1	20	20	2	2			2	
H9847	001	0	1	04	01	H9847_001_0	5	1	001111111111111111111000011100001111111111101101	Group 1	1	20	20	2	2			2	
H9847	001	0	1	04	01	H9847_001_0	5	2	010000000000000000000001100000000000000000000000	Group 2	1	40	40	2	2			2	
H9847	001	0	1	04	01	H9847_001_0	5	3	000000000000000000000100000000000000000000000000	Group 3	2				1	100.00	100.00	2	
H9847	001	0	1	04	01	H9847_001_0	5	4	000000000000000000000000000001000000000000010010	Group 4	2				2			2	
H9847	801	0	1	04	01	H9847_801_0	5	1	010111110111111111111101111110001111111111101111	Group 1	1	20	20	1	2			2	
H9847	801	0	1	04	01	H9847_801_0	5	2	001000001000000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H9847	802	0	1	04	01	H9847_802_0	3	1	010111110111111111111101111110001111111111101111	Group 1	1	20	20	1	2			2	
H9847	802	0	1	04	01	H9847_802_0	3	2	001000001000000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H9847	803	0	1	04	01	H9847_803_0	3	1	010111110111111111111101111110001111111111101111	Group 1	1	20	20	1	2			2	
H9847	803	0	1	04	01	H9847_803_0	3	2	001000001000000000000000000000000000000000000000	Group 2	1	50	50	1	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H9930	001	0	1	04	01	H9930_001_0	2	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H9930	001	0	1	04	01	H9930_001_0	2	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H9930	001	0	1	04	01	H9930_001_0	2	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H9930	001	0	1	04	01	H9930_001_0	2	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H9930	001	0	1	04	01	H9930_001_0	2	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H9930	001	0	1	04	01	H9930_001_0	2	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H9930	001	0	1	04	01	H9930_001_0	2	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	6	000000001001000000010000000000000000000000000000	Outpatient Mental Health	1	50	50	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	5	000000100000100000001000000000000000000000000000	Therapy/Rehab Services	2				1	35.00	35.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	4	000011010110000000000000000000000000000000000000	Physician Services	2				1	35.00	35.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	3	000100000000000000000000000000000000000000000000	Home Health Services	1	30	30	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	2	001000000000000000000000000000000000000000000000	Partial Hospitalization	1	30	30	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	15	000000000000000000000000000000000000000000001010	Dental  Vision Wear	1	20	20	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	14	000000000000000000000000001000000000000000000000	Renal Dialysis	2				1	50.00	50.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	13	000000000000000000000000000000000000000000000101	Vision/Hearing Exam	2				1	35.00	35.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	12	000000000000000000000000000100001111111111000000	Preventative Services	2				1	0.00	0.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	11	000000000000000000000000000000000000000000100000	Part B Drugs	1	20	20	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	10	000000000000000000000100000000000000000000000000	Ambulance	2				1	100.00	100.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	1	010000000000000000000000000000000000000000000000	CORF	2				1	15.00	15.00	2	
H9930	003	0	1	04	01	H9930_003_0	3	7	000000000000000001100000000000000000000000000000	Outpatient Surgery	1	30	30	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	9	000000000000000000000001110000000000000000000000	Medical Equipment	1	30	30	3	2			2	
H9930	003	0	1	04	01	H9930_003_0	3	8	000000000000011110000000000000000000000000000000	Diagnostic	1	30	30	3	2			2	
H9930	009	0	1	04	01	H9930_009_0	4	6	000000000000000000000000010000000000000000000000	Diabetes Monitoring Supplies	1	0	20	3	2			2	
H9930	009	0	1	04	01	H9930_009_0	4	5	000000000000000000000000000000000001000001000000	Nutrition Therapy	1	0	20	3	2			2	
H9930	009	0	1	04	01	H9930_009_0	4	4	000000000000000000000000000000000010100000000000	Routine Physical Exam	2				2			2	
H9930	009	0	1	04	01	H9930_009_0	4	1	011111110110111111111101101101001100011110100000	Out-Of-Network Services	1	20	20	3	2			2	
H9930	009	0	1	04	01	H9930_009_0	4	2	000000001001000000000000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H9930	009	0	1	04	01	H9930_009_0	4	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H9930	801	0	1	04	01	H9930_801_0	6	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H9930	801	0	1	04	01	H9930_801_0	6	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H9930	801	0	1	04	01	H9930_801_0	6	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H9930	802	0	1	04	01	H9930_802_0	6	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
H9930	802	0	1	04	01	H9930_802_0	6	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H9930	802	0	1	04	01	H9930_802_0	6	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H9930	803	0	1	04	01	H9930_803_0	6	1	011111110110111111101101111100001111111111100000	Out-Of-Network Services	1	20	20	3	2			2	
H9930	803	0	1	04	01	H9930_803_0	6	2	000000001001000000010000000000000000000000000000	OON Mental Health and Substance Abuse	1	50	50	3	2			2	
H9930	803	0	1	04	01	H9930_803_0	6	3	000000000000000000000000000000000000000000001111	OON Additional Benefits	1	20	20	3	2			2	
R3175	001	0	1	31	11	R3175_001_0	6	11	000000000000000000000000000010000000000000010000	Group 11	1	50	50	6	2			2	
R3175	001	0	1	31	11	R3175_001_0	6	10	000010000010000000000000000000000010000000000000	Group 10	2				1	25.00	25.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	1	010000110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	12	000001000000000000000000000000000000000000000000		1	0	50	6	1	0.00	35.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
R3175	001	0	1	31	11	R3175_001_0	6	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	6	1	7.00	7.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R3175	001	0	1	31	11	R3175_001_0	6	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	6	000010000010000010000000000000000010000000000000	Group 6	2				1	20.00	20.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	6	1	7.00	7.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	1	010000110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	10	000000000000000000000000000010000000000000010000	Group 10	1	50	50	6	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	11	000001000000000000000000000000000000000000000000		1	0	50	6	1	0.00	35.00	2	
R3175	003	0	1	31	11	R3175_003_0	5	4	100000000000000000000000001000000000000000010010	Group 4	2				1	0.00	0.00	2	
R3175	003	0	1	31	11	R3175_003_0	5	1	011101111111111111111111110101000111111111100101	Group 1	1	30	30	6	2			2	
R3175	003	0	1	31	11	R3175_003_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	10.00	2	
R3175	003	0	1	31	11	R3175_003_0	5	3	000000000000000000000000000000001000000000001000	Group 3	1	0	30	6	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
R3175	801	0	1	31	11	R3175_801_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
R3175	801	0	1	31	11	R3175_801_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
R3175	801	0	1	31	11	R3175_801_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R3175	801	0	1	31	11	R3175_801_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
R3175	802	0	1	31	11	R3175_802_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
R3175	802	0	1	31	11	R3175_802_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
R3175	802	0	1	31	11	R3175_802_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
R3175	802	0	1	31	11	R3175_802_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
R3175	803	0	1	31	11	R3175_803_0	3	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
R3175	803	0	1	31	11	R3175_803_0	3	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
R3175	803	0	1	31	11	R3175_803_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
