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_grp_lbl	pbp_c_oon_outpt_bendesc_cats	pbp_c_oon_outpt_coins_yn	pbp_c_oon_outpt_coins_min_pct	pbp_c_oon_outpt_coins_max_pct	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
H0084	001	0	1	04	01	H0084_001_0	10	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	10	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
H0084	001	0	1	04	01	H0084_001_0	10	11	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
H0084	001	0	1	04	01	H0084_001_0	10	12	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
H0084	001	0	1	04	01	H0084_001_0	10	2	$10 Copay	000000000000000000000000000000000000000000010110	2			1	10.00	10.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	9	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
H0084	001	0	1	04	01	H0084_001_0	10	4	$0 - $40 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	40.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	5	$25 -$40 Copay	000000001001000000010000000000000000000000000000	2			1	25.00	40.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	6	$40 Copay	011001110010100000001000000000000000000000000001	2			1	40.00	40.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	7	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	8	$175 Copay	000000000000000001100000000000000000000000000000	2			1	175.00	175.00	2	
H0084	001	0	1	04	01	H0084_001_0	10	3	$25 Copay	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
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H0317	004	0	1	04	01	H0317_004_0	3	4		000000100000110000001000000000000000000000000000	1	30	30	1	40.00	100.00	2	
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H0317	006	0	1	04	01	H0317_006_0	5	4		000000100000110000001000000000000000000000000000	1	30	30	1	40.00	100.00	2	
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H0317	006	0	1	04	01	H0317_006_0	5	7		000000000000000000000000000100000100011111000010	2			1	0.00	0.00	2	
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H0317	006	0	1	04	01	H0317_006_0	5	9		000000000000000000000000001000000000000000000000	1	0	20	2			2	
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H0317	006	0	1	04	01	H0317_006_0	5	10		000000000000000001000000000000000000000000000000	2			1	100.00	150.00	2	
H0317	006	0	1	04	01	H0317_006_0	5	1		010100000000000000100001000000000000000000010000	1	30	30	2			2	
H0317	801	0	1	04	01	H0317_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H0317	801	0	1	04	01	H0317_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H0317	801	0	1	04	01	H0317_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H0317	802	0	1	04	01	H0317_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H0317	802	0	1	04	01	H0317_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H0317	802	0	1	04	01	H0317_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H0317	803	0	1	04	01	H0317_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H0317	803	0	1	04	01	H0317_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H0317	803	0	1	04	01	H0317_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H0319	001	0	1	04	01	H0319_001_0	3	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H0319	001	0	1	04	01	H0319_001_0	3	3	Group 3	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H0319	001	0	1	04	01	H0319_001_0	3	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H0319	001	0	1	04	01	H0319_001_0	3	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
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H0319	001	0	1	04	01	H0319_001_0	3	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
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H0319	004	0	1	04	01	H0319_004_0	4	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H0319	004	0	1	04	01	H0319_004_0	4	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H0319	004	0	1	04	01	H0319_004_0	4	1	Group 1	010111110110101101101001110100001011111111101111	1	30	30	2			2	
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H0319	004	0	1	04	01	H0319_004_0	4	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H0319	004	0	1	04	01	H0319_004_0	4	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H0319	004	0	1	04	01	H0319_004_0	4	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
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H0370	001	0	1	04	01	H0370_001_0	7	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H0370	001	0	1	04	01	H0370_001_0	7	3	DME/Pros	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H0370	801	0	1	04	01	H0370_801_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
H0370	802	0	1	04	01	H0370_802_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
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H0620	002	0	1	04	01	H0620_002_0	3	1	Group 1	011101111111111111111101110100000111111111100101	1	30	30	2			2	
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H0620	002	0	1	04	01	H0620_002_0	3	3	Group 3	100000000000000000000000001000000000000000010010	2			1	0.00	0.00	2	