R3175	803	0	1	31	11	R3175_803_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	35.00	35.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	10	000000000000000000000000001000000000000000000000	Group 10	1	20	20	2	2			2	
R3175	804	0	1	31	11	R3175_804_0	3	11	000000000000000000000000000100001100000000000000	Group 11	2				1	0.00	0.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	3	000100000000001101100000000001000001111111000000	Group 3	1	40	40	2	2			2	
R3175	804	0	1	31	11	R3175_804_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	40	40	2	1	7.00	7.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R3175	804	0	1	31	11	R3175_804_0	3	9	000000000000000000000001110000000000000000100010	Group 9	1	30	30	2	2			2	
R3444	001	0	1	31	11	R3444_001_0	11	5	001000001001000000010000000000000000000000000000	50 % Coinsurance	1	50	50	2	2			2	
R3444	001	0	1	31	11	R3444_001_0	11	3	000000000000000000000000000000000000000000011000	$15 Copay	2				1	15.00	15.00	2	
R3444	001	0	1	31	11	R3444_001_0	11	4	010011110110111111101101111100000101111111100111	20% Coinsurance	1	20	20	2	2			2	
R3444	001	0	1	31	11	R3444_001_0	11	1	000100000100000000000010000001001010000000000010	$0 Cost Sharing	2				1	0.00	0.00	2	
R3444	001	0	1	31	11	R3444_001_0	11	2	000000000000000000000000000000000000000000000100	$10 Copay	2				1	10.00	10.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	2	000000000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	3	000010000000000000000000000000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	4	000000001001000000010000000000000000000000000000	$15 Copay - Group	2				1	15.00	15.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	5	011001110110100000001000001000000000000000000111	$30 Copay	2				1	30.00	30.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	7	000000000000000001100100000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	6	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
R3444	002	0	1	31	11	R3444_002_0	9	8	000000000000011110000001100000000000000000100000	20 % Coinsurance	1	20	20	2	2			2	
R3444	003	0	1	31	11	R3444_003_0	8	7	000001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay - Individual	2				1	15.00	15.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	5	011000010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R3444	003	0	1	31	11	R3444_003_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R3444	003	0	1	31	11	R3444_003_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R3444	003	0	1	31	11	R3444_003_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R3444	003	0	1	31	11	R3444_003_0	8	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	6	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	7	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	8	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	9	000000000000011110000001100000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R3444	004	0	1	31	11	R3444_004_0	8	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	4	000000001001000000010000000000000000000000000000	$15 Copay - Group	2				1	15.00	15.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	3	000010000000000000000000000000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	2	000000000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
R3444	004	0	1	31	11	R3444_004_0	8	5	011001110110100000001000001000000000000000000111	$30 Copay	2				1	30.00	30.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	9	000000000000000001100000000000000000000000000000	$225 Copay	2				1	225.00	225.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	8	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	7	010000010110000000001000001000000000000000000000	$40 Copay	2				1	40.00	40.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	5	001001100000100000000000000000000000000000000111	$30 Copay	2				1	30.00	30.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	6	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	4	000010000000000000000000000000000000000000000000	$25 Copay	2				1	25.00	25.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	3	000000001001000000010000000000000000000000000000	$15 Copay - Group	2				1	15.00	15.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	2	000000000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
R3444	005	0	1	31	11	R3444_005_0	8	11	000000000000000000000001100000000000000000000000	35% Coinsurance	1	35	35	2	2			2	
R3444	005	0	1	31	11	R3444_005_0	8	10	000000000000011110000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R3444	005	0	1	31	11	R3444_005_0	8	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R3444	006	0	1	31	11	R3444_006_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R3444	006	0	1	31	11	R3444_006_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R3444	006	0	1	31	11	R3444_006_0	8	1	000100000100010011000010010100001111111111001010	$0 Copay	2				1	0.00	0.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	5	011000010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay - Individual	2				1	15.00	15.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	7	000001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R3444	006	0	1	31	11	R3444_006_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay- Individual	2				1	15.00	15.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	7	000000100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	8	000000000000000001100100000000000000000000000000	$50 Copay	2				1	50.00	50.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	9	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R3444	007	0	1	31	11	R3444_007_0	8	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	10	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R3444	007	0	1	31	11	R3444_007_0	8	11	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R3444	007	0	1	31	11	R3444_007_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R3444	007	0	1	31	11	R3444_007_0	8	5	011001010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	1	010011110110100000001000000000000010000000011101	Group 1	2				1	40.00	40.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	6	1	14.00	14.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R5287	002	0	1	31	11	R5287_002_0	5	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	6	1	13.00	13.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
R5287	002	0	1	31	11	R5287_002_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	1	010011110110100000001000000000000010000000011101	Group 1	2				1	40.00	40.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R5287	003	0	1	31	11	R5287_003_0	6	6	000000000000000000000000000000000000000000010000	Group 6	2				1	40.00	40.00	2	
R5287	003	0	1	31	11	R5287_003_0	6	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
R5287	003	0	1	31	11	R5287_003_0	6	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
R5287	003	0	1	31	11	R5287_003_0	6	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
R5287	003	0	1	31	11	R5287_003_0	6	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
R5287	003	0	1	31	11	R5287_003_0	6	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
R5287	801	0	1	31	11	R5287_801_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	1	2			2	
R5287	801	0	1	31	11	R5287_801_0	4	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
R5287	801	0	1	31	11	R5287_801_0	4	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R5287	801	0	1	31	11	R5287_801_0	4	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
R5287	802	0	1	31	11	R5287_802_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	1	2			2	
R5287	802	0	1	31	11	R5287_802_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
R5287	805	0	1	31	11	R5287_805_0	5	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	1	2			2	
R5287	805	0	1	31	11	R5287_805_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	2	2			2	