H0620	002	0	1	04	01	H0620_002_0	3	4	Group 4	000000000000000000000000000000001000000000001000	1	0	30	2			2	
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H0623	001	0	1	04	01	H0623_001_0	6	3		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H0623	001	0	1	04	01	H0623_001_0	6	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H0623	005	0	1	04	01	H0623_005_0	6	1		011111111111111111111000000000000011111111001101	1	30	30	2			2	
H0623	005	0	1	04	01	H0623_005_0	6	2		000000000000000000000100001000000000000000000000	1	20	20	2			2	
H0623	005	0	1	04	01	H0623_005_0	6	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H0623	005	0	1	04	01	H0623_005_0	6	3		000000000000000000000001100000000000000000000000	1	40	40	2			2	
H0623	005	0	1	04	01	H0623_005_0	6	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H0623	005	0	1	04	01	H0623_005_0	6	6		000000000000000000000000000001101000000000011000	1	50	50	2			2	
H0623	006	0	1	04	01	H0623_006_0	4	3		000000000000000000000001110000000000000000000000	1	25	25	2			2	
H0623	006	0	1	04	01	H0623_006_0	4	5		000000000000000000000000000001101000000000011000	1	50	50	2			2	
H0623	006	0	1	04	01	H0623_006_0	4	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H0623	006	0	1	04	01	H0623_006_0	4	1		011111111111111111111000000000000011111111001101	1	30	30	2			2	
H0623	006	0	1	04	01	H0623_006_0	4	2		000000000000000000000100001000000000000000100000	1	20	20	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H0623	009	0	1	04	01	H0623_009_0	4	3		000000000000000000000001110000000000000000000000	1	25	25	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	1		011111111111111111111000000000000011111111001101	1	30	30	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	2		000000000000000000000100001000000000000000100000	1	20	20	2			2	
H0623	801	0	1	04	01	H0623_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H0623	801	0	1	04	01	H0623_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H0623	801	0	1	04	01	H0623_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H0623	802	0	1	04	01	H0623_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H0623	802	0	1	04	01	H0623_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H0623	802	0	1	04	01	H0623_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H0623	803	0	1	04	01	H0623_803_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H0623	803	0	1	04	01	H0623_803_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H0623	803	0	1	04	01	H0623_803_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H0710	001	0	1	04	01	H0710_001_0	4	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H0710	001	0	1	04	01	H0710_001_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H0710	001	0	1	04	01	H0710_001_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H0710	001	0	1	04	01	H0710_001_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H0710	001	0	1	04	01	H0710_001_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H0710	001	0	1	04	01	H0710_001_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H0710	003	0	1	04	01	H0710_003_0	4	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	1	Group 1	010111110110101101101001110100001011111111101111	1	30	30	2			2	
H0710	003	0	1	04	01	H0710_003_0	4	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H0710	003	0	1	04	01	H0710_003_0	4	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H0710	003	0	1	04	01	H0710_003_0	4	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H0710	003	0	1	04	01	H0710_003_0	4	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1108	001	0	1	04	01	H1108_001_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1108	001	0	1	04	01	H1108_001_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H1108	001	0	1	04	01	H1108_001_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1108	002	0	1	04	01	H1108_002_0	5	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1108	002	0	1	04	01	H1108_002_0	5	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1108	002	0	1	04	01	H1108_002_0	5	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1108	002	0	1	04	01	H1108_002_0	5	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H1108	002	0	1	04	01	H1108_002_0	5	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1108	002	0	1	04	01	H1108_002_0	5	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H1108	006	0	1	04	01	H1108_006_0	3	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1108	006	0	1	04	01	H1108_006_0	3	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1108	006	0	1	04	01	H1108_006_0	3	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1108	006	0	1	04	01	H1108_006_0	3	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1108	006	0	1	04	01	H1108_006_0	3	10	Group 10	000000000000000000000000000000000000000000000010	1	30	50	2			2	
H1108	006	0	1	04	01	H1108_006_0	3	1	Group 1	010111110110101101101001110100001011111111101101	1	30	30	2			2	