R5287	806	0	1	31	11	R5287_806_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	6	000000000000000010000000000000000000000000000000	Group 6	2				1	20.00	20.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	5	000000000000010000000000000000000000000000000000	Group 5	1	30	30	2	1	7.00	7.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	4	000000001001000000010000000000000000000000000000	Group 4	2				1	35.00	45.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	1	010011110110100000001000000000000010000000001101	Group 1	2				1	40.00	40.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R5287	806	0	1	31	11	R5287_806_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	1	2			2	
R5287	806	0	1	31	11	R5287_806_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R5342	001	0	1	31	11	R5342_001_0	5	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
R5342	001	0	1	31	11	R5342_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	15.00	15.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	6	2			2	
R5342	002	0	1	31	11	R5342_002_0	5	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R5342	002	0	1	31	11	R5342_002_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	15.00	15.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R5342	003	0	1	31	11	R5342_003_0	6	1	011101111111111111111111110101000111111111101101	Group 1	1	30	30	6	2			2	
R5342	003	0	1	31	11	R5342_003_0	6	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
R5342	003	0	1	31	11	R5342_003_0	6	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
R5342	003	0	1	31	11	R5342_003_0	6	2	000010000000000000000000000000000000000000000000	Group 2	1	20	30	6	2			2	
R5342	003	0	1	31	11	R5342_003_0	6	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	4	000000000000000000000000000000000000000000000010	Group 4	2				1	0.00	0.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	0	30	6	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	2	000010000000000000000000000000000000000000000000	Group 2	1	0	30	6	1	0.00	25.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	1	011101111111111111111101110101000111111111101101	Group 1	1	30	30	6	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	5	000000000000000000000000001000000000000000000000	Group 5	1	20	20	6	2			2	
R5342	801	0	1	31	11	R5342_801_0	3	3	000100000000000001100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R5342	801	0	1	31	11	R5342_801_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R5342	801	0	1	31	11	R5342_801_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	6	000000000000011100000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R5342	801	0	1	31	11	R5342_801_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R5342	802	0	1	31	11	R5342_802_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R5342	802	0	1	31	11	R5342_802_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R5342	802	0	1	31	11	R5342_802_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R5342	803	0	1	31	11	R5342_803_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R5342	803	0	1	31	11	R5342_803_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R5342	803	0	1	31	11	R5342_803_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R5342	804	0	1	31	11	R5342_804_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0.00	0.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R5342	804	0	1	31	11	R5342_804_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R5566	005	0	1	31	11	R5566_005_0	6	1	011111111111111111111101110100001011111111101111	Group 1	1	40	40	1	2			2	
R5566	005	0	1	31	11	R5566_005_0	6	2	000000000000000000000000000000000100000000000000	Group 2	1	0	0	1	2			2	
R5566	005	0	1	31	11	R5566_005_0	6	3	000000000000000000000000001000000000000000000000	Group 3	1	0	40	1	2			2	
R5566	804	0	1	31	11	R5566_804_0	4	1	000000000000000000000000001000000100000000000000	Group 1	1	20	50	1	2			2	
R5566	804	0	1	31	11	R5566_804_0	4	2	011111111111111111111101110100000011111111101111	Group 2	1	50	50	1	2			2	
R5566	804	0	1	31	11	R5566_804_0	4	3	000000000000000000000000000000001000000000000000	Group 3	1	50	50	2	2			2	
R5566	805	0	1	31	11	R5566_805_0	5	2	011111111111111111111101110100000011111111101111	Group 2	1	50	50	1	2			2	
R5566	805	0	1	31	11	R5566_805_0	5	3	000000000000000000000000000000001000000000000000	Group 3	1	50	50	2	2			2	
R5566	805	0	1	31	11	R5566_805_0	5	1	000000000000000000000000001000000100000000000000	Group 1	1	20	50	1	2			2	
R5595	001	0	1	31	11	R5595_001_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
R5595	001	0	1	31	11	R5595_001_0	8	3	000000000000000000000000000000001000000000000000	Tier 3	1	30	30	6	2			2	
R5595	001	0	1	31	11	R5595_001_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
R5595	001	0	1	31	11	R5595_001_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
R5595	001	0	1	31	11	R5595_001_0	8	1	011111111111111111111001110100000111111111111101	Tier 1	1	30	30	6	2			2	
R5595	003	0	1	31	11	R5595_003_0	9	3	000000000000000000000000000000001000000000000000	Tier 3	1	30	30	6	2			2	
R5595	003	0	1	31	11	R5595_003_0	9	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
R5595	003	0	1	31	11	R5595_003_0	9	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
R5595	003	0	1	31	11	R5595_003_0	9	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
R5595	003	0	1	31	11	R5595_003_0	9	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
R5595	004	0	1	31	11	R5595_004_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
R5595	004	0	1	31	11	R5595_004_0	8	3	000000000000000000000000000000001000000000000000	Tier 3	1	20	20	6	2			2	
R5595	004	0	1	31	11	R5595_004_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
R5595	004	0	1	31	11	R5595_004_0	8	1	011111111111111111111001110100000111111111101101	Tier 1	1	20	20	6	2			2	
R5595	004	0	1	31	11	R5595_004_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
R5595	005	0	1	31	11	R5595_005_0	10	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	100.00	100.00	2	
R5595	005	0	1	31	11	R5595_005_0	10	1	011111111111111111111001110100000111111111101101	Tier 1	1	30	30	6	2			2	
R5595	005	0	1	31	11	R5595_005_0	10	3	000000000000000000000000000000001000000000000000	Tier 3	1	30	30	6	2			2	
R5595	005	0	1	31	11	R5595_005_0	10	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
R5595	005	0	1	31	11	R5595_005_0	10	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
R5595	006	0	1	31	11	R5595_006_0	10	7	100000000000000000000000000000000000000000000010	Tier 7	2				1	0.00	0.00	2	
R5595	006	0	1	31	11	R5595_006_0	10	6	000000000000000000000000000000000000000000011000	Tier 6	1	20	50	6	2			2	
R5595	006	0	1	31	11	R5595_006_0	10	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	0.00	0.00	2	
R5595	006	0	1	31	11	R5595_006_0	10	3	000000000000000000000010000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
R5595	006	0	1	31	11	R5595_006_0	10	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	50.00	50.00	2	
R5595	006	0	1	31	11	R5595_006_0	10	1	011111111111111111111001110100000111111111100101	Tier 1	1	20	20	6	2			2	
R5595	006	0	1	31	11	R5595_006_0	10	5	000000000000000000000000000000001000000000000000	Tier 5	1	20	20	6	2			2	
R5595	007	0	1	31	11	R5595_007_0	8	5	100000000000000000000000000000000000000000000010	Tier 5	2				1	0.00	0.00	2	
R5595	007	0	1	31	11	R5595_007_0	8	1	011111111111111111111001110100000111111111111101	Tier 1	1	30	30	6	2			2	
R5595	007	0	1	31	11	R5595_007_0	8	2	000000000000000000000100000000000000000000000000	Tier 2	2				1	150.00	150.00	2	
R5595	007	0	1	31	11	R5595_007_0	8	3	000000000000000000000000000000001000000000000000	Tier 3	1	30	30	6	2			2	
R5595	007	0	1	31	11	R5595_007_0	8	4	000000000000000000000000001000000000000000000000	Tier 4	2				1	25.00	25.00	2	
R5595	801	0	1	31	11	R5595_801_0	6	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
R5595	801	0	1	31	11	R5595_801_0	6	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
R5595	801	0	1	31	11	R5595_801_0	6	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
R5595	802	0	1	31	11	R5595_802_0	6	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
R5595	802	0	1	31	11	R5595_802_0	6	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
R5595	802	0	1	31	11	R5595_802_0	6	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
R5595	803	0	1	31	11	R5595_803_0	6	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
R5595	803	0	1	31	11	R5595_803_0	6	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
R5595	803	0	1	31	11	R5595_803_0	6	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
R5595	804	0	1	31	11	R5595_804_0	6	3	000100000000000000000000000000000000000000000000	Tier 3	2				1	0.00	0.00	2	
R5595	804	0	1	31	11	R5595_804_0	6	2	000000001001000000010000000000000000000000000000	Tier 2	1	50	50	6	2			2	
R5595	804	0	1	31	11	R5595_804_0	6	1	011011110110111111101101111100001111111111101111	Tier 1	1	20	20	6	2			2	
R5674	001	0	1	31	11	R5674_001_0	12	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
R5674	001	0	1	31	11	R5674_001_0	12	13	000000000000000000000000000000000000010000000000	Colorectal Screening Group 2	2				1	20.00	35.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	12	000000000000000000000000000000000000010000000000	Colorectal Screening Group	1	40	40	1	2			2	
R5674	001	0	1	31	11	R5674_001_0	12	11	000000000000000000000001110000000000000000000000	25% Group	1	25	25	1	2			2	
R5674	001	0	1	31	11	R5674_001_0	12	10	000001100100100000011000001000000000000010000101	$40 Group	2				1	40.00	40.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	1	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
R5674	001	0	1	31	11	R5674_001_0	12	9	000000011001000000000000000000000010000000001000	$35 Group	2				1	35.00	35.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	4	000000000010000001100000000000000101100000000000	$20-$35 Group	2				1	20.00	35.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	7	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
R5674	001	0	1	31	11	R5674_001_0	12	8	000000000000000000000000000000000000001101000000	30% Group	1	30	30	1	2			2	
R5674	001	0	1	31	11	R5674_001_0	12	3	000000000000000000000000000000001000000000000000	Health Education Wellness	2				1	0.00	35.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	13	000000000000000000000000000000001000000000000000	Health Education Wellness	2				1	0.00	40.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	12	000000000010000001100000000000000101100000000000	$20-$35 Group	2				1	20.00	35.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	11	000000000000000000000001110000000000000000000000	25% Group	1	25	25	1	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	10	000001101100100000011000001000000000000010001101	$40 Group	2				1	40.00	40.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	1	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	3	000000000000000000000000000000000000010000000000	Colorectal Screening Group	2				1	20.00	35.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	9	000000010001000000000000000000000010000000000000	$35 Group	2				1	35.00	35.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	8	000000000000000000000000000000000000001101000000	30% Group	1	30	30	1	2			2	
R5674	801	0	1	31	11	R5674_801_0	7	7	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
R5674	801	0	1	31	11	R5674_801_0	7	4	000000000000000000000000000000000000010000000000	Colorectal Screening Group 2	1	40	40	1	2			2	
R5674	802	0	1	31	11	R5674_802_0	7	1	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
R5674	802	0	1	31	11	R5674_802_0	7	10	000001101100100000011000001000000000000010001101	$40 Group	2				1	40.00	40.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	11	000000000000000000000001110000000000000000000000	25% Group	1	25	25	1	2			2	
R5674	802	0	1	31	11	R5674_802_0	7	12	000000000010000001100000000000000101100000000000	$20-$35 Group	2				1	20.00	35.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	13	000000000000000000000000000000001000000000000000	Health Education Wellness	2				1	0.00	40.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
R5674	802	0	1	31	11	R5674_802_0	7	9	000000010001000000000000000000000010000000000000	$35 Group	2				1	35.00	35.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	7	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	4	000000000000000000000000000000000000010000000000	Colorectal Screening Group 2	1	40	40	1	2			2	
R5674	802	0	1	31	11	R5674_802_0	7	3	000000000000000000000000000000000000010000000000	Colorectal Screening Group	2				1	20.00	35.00	2	
R5674	802	0	1	31	11	R5674_802_0	7	8	000000000000000000000000000000000000001101000000	30% Group	1	30	30	1	2			2	
R5674	803	0	1	31	11	R5674_803_0	7	12	000000000010000001100000000000000101100000000000	$20-$35 Group	2				1	20.00	35.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	13	000000000000000000000000000000001000000000000000	Health Education Wellness	2				1	0.00	40.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	2	000100000000011110000000000000000000000000000010	40% Group	1	40	40	1	2			2	
R5674	803	0	1	31	11	R5674_803_0	7	3	000000000000000000000000000000000000010000000000	Colorectal Screening Group	2				1	20.00	35.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	4	000000000000000000000000000000000000010000000000	Colorectal Screening Group 2	1	40	40	1	2			2	
R5674	803	0	1	31	11	R5674_803_0	7	5	000000000000000000000100000000000000000000000000	Ambulance Group	1	40	40	1	1	100.00	100.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	6	011000000000000000000000000100000000000000000000	$0 Group	2				1	0.00	0.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	7	000010000000000000000000000000000000000000000000	$20 Group	2				1	20.00	20.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	8	000000000000000000000000000000000000001101000000	30% Group	1	30	30	1	2			2	
R5674	803	0	1	31	11	R5674_803_0	7	9	000000010001000000000000000000000010000000000000	$35 Group	2				1	35.00	35.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	1	000000000000000000000000000000000000000000100000	20% Group	1	20	20	1	2			2	
R5674	803	0	1	31	11	R5674_803_0	7	10	000001101100100000011000001000000000000010001101	$40 Group	2				1	40.00	40.00	2	
R5674	803	0	1	31	11	R5674_803_0	7	11	000000000000000000000001110000000000000000000000	25% Group	1	25	25	1	2			2	
R5826	001	0	1	31	11	R5826_001_0	5	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
R5826	001	0	1	31	11	R5826_001_0	5	2	000011010111000000000000000000000111100000001101		2				1	40.00	40.00	2	
R5826	001	0	1	31	11	R5826_001_0	5	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
R5826	001	0	1	31	11	R5826_001_0	5	7	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
R5826	001	0	1	31	11	R5826_001_0	5	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
R5826	001	0	1	31	11	R5826_001_0	5	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
R5826	001	0	1	31	11	R5826_001_0	5	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
R5826	001	0	1	31	11	R5826_001_0	5	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	40.00	40.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
R5826	002	0	1	31	11	R5826_002_0	6	7	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
R5826	002	0	1	31	11	R5826_002_0	6	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
R5826	002	0	1	31	11	R5826_002_0	6	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	40.00	40.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	2	000011010111000000000000000000000111100000001101		2				1	40.00	40.00	2	
R5826	002	0	1	31	11	R5826_002_0	6	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
R5826	003	0	1	31	11	R5826_003_0	5	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	40.00	40.00	2	
R5826	003	0	1	31	11	R5826_003_0	5	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
R5826	003	0	1	31	11	R5826_003_0	5	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
R5826	003	0	1	31	11	R5826_003_0	5	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
R5826	003	0	1	31	11	R5826_003_0	5	7	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
R5826	003	0	1	31	11	R5826_003_0	5	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
R5826	003	0	1	31	11	R5826_003_0	5	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
R5826	003	0	1	31	11	R5826_003_0	5	2	000011010111000000000000000000000111100000001101		2				1	40.00	40.00	2	