H1108	006	0	1	04	01	H1108_006_0	3	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H1108	006	0	1	04	01	H1108_006_0	3	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H1108	006	0	1	04	01	H1108_006_0	3	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1108	006	0	1	04	01	H1108_006_0	3	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1108	801	0	1	04	01	H1108_801_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1108	801	0	1	04	01	H1108_801_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1108	801	0	1	04	01	H1108_801_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1108	801	0	1	04	01	H1108_801_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1108	802	0	1	04	01	H1108_802_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1108	802	0	1	04	01	H1108_802_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1108	802	0	1	04	01	H1108_802_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1108	802	0	1	04	01	H1108_802_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1108	803	0	1	04	01	H1108_803_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1108	803	0	1	04	01	H1108_803_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1108	803	0	1	04	01	H1108_803_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1108	803	0	1	04	01	H1108_803_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H1110	001	0	1	04	01	H1110_001_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1110	001	0	1	04	01	H1110_001_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	35	35	2			2	
H1110	003	0	1	04	01	H1110_003_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	35	35	2			2	
H1110	003	0	1	04	01	H1110_003_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1110	003	0	1	04	01	H1110_003_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1110	003	0	1	04	01	H1110_003_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H1110	003	0	1	04	01	H1110_003_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H1110	801	0	1	04	01	H1110_801_0	3	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1110	801	0	1	04	01	H1110_801_0	3	1	Tier 1	011111110110111111101101111100001111111111101111	1	20	20	2			2	
H1110	801	0	1	04	01	H1110_801_0	3	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	802	0	1	04	01	H1110_802_0	3	1	Tier 1	011111110110111111101101111100001111111111101111	1	20	20	2			2	
H1110	802	0	1	04	01	H1110_802_0	3	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1110	802	0	1	04	01	H1110_802_0	3	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	804	0	1	04	01	H1110_804_0	3	1	Tier 1	011111110110111111101101111100001111111111101111	1	20	20	2			2	
H1110	804	0	1	04	01	H1110_804_0	3	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	804	0	1	04	01	H1110_804_0	3	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1110	805	0	2	04	01	H1110_805_0	3	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H1110	805	0	2	04	01	H1110_805_0	3	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1110	805	0	2	04	01	H1110_805_0	3	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	806	0	2	04	01	H1110_806_0	3	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H1110	806	0	2	04	01	H1110_806_0	3	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	806	0	2	04	01	H1110_806_0	3	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1110	807	0	2	04	01	H1110_807_0	3	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H1110	807	0	2	04	01	H1110_807_0	3	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	807	0	2	04	01	H1110_807_0	3	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1302	001	0	1	04	01	H1302_001_0	5	4	OON - Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1302	001	0	1	04	01	H1302_001_0	5	3	OON - Eyewear	000000000000000000000000000000000000000000000010	2			1	50.00	50.00	2	
H1302	001	0	1	04	01	H1302_001_0	5	2	OON - 25% Coinsurance Group	011111111111111111111001110100001111111111101101	1	25	25	2			2	
H1302	001	0	1	04	01	H1302_001_0	5	1	OON - 10% Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
H1302	004	0	1	04	01	H1302_004_0	4	1	OON - 10% Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
H1302	004	0	1	04	01	H1302_004_0	4	2	OON - 25% Coinsurance Group	011111111111111111111001110100001111111111101101	1	25	25	2			2	
H1302	004	0	1	04	01	H1302_004_0	4	3	OON - Eyewear	000000000000000000000000000000000000000000000010	2			1	50.00	50.00	2	
H1302	004	0	1	04	01	H1302_004_0	4	4	OON - Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	5	Group 5	000000000000010000000000000000000000000000000000	2			1	10.00	10.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	3	Group 3	000100000000001101100001110000000001111111100000	1	30	30	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	12	Group 12	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	11	Group 11	000000000000000000000000000000000000000000000010	1	30	50	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	1	Group 1	000010000010000000000000000000000010000000000000	2			1	25.00	25.00	2	