R5826	004	0	1	31	11	R5826_004_0	5	7	000000000000000000000000001000000000000000000000		1	20	20	6	1	0.00	0.00	2	
R5826	004	0	1	31	11	R5826_004_0	5	6	000000000000000000000000000000001000000000011000		1	50	50	6	2			2	
R5826	004	0	1	31	11	R5826_004_0	5	8	000000000000000000000000000000000000000000000010		2				1	0.00	0.00	2	
R5826	004	0	1	31	11	R5826_004_0	5	1	011100000000000001100001100000000000000000000000		1	30	30	6	2			2	
R5826	004	0	1	31	11	R5826_004_0	5	2	000011010111000000000000000000000111100000001101		2				1	35.00	35.00	2	
R5826	004	0	1	31	11	R5826_004_0	5	3	000000101000111110011000000100000000011111000000		1	30	30	6	1	35.00	35.00	2	
R5826	004	0	1	31	11	R5826_004_0	5	4	000000000000000000000100000000000000000000000000		2				1	100.00	100.00	2	
R5826	004	0	1	31	11	R5826_004_0	5	5	000000000000000000000000010000000000000000100000		1	20	30	6	2			2	
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R5826	824	0	1	31	11	R5826_824_0	8	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
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R5826	825	0	1	31	11	R5826_825_0	8	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	825	0	1	31	11	R5826_825_0	8	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
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R5826	827	0	1	31	11	R5826_827_0	8	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	827	0	1	31	11	R5826_827_0	8	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
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R5826	828	0	1	31	11	R5826_828_0	10	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	828	0	1	31	11	R5826_828_0	10	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
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R5826	831	0	1	31	11	R5826_831_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
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R5826	832	0	1	31	11	R5826_832_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	832	0	1	31	11	R5826_832_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	833	0	1	31	11	R5826_833_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	833	0	1	31	11	R5826_833_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	833	0	1	31	11	R5826_833_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	834	0	1	31	11	R5826_834_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	834	0	1	31	11	R5826_834_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	834	0	1	31	11	R5826_834_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	835	0	1	31	11	R5826_835_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	835	0	1	31	11	R5826_835_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	835	0	1	31	11	R5826_835_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	836	0	1	31	11	R5826_836_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	836	0	1	31	11	R5826_836_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	836	0	1	31	11	R5826_836_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	837	0	1	31	11	R5826_837_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	837	0	1	31	11	R5826_837_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	837	0	1	31	11	R5826_837_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	838	0	1	31	11	R5826_838_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	838	0	1	31	11	R5826_838_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	838	0	1	31	11	R5826_838_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	839	0	1	31	11	R5826_839_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	839	0	1	31	11	R5826_839_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	839	0	1	31	11	R5826_839_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	840	0	1	31	11	R5826_840_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	840	0	1	31	11	R5826_840_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	840	0	1	31	11	R5826_840_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	841	0	1	31	11	R5826_841_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	841	0	1	31	11	R5826_841_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	841	0	1	31	11	R5826_841_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	842	0	1	31	11	R5826_842_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	842	0	1	31	11	R5826_842_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	842	0	1	31	11	R5826_842_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	843	0	1	31	11	R5826_843_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	843	0	1	31	11	R5826_843_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	843	0	1	31	11	R5826_843_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	844	0	1	31	11	R5826_844_0	8	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	844	0	1	31	11	R5826_844_0	8	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	844	0	1	31	11	R5826_844_0	8	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	845	0	1	31	11	R5826_845_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	845	0	1	31	11	R5826_845_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	845	0	1	31	11	R5826_845_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	846	0	1	31	11	R5826_846_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	846	0	1	31	11	R5826_846_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	846	0	1	31	11	R5826_846_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	847	0	1	31	11	R5826_847_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	847	0	1	31	11	R5826_847_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	847	0	1	31	11	R5826_847_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	848	0	1	31	11	R5826_848_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	848	0	1	31	11	R5826_848_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	848	0	1	31	11	R5826_848_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	849	0	1	31	11	R5826_849_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	849	0	1	31	11	R5826_849_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	849	0	1	31	11	R5826_849_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	850	0	1	31	11	R5826_850_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	850	0	1	31	11	R5826_850_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	850	0	1	31	11	R5826_850_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	851	0	1	31	11	R5826_851_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	851	0	1	31	11	R5826_851_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	851	0	1	31	11	R5826_851_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	852	0	1	31	11	R5826_852_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	852	0	1	31	11	R5826_852_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	852	0	1	31	11	R5826_852_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	853	0	1	31	11	R5826_853_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	853	0	1	31	11	R5826_853_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	853	0	1	31	11	R5826_853_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	854	0	1	31	11	R5826_854_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	854	0	1	31	11	R5826_854_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	854	0	1	31	11	R5826_854_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	855	0	1	31	11	R5826_855_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	855	0	1	31	11	R5826_855_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	855	0	1	31	11	R5826_855_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	856	0	1	31	11	R5826_856_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	856	0	1	31	11	R5826_856_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	856	0	1	31	11	R5826_856_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	857	0	1	31	11	R5826_857_0	6	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	857	0	1	31	11	R5826_857_0	6	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	857	0	1	31	11	R5826_857_0	6	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5826	858	0	1	31	11	R5826_858_0	7	1	011011110110101111101101111100001111111111101111		1	20	20	6	2			2	
R5826	858	0	1	31	11	R5826_858_0	7	2	000000001001000000010000000000000000000000010000		1	50	50	6	2			2	
R5826	858	0	1	31	11	R5826_858_0	7	3	000100000000010000000000000000000000000000000000		1	0	20	6	2			2	
R5863	001	0	1	31	11	R5863_001_0	11	1	000000000000000000000100000000000000000000000000	Group 1	2				1	200.00	200.00	2	
R5863	001	0	1	31	11	R5863_001_0	11	2	000000000000000001100000000000000000000000000000	Group 2	2				1	0.00	450.00	2	
R5863	001	0	1	31	11	R5863_001_0	11	9	000000000000000010000000000000000000000000000000	Group 9	2				1	20.00	20.00	2	
R5863	001	0	1	31	11	R5863_001_0	11	8	000000000000000100000000000000000000000000100000	Group 8	1	25	25	2	2			2	
R5863	001	0	1	31	11	R5863_001_0	11	7	000000000000011000000001100000000000000000001111	Group 7	1	30	30	2	2			2	
R5863	001	0	1	31	11	R5863_001_0	11	6	000000000000000000000000011000000000000000010000	Group 6	1	20	20	2	2			2	
R5863	001	0	1	31	11	R5863_001_0	11	5	011001111111100000011000000000000000000000000000	Group 5	2				1	45.00	45.00	2	
R5863	001	0	1	31	11	R5863_001_0	11	4	000010000000000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R5863	001	0	1	31	11	R5863_001_0	11	3	000100000000000000000000000100001101111111000000	Group 3	2				1	0.00	0.00	2	
R5863	801	0	1	31	11	R5863_801_0	4	1	000100000000010000000000000100001100000000000000	Group 1	2				1	0.00	0.00	2	
R5863	801	0	1	31	11	R5863_801_0	4	2	011011110110101111101101111000000111111111101111	Group 2	1	20	20	2	2			2	
R5863	801	0	1	31	11	R5863_801_0	4	3	000000001001000000010000000000000000000000000000	Group 3	1	50	50	2	2			2	
R5863	803	0	1	31	11	R5863_803_0	4	1	000100000000010000000000000100001100000000000000	Group 1	2				1	0.00	0.00	2	
R5863	803	0	1	31	11	R5863_803_0	4	3	000000001001000000010000000000000000000000000000	Group 3	1	50	50	2	2			2	
R5863	803	0	1	31	11	R5863_803_0	4	2	011011110110101111101101111000000111111111101111	Group 2	1	20	20	2	2			2	
R5863	804	0	1	31	11	R5863_804_0	4	1	000100000000010000000000000100001100000000000000	Group 1	2				1	0.00	0.00	2	
R5863	804	0	1	31	11	R5863_804_0	4	2	011011110110101111101101111000000111111111101111	Group 2	1	20	20	2	2			2	
R5863	804	0	1	31	11	R5863_804_0	4	3	000000001001000000010000000000000000000000000000	Group 3	1	50	50	2	2			2	
R5863	806	0	1	31	11	R5863_806_0	4	3	000000001001000000010000000000000000000000000000	Group 3	1	50	50	2	2			2	
R5863	806	0	1	31	11	R5863_806_0	4	2	011011110110101111101101111000000111111111101111	Group 2	1	20	20	2	2			2	
R5863	806	0	1	31	11	R5863_806_0	4	1	000100000000010000000000000100001100000000000000	Group 1	2				1	0.00	0.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	13	000000000000000000000000000000000000000000010000	OON Preventive Dental	1	50	50	3	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	11	000000000000000000000000000000000000000000001000	OON No Copayment Comprehensive Dental	2				1	0.00	0.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	10	000100000010000001001000000101111111110100000000	OON No Copayment	2				1	0.00	0.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	10	000100000010000001001000000101111111110100000000	OON No Copayment	2				1	0.00	0.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	11	000000000000000000000000000000000000000000001000	OON No Copayment Comprehensive Dental	2				1	0.00	0.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
R5941	002	0	1	31	11	R5941_002_0	10	13	000000000000000000000000000000000000000000010000	OON Preventive Dental	1	50	50	6	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
R5941	002	0	1	31	11	R5941_002_0	10	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	20.00	20.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	7	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	10	000100000010000001001000000101111111110100000000	OON No Copayment	2				1	0.00	0.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	11	000000000000000000000000000000000000000000001000	OON No Copayment Comprehensive Dental	2				1	0.00	0.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	7	13	000000000000000000000000000000000000000000010000	OON Preventive Dental	1	50	50	6	2			2	
R5941	003	0	1	31	11	R5941_003_0	7	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	7	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	7	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
R5941	003	0	1	31	11	R5941_003_0	7	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	6	000010000000000000000000000000000000000000000000	OON PCP	2				1	15.00	15.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	1	000000000000000100000000001000000000000011100000	20% Coinsurance OON	1	20	20	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	8	8	001000001001000000010000000000000000000000000000	OON Mental Health/Substance Abuse	2				1	45.00	45.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	9	000000000000000000000100000000000000000000000000	OON Ambulance Services	2				1	100.00	100.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	7	010001110100100000000000000000000000001000000101	OON Specialist	2				1	40.00	40.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	10	000100000010000001001000000101111111110100000000	OON No Copayment	2				1	0.00	0.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	11	000000000000000000000000000000000000000000001000	OON No Copayment Comprehensive Dental	2				1	0.00	0.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	12	000000000000000000000000000000000000000000000010	OON Eyewear	2				1	0.00	40.00	2	
R5941	004	0	1	31	11	R5941_004_0	8	13	000000000000000000000000000000000000000000010000	OON Preventive Dental	1	50	50	6	2			2	
R5941	004	0	1	31	11	R5941_004_0	8	2	000000000000001010000000000000000000000000000000	25% Coinsurance OON	1	25	25	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	8	3	000000000000000000000001110000000000000000000000	30% Coinsurance OON	1	30	30	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	8	4	000000000000010000000000000000000000000000000000	OON Labs	1	0	25	3	2			2	
R5941	004	0	1	31	11	R5941_004_0	8	5	000000000000000000100000000000000000000000000000	OON Outpatient Surgery	2				1	275.00	275.00	2	
R5941	801	0	1	31	11	R5941_801_0	5	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R5941	801	0	1	31	11	R5941_801_0	5	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R5941	802	0	1	31	11	R5941_802_0	6	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R5941	802	0	1	31	11	R5941_802_0	6	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R5941	805	0	1	31	11	R5941_805_0	5	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R5941	805	0	1	31	11	R5941_805_0	5	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R5941	806	0	1	31	11	R5941_806_0	6	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R5941	806	0	1	31	11	R5941_806_0	6	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R5941	807	0	1	31	11	R5941_807_0	5	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R5941	807	0	1	31	11	R5941_807_0	5	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R5941	808	0	1	31	11	R5941_808_0	6	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R5941	808	0	1	31	11	R5941_808_0	6	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R6801	001	0	1	31	11	R6801_001_0	11	2	000000000000000000000000000000000000000000000100	$10 Copay	2				1	10.00	10.00	2	
R6801	001	0	1	31	11	R6801_001_0	11	1	000100000100000000000010000001001010000000000010	0% Cost Sharing	1	0	0	2	2			2	
R6801	001	0	1	31	11	R6801_001_0	11	3	000000000000000000000000000000000000000000011000	$15 Copay	2				1	15.00	15.00	2	
R6801	001	0	1	31	11	R6801_001_0	11	4	010011110110111111101101111100000101111111100111	20% Coinsurance	1	20	20	2	2			2	
R6801	001	0	1	31	11	R6801_001_0	11	5	001000001001000000010000000000000000000000000000	50% Coinsurance	1	50	50	2	2			2	