H1303	004	0	1	04	01	H1303_004_0	5	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1303	004	0	1	04	01	H1303_004_0	5	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1303	004	0	1	04	01	H1303_004_0	5	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H1303	004	0	1	04	01	H1303_004_0	5	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1303	004	0	1	04	01	H1303_004_0	5	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1303	004	0	1	04	01	H1303_004_0	5	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H1303	006	0	1	04	01	H1303_006_0	5	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1303	006	0	1	04	01	H1303_006_0	5	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H1303	006	0	1	04	01	H1303_006_0	5	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1303	006	0	1	04	01	H1303_006_0	5	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1303	006	0	1	04	01	H1303_006_0	5	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1303	006	0	1	04	01	H1303_006_0	5	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1303	006	0	1	04	01	H1303_006_0	5	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1303	006	0	1	04	01	H1303_006_0	5	10	Group 10	000000000000000000000000000000000000000000000010	1	30	50	2			2	
H1303	006	0	1	04	01	H1303_006_0	5	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H1303	006	0	1	04	01	H1303_006_0	5	1	Group 1	010111110110101101101001110100001011111111101101	1	30	30	2			2	
H1303	801	0	1	04	01	H1303_801_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1303	801	0	1	04	01	H1303_801_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1303	801	0	1	04	01	H1303_801_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1303	801	0	1	04	01	H1303_801_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1303	803	0	1	04	01	H1303_803_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1303	803	0	1	04	01	H1303_803_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1303	803	0	1	04	01	H1303_803_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1303	803	0	1	04	01	H1303_803_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1304	001	0	1	04	01	H1304_001_0	2	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H1304	001	0	1	04	01	H1304_001_0	2	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H1304	001	0	1	04	01	H1304_001_0	2	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H1304	001	0	1	04	01	H1304_001_0	2	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1304	001	0	1	04	01	H1304_001_0	2	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H1304	001	0	1	04	01	H1304_001_0	2	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H1304	001	0	1	04	01	H1304_001_0	2	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1304	001	0	1	04	01	H1304_001_0	2	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H1304	001	0	1	04	01	H1304_001_0	2	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	1	$35.00 copay	000011111111100000011000000000000010000000001101	2			1	35.00	35.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	9	Misc. flat benefit amount.  no in-out	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	8	$0 to $300	000000000000000001000000000000000000000000000000	2			1	0.00	300.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	7	$0 to 20% cost sharing	000000000000010000000000000000000000000000000000	1	0	20	2			2	
H1304	002	0	1	04	01	H1304_002_0	4	6	$0 cost sharing	011000000000000000000000010100000101111111000000	2			1	0.00	0.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	5	10% coinsurance	000000000000000000000000001000000000000000100000	1	10	10	2			2	
H1304	002	0	1	04	01	H1304_002_0	4	4	20% coinsurance	000100000000001110000001100000000000000000000000	1	20	20	2			2	
H1304	002	0	1	04	01	H1304_002_0	4	3	$300 copay	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	2	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1304	002	0	1	04	01	H1304_002_0	4	10	$0 to $35	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
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H1355	001	0	1	04	01	H1355_001_0	4	3	Group 3	100000000000000000000000000000000000000000000000	2			2			2	
H1355	001	0	1	04	01	H1355_001_0	4	1	Group 1	011000001001000000011001110000000000000000000000	1	30	30	2			2	
H1355	801	0	1	04	01	H1355_801_0	3	3	Group 3	000100000000010000000000000000000000000000000000	2			2			2	
H1355	801	0	1	04	01	H1355_801_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1355	801	0	1	04	01	H1355_801_0	3	1	Group 1	011011110110101111111101111100001111111111101111	1	20	20	2			2	
H1355	802	0	1	04	01	H1355_802_0	3	1	Group 1	011011110110101111111101111100001111111111101111	1	20	20	2			2	
H1355	802	0	1	04	01	H1355_802_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1355	802	0	1	04	01	H1355_802_0	3	3	Group 3	000100000000010000000000000000000000000000000000	2			2			2	
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H1417	001	0	1	04	01	H1417_001_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	2	Renal Dialysis	000000000000000000000000001100000000000000000000	2			2			2	