R6801	002	0	1	31	11	R6801_002_0	8	7	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	9	000001000100000000000000000000000000000000000000	$30 Copay	2				1	30.00	30.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	8	000000000000011110000001100000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R6801	002	0	1	31	11	R6801_002_0	8	4	011000110010100000001000001000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	3	000000001001000000010000000000000000000000000000	$10 Copay - Group	2				1	10.00	10.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	5	000000001001000000010000000000000000000000000000	$30 copay - Individual	2				1	30.00	30.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	2	000010000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R6801	002	0	1	31	11	R6801_002_0	8	6	000000000000000001100000000000000000000000000000	$175 Copay	2				1	175.00	175.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	5	011000010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R6801	003	0	1	31	11	R6801_003_0	9	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R6801	003	0	1	31	11	R6801_003_0	9	10	000000000000000000000001100000000000000000000000	10% and 20%  Coinsurance	1	10	20	2	2			2	
R6801	003	0	1	31	11	R6801_003_0	9	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	6	000000001001000000010000000000000000000000000000	$15 Copay - Individual	2				1	15.00	15.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R6801	003	0	1	31	11	R6801_003_0	9	7	000001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	9	000000000000000000000001100000000000000000000000	30% Coinsurance	1	30	30	2	2			2	
R6801	004	0	1	31	11	R6801_004_0	9	8	000000000000011110000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R6801	004	0	1	31	11	R6801_004_0	9	7	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	2	000010000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	5	000000001001000000010000000000000000000000000000	$25 Copay - Individual	2				1	25.00	25.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	4	011001110110100000001000001000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	3	000000001001000000010000000000000000000000000000	$10 Copay - Group	2				1	10.00	10.00	2	
R6801	004	0	1	31	11	R6801_004_0	9	6	000000000000000001100000000000000000000000000000	$100Copay	2				1	100.00	100.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	6	000000001001000000010000000000000000000000000000	$25 Copay - Individual	2				1	25.00	25.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	7	010000010110000000001000001000000000000000000000	$35 Copay	2				1	35.00	35.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	8	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	5	001001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	4	000010000000000000000000000000000000000000000000	$20 Copay	2				1	20.00	20.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	3	000000001001000000010000000000000000000000000000	$10 Copay - Group	2				1	10.00	10.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	2	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	11	000000000000000000000001100000000000000000000000	35% Coinsurance	1	35	35	2	2			2	
R6801	005	0	1	31	11	R6801_005_0	8	10	000000000000011110000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R6801	005	0	1	31	11	R6801_005_0	8	9	000000000000000001100000000000000000000000000000	$225 Copay	2				1	225.00	225.00	2	
R6801	005	0	1	31	11	R6801_005_0	8	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R6801	006	0	1	31	11	R6801_006_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R6801	006	0	1	31	11	R6801_006_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R6801	006	0	1	31	11	R6801_006_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	5	011000010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay - Individual	2				1	15.00	15.00	2	
R6801	006	0	1	31	11	R6801_006_0	8	7	000001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R6801	007	0	1	31	11	R6801_007_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R6801	007	0	1	31	11	R6801_007_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R6801	007	0	1	31	11	R6801_007_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	9	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	5	011001010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay - Individual	2				1	15.00	15.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	7	000000100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	8	000000000000000001100000000000000000000000000000	$50 Copay	2				1	50.00	50.00	2	
R6801	007	0	1	31	11	R6801_007_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	1	010001110100100000001000000000000000000000001101	Group 1	2				1	30.00	30.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	7	000000000000000000000100000000000000000000000000	Group 7	2				1	150.00	150.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	6	2			2	
R7444	001	0	1	31	11	R7444_001_0	5	4	000010000010000000000000000000000010000000000000	Group 4	2				1	25.00	25.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	6	1	7.00	7.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	10	000000000000000010000000000000000000000000000000	Group 10	2				1	20.00	20.00	2	
R7444	001	0	1	31	11	R7444_001_0	5	8	000000000000000000000000001000000000000000000000	Group 8	1	20	20	6	2			2	
R7444	001	0	1	31	11	R7444_001_0	5	9	000000000000000000000000000100001100000000000000	Group 9	2				1	0.00	0.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R7444	801	0	1	31	11	R7444_801_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R7444	801	0	1	31	11	R7444_801_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
R7444	801	0	1	31	11	R7444_801_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R7444	801	0	1	31	11	R7444_801_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R7444	802	0	1	31	11	R7444_802_0	4	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R7444	802	0	1	31	11	R7444_802_0	4	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
R7444	802	0	1	31	11	R7444_802_0	4	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R7444	803	0	1	31	11	R7444_803_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
R7444	803	0	1	31	11	R7444_803_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R7444	803	0	1	31	11	R7444_803_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R7444	803	0	1	31	11	R7444_803_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	8	000000000000000000000100000000000000000000000000	Group 8	2				1	150.00	150.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	7	000000000000000010000000000000000000000000000000	Group 7	2				1	20.00	20.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	1	010001110100100000001000000000000000000000001101	Group 1	2				1	40.00	40.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	10	000000000000000000000000000100001100000000000000	Group 10	2				1	0	0	2	
R7444	804	0	1	31	11	R7444_804_0	3	2	001000000000000000000000000000000000000000000000	Group 2	2				1	75.00	75.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	3	000100000000001101100001110001000001111111100010	Group 3	1	30	30	2	2			2	
R7444	804	0	1	31	11	R7444_804_0	3	4	000010000010000000000000000000000010000000000000	Group 4	2				1	30.00	30.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	9	000000000000000000000000001000000000000000000000	Group 9	1	20	20	2	2			2	
R7444	804	0	1	31	11	R7444_804_0	3	6	000000000000010000000000000000000000000000000000	Group 6	1	30	30	2	1	7.00	7.00	2	
R7444	804	0	1	31	11	R7444_804_0	3	5	000000001001000000010000000000000000000000000000	Group 5	2				1	35.00	45.00	2	
R9896	001	0	1	31	11	R9896_001_0	11	4	010011110110111111101101111100000101111111100111	20% Coinsurance	1	20	20	2	2			2	
R9896	001	0	1	31	11	R9896_001_0	11	5	001000001001000000010000000000000000000000000000	50% Coinsurance	1	50	50	2	2			2	
R9896	001	0	1	31	11	R9896_001_0	11	1	000100000100000000000010000001001010000000000010	$0 Cost Sharing	2				1	0.00	0.00	2	
R9896	001	0	1	31	11	R9896_001_0	11	2	000000000000000000000000000000000000000000000100	$10 Copay	2				1	10.00	10.00	2	
R9896	001	0	1	31	11	R9896_001_0	11	3	000000000000000000000000000000000000000000011000	$15 Copay	2				1	15.00	15.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	4	000000001001000000010000000000000000000000000000	$15 Copay - Group	2				1	15.00	15.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	5	000000000000000000000000000000000000000000000100	$25 Copay	2				1	25.00	25.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	6	011001110110100000001000001000000000000000000111	$30 Copay	2				1	30.00	30.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	7	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	8	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	3	000010000000000000000000000000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	2	000000000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	9	000000000000000001100000000000000000000000000000	$185 Copay	2				1	185.00	185.00	2	
R9896	002	0	1	31	11	R9896_002_0	8	11	000000000000000000000001100000000000000000000000	35% Coinsurance	1	35	35	2	2			2	
R9896	002	0	1	31	11	R9896_002_0	8	10	000000000000011110000000000000000000000000100000	20% Consurance	1	20	20	2	2			2	
R9896	003	0	1	31	11	R9896_003_0	8	5	011000010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R9896	003	0	1	31	11	R9896_003_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R9896	003	0	1	31	11	R9896_003_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R9896	003	0	1	31	11	R9896_003_0	8	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay - Individual	2				1	15.00	15.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R9896	003	0	1	31	11	R9896_003_0	8	7	000001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	9	000000000000011110000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R9896	004	0	1	31	11	R9896_004_0	8	8	000000000000000001100000000000000000000000000000	$165 Copay	2				1	165.00	165.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	7	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	6	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	4	010000010110000000001000001000000000000000000100	$25 Copay	2				1	25.00	25.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	3	000000001001000000010000000000000000000000000000	$15 Copay - Group	2				1	15.00	15.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	2	000010000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
R9896	004	0	1	31	11	R9896_004_0	8	10	000000000000000000000001100000000000000000000000	35% Coinsurance	1	35	35	2	2			2	
R9896	004	0	1	31	11	R9896_004_0	8	5	001001100000100000000000000000000000000000000111	$30 Copay	2				1	30.00	30.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	6	011001110110100000001000001000000000000000000111	$30 Copay	2				1	30.00	30.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	7	000000001001000000010000000000000000000000000000	$30 Copay - Individual	2				1	30.00	30.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	8	000000000000000000000100000000000000000000000000	$150 Copay	2				1	150.00	150.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	5	000000000000000000000000000000000000000000000100	$25 Copay	2				1	25.00	25.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	4	000000001001000000010000000000000000000000000000	$15 Copay - Group	2				1	15.00	15.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	3	000010000000000000000000000000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	2	000000000000000000000000000000000000000000010000	$10 Copay	2				1	10.00	10.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	11	000000000000000000000001100000000000000000000000	35% Coinsurance	1	35	35	2	2			2	
R9896	005	0	1	31	11	R9896_005_0	9	10	000000000000011110000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R9896	005	0	1	31	11	R9896_005_0	9	9	000000000000000001100000000000000000000000000000	$250 Copay	2				1	250.00	250.00	2	
R9896	005	0	1	31	11	R9896_005_0	9	1	000100000100000001000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	1	000100000100010011000010010100001111111111001010	$0 Cost Sharing	2				1	0.00	0.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R9896	006	0	1	31	11	R9896_006_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R9896	006	0	1	31	11	R9896_006_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R9896	006	0	1	31	11	R9896_006_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	5	011000010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay- Individual	2				1	15.00	15.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	7	000001100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	8	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R9896	006	0	1	31	11	R9896_006_0	8	9	000000000000000001100000000000000000000000000000	$100 Copay	2				1	100.00	100.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	1	000100000100010011000010010100001111111111001010		2				1	0.00	0.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	10	000000000000000000000001100000000000000000000000	10% and 20% Coinsurance	1	10	20	2	2			2	
R9896	007	0	1	31	11	R9896_007_0	8	11	000000000000001000000000000000000000000000000000	10% Coinsurance	1	10	10	2	2			2	
R9896	007	0	1	31	11	R9896_007_0	8	12	000000000000000100000000000000000000000000100000	20% Coinsurance	1	20	20	2	2			2	
R9896	007	0	1	31	11	R9896_007_0	8	2	000010000000000000000000000000000000000000000000	$5 Copay	2				1	5.00	5.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	9	000000000000000000000100000000000000000000000000	$75 Copay	2				1	75.00	75.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	4	000000000000000000000000000000000000000000010110	$10 Copay	2				1	10.00	10.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	5	011001010110000000001000001000000000000000000000	$15 Copay	2				1	15.00	15.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	6	000000001001000000010000000000000000000000000000	$15 Copay -Individual	2				1	15.00	15.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	7	000000100000100000000000000000000000000000000001	$25 Copay	2				1	25.00	25.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	8	000000000000000001100000000000000000000000000000	$50 Copay	2				1	50.00	50.00	2	
R9896	007	0	1	31	11	R9896_007_0	8	3	000000001001000000010000000000000000000000000000	$5 Copay - Group	2				1	5.00	5.00	2	
R9943	001	0	1	31	11	R9943_001_0	14	1	100101101111111010111000000100000111111111011111	20% OON Coinsurance Group	1	20	20	2	2			2	
R9943	001	0	1	31	11	R9943_001_0	14	2	011000000000000001000000001000000000000000000000	10% OON Coinsurance Group	1	10	10	2	2			2	
R9943	001	0	1	31	11	R9943_001_0	14	9	000000000000000000000000000000001000000000000000	$0 Copayment Group	2				1	0.00	0.00	2	
R9943	001	0	1	31	11	R9943_001_0	14	8	000000000000000000000000010000000000000000000000	15% Coinsurance Group	1	15	15	2	2			2	
R9943	001	0	1	31	11	R9943_001_0	14	7	000000000000000000000100000000000000000000000000	$100 Copayment Group	2				1	100.00	100.00	2	
R9943	001	0	1	31	11	R9943_001_0	14	6	000000000000011010000000000000000000000000000000	$150 Copayment Group	2				1	150.00	150.00	2	
R9943	001	0	1	31	11	R9943_001_0	14	5	000000010000000000000000000000000000000000000000	$35 Copayment Group	2				1	35.00	35.00	2	
R9943	001	0	1	31	11	R9943_001_0	14	3	000000000000000100000001100000000000000000100000	30% OON Coinsurance Group	1	30	30	2	2			2	
R9943	001	0	1	31	11	R9943_001_0	14	4	000010000000000000000000000000000000000000000000	$25 Copayment Group	2				1	25.00	25.00	2	
R9943	805	0	1	31	11	R9943_805_0	6	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R9943	805	0	1	31	11	R9943_805_0	6	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R9943	806	0	1	31	11	R9943_806_0	6	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R9943	806	0	1	31	11	R9943_806_0	6	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
R9943	807	0	1	31	11	R9943_807_0	6	1	011111110110111111111101111100001111111111101111		1	20	20	6	2			2	
R9943	807	0	1	31	11	R9943_807_0	6	2	000000001001000000000000000000000000000000000000		1	50	50	6	2			2	