H1417	001	0	1	04	01	H1417_001_0	4	1	Office Visits	011111111111111111011000000000001111111111101101	2			1	30.00	30.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	6	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	5	ASC	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1417	002	0	1	04	01	H1417_002_0	6	6	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	002	0	1	04	01	H1417_002_0	6	5	ASC	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1417	002	0	1	04	01	H1417_002_0	6	4	DME	000000000000000000000001110000000000000000000000	1	20	20	2			2	
H1417	002	0	1	04	01	H1417_002_0	6	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H1417	002	0	1	04	01	H1417_002_0	6	2	Renal Dialysis	000000000000000000000000001100000000000000000000	2			2			2	
H1417	002	0	1	04	01	H1417_002_0	6	1	Office Visits	011111111111111111011000000000001111111111101101	2			1	30.00	30.00	2	
H1417	003	0	1	04	01	H1417_003_0	12	3	DME	000000000000000000000001110000000000000000000000	1	20	20	2			2	
H1417	003	0	1	04	01	H1417_003_0	12	7	Renal Dialysis	000000000000000000000000001000000000000000000000	2			1	0.00	0.00	2	
H1417	003	0	1	04	01	H1417_003_0	12	4	Out Patient Services / Preventive	011011111111111111011000000100001111111111101101	2			1	50.00	50.00	2	
H1417	003	0	1	04	01	H1417_003_0	12	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1417	003	0	1	04	01	H1417_003_0	12	1	Home Health	000100000000000000000000000000000000000000000000	2			1	50.00	50.00	2	
H1417	003	0	1	04	01	H1417_003_0	12	6	Ambulatory Surgery Center	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1417	003	0	1	04	01	H1417_003_0	12	5	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	004	0	1	04	01	H1417_004_0	12	6	Ambulatory Surgery Center	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1417	004	0	1	04	01	H1417_004_0	12	7	Renal Dialysis	000000000000000000000000001000000000000000000000	2			1	0.00	0.00	2	
H1417	004	0	1	04	01	H1417_004_0	12	5	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	004	0	1	04	01	H1417_004_0	12	3	DME	000000000000000000000001110000000000000000000000	1	20	20	2			2	
H1417	004	0	1	04	01	H1417_004_0	12	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1417	004	0	1	04	01	H1417_004_0	12	1	Home Health	000100000000000000000000000000000000000000000000	2			1	50.00	50.00	2	
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H1417	005	0	1	04	01	H1417_005_0	11	6	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	005	0	1	04	01	H1417_005_0	11	5	ASC	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H1417	005	0	1	04	01	H1417_005_0	11	4	DME	000000000000000000000001110000000000000000000000	1	20	20	2			2	
H1417	005	0	1	04	01	H1417_005_0	11	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
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H1417	006	0	1	04	01	H1417_006_0	12	7	Renal Dialysis	000000000000000000000000001000000000000000000000	2			1	0.00	0.00	2	
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H1418	014	0	1	04	01	H1418_014_0	4	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H1418	014	0	1	04	01	H1418_014_0	4	7		000000000000000000000000001000000000000000000000	2			1	0.00	50.00	2	
H1418	014	0	1	04	01	H1418_014_0	4	8		000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H1418	801	0	1	04	01	H1418_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1418	801	0	1	04	01	H1418_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1418	801	0	1	04	01	H1418_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1418	802	0	1	04	01	H1418_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1418	802	0	1	04	01	H1418_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1418	802	0	1	04	01	H1418_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1418	803	0	1	04	01	H1418_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1418	803	0	1	04	01	H1418_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1418	803	0	1	04	01	H1418_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	001	0	1	04	01	H1509_001_0	6	1	Group 1	000010000010000000000000000000000010000000000000	2			1	20.00	20.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	11	Group 11	000000000000000000000000000000000000000000000010	1	30	50	2			2	
H1509	001	0	1	04	01	H1509_001_0	6	12	Group 12	000000000000000000000001110000000000000000100000	1	30	30	2			2	
H1509	001	0	1	04	01	H1509_001_0	6	13	Group 13	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H1509	001	0	1	04	01	H1509_001_0	6	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	3	Group 3	000100000000001101100000000000000001111111000000	1	25	25	2			2	
H1509	001	0	1	04	01	H1509_001_0	6	4	Group 4	000000000000010000000000000000000000000000000000	2			1	10.00	10.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	5	Group 5	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	6	Group 6	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	7	Group 7	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	8	Group 8	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1509	001	0	1	04	01	H1509_001_0	6	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1509	005	0	1	04	01	H1509_005_0	5	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1509	005	0	1	04	01	H1509_005_0	5	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H1509	005	0	1	04	01	H1509_005_0	5	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H1509	005	0	1	04	01	H1509_005_0	5	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1509	005	0	1	04	01	H1509_005_0	5	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1509	005	0	1	04	01	H1509_005_0	5	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	005	0	1	04	01	H1509_005_0	5	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	005	0	1	04	01	H1509_005_0	5	2	Group 2	000000000000010000000000000000000000000000000000	2			1	10.00	10.00	2	
H1509	005	0	1	04	01	H1509_005_0	5	1	Group 1	010111110110101101101001110100001011111111101101	1	30	30	2			2	
H1509	005	0	1	04	01	H1509_005_0	5	10	Group 10	000000000000000000000000000000000000000000000010	1	30	50	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1509	006	0	1	04	01	H1509_006_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1509	007	0	1	04	01	H1509_007_0	6	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1509	007	0	1	04	01	H1509_007_0	6	8	Group 8	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	7	Group 7	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	6	Group 6	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	5	Group 5	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	4	Group 4	000000000000010000000000000000000000000000000000	2			1	10.00	10.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	3	Group 3	000100000000001101100001110000000001111111100010	1	30	30	2			2	
H1509	007	0	1	04	01	H1509_007_0	6	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H1509	007	0	1	04	01	H1509_007_0	6	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H1509	007	0	1	04	01	H1509_007_0	6	1	Group 1	000010000010000000000000000000000010000000000000	2			1	25.00	25.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	4	Group 4	000000000000010000000000000000000000000000000000	2			1	10.00	10.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	3	Group 3	000100000000001101100001110000000001111111100010	1	30	30	2			2	
H1509	009	0	1	04	01	H1509_009_0	2	6	Group 6	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	5	Group 5	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	1	Group 1	000010000010000000000000000000000010000000000000	2			1	25.00	25.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	7	Group 7	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	8	Group 8	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1509	009	0	1	04	01	H1509_009_0	2	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H1509	009	0	1	04	01	H1509_009_0	2	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H1509	801	0	1	04	01	H1509_801_0	6	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	801	0	1	04	01	H1509_801_0	6	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	801	0	1	04	01	H1509_801_0	6	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1509	801	0	1	04	01	H1509_801_0	6	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1509	803	0	1	04	01	H1509_803_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1509	803	0	1	04	01	H1509_803_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	803	0	1	04	01	H1509_803_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	803	0	1	04	01	H1509_803_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1509	804	0	1	04	01	H1509_804_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	804	0	1	04	01	H1509_804_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	804	0	1	04	01	H1509_804_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1509	804	0	1	04	01	H1509_804_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1509	806	0	2	04	01	H1509_806_0	5	4	Group 4	001000001000000000000000000000000000000000000000	1	45	45	2			2	
H1509	806	0	2	04	01	H1509_806_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	806	0	2	04	01	H1509_806_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	806	0	2	04	01	H1509_806_0	5	1	Group 1	010011110111101111111101111100001010111111101111	1	20	20	2			2	
H1509	807	0	2	04	01	H1509_807_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	807	0	2	04	01	H1509_807_0	5	1	Group 1	010011110111101111111101111100001010111111101111	1	20	20	2			2	
H1509	807	0	2	04	01	H1509_807_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	807	0	2	04	01	H1509_807_0	5	4	Group 4	001000001000000000000000000000000000000000000000	1	45	45	2			2	
H1509	808	0	2	04	01	H1509_808_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1509	808	0	2	04	01	H1509_808_0	5	4	Group 4	001000001000000000000000000000000000000000000000	1	45	45	2			2	
H1509	808	0	2	04	01	H1509_808_0	5	1	Group 1	010011110111101111111101111100001010111111101111	1	20	20	2			2	
H1509	808	0	2	04	01	H1509_808_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1510	001	0	1	04	01	H1510_001_0	8	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1510	001	0	1	04	01	H1510_001_0	8	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1510	001	0	1	04	01	H1510_001_0	8	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1510	001	0	1	04	01	H1510_001_0	8	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1510	001	0	1	04	01	H1510_001_0	8	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1510	001	0	1	04	01	H1510_001_0	8	6		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1510	001	0	1	04	01	H1510_001_0	8	7		000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1510	004	0	1	04	01	H1510_004_0	8	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1510	004	0	1	04	01	H1510_004_0	8	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H1510	004	0	1	04	01	H1510_004_0	8	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1510	004	0	1	04	01	H1510_004_0	8	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1510	004	0	1	04	01	H1510_004_0	8	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1510	004	0	1	04	01	H1510_004_0	8	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1510	005	0	1	04	01	H1510_005_0	8	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1510	005	0	1	04	01	H1510_005_0	8	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H1510	005	0	1	04	01	H1510_005_0	8	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1510	005	0	1	04	01	H1510_005_0	8	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H1510	005	0	1	04	01	H1510_005_0	8	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1510	005	0	1	04	01	H1510_005_0	8	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1510	805	0	1	04	01	H1510_805_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1510	805	0	1	04	01	H1510_805_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1510	805	0	1	04	01	H1510_805_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1510	806	0	1	04	01	H1510_806_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1510	806	0	1	04	01	H1510_806_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1510	806	0	1	04	01	H1510_806_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1510	807	0	1	04	01	H1510_807_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1510	807	0	1	04	01	H1510_807_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1510	807	0	1	04	01	H1510_807_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1517	001	0	1	04	01	H1517_001_0	10	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	7	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	8	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	9	OON Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	12	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	11	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	10	OON No Copayment	000100000000000000001000000100001111111100000000	2			1	0.00	0.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	40.00	275.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H1517	001	0	1	04	01	H1517_001_0	10	2	30% OON Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H1517	001	0	1	04	01	H1517_001_0	10	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	25.00	40.00	2	
H1517	001	0	1	04	01	H1517_001_0	10	1	20% OON Coinsurance	000000000000000100000000001000000000000011100000	1	20	20	2			2	
H1517	003	0	1	04	01	H1517_003_0	10	9	OON Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	8	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	25.00	25.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	25.00	225.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	25	2			2	
H1517	003	0	1	04	01	H1517_003_0	10	2	25% OON Coinsurance	000000000000001010000001110000000000000000000000	1	25	25	2			2	
H1517	003	0	1	04	01	H1517_003_0	10	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	225.00	225.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	15.00	25.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	12	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	25.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	11	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	10	OON No Copayment	000100000000000000001000000100001111111100000000	2			1	0.00	0.00	2	
H1517	003	0	1	04	01	H1517_003_0	10	1	20% OON Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H1517	003	0	1	04	01	H1517_003_0	10	7	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	25.00	50.00	2	
H1517	801	0	1	04	01	H1517_801_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1517	801	0	1	04	01	H1517_801_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H1517	802	0	1	04	01	H1517_802_0	5	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1517	802	0	1	04	01	H1517_802_0	5	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H1517	803	0	1	04	01	H1517_803_0	5	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H1517	803	0	1	04	01	H1517_803_0	5	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1595	001	0	1	04	01	H1595_001_0	7	1	OON - Group 1- General Services	011011111111111111110000011000000111111111100111	1	30	30	2			2	
H1595	001	0	1	04	01	H1595_001_0	7	2	OON - Group 2- DME  Prosthetic Devices	000000000000000000000001100000000000000000000000	1	50	50	2			2	
H1595	001	0	1	04	01	H1595_001_0	7	4	OON - Group 4 - Ambulance Services	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H1595	001	0	1	04	01	H1595_001_0	7	3	OON - Group 3 - Same as In-Network	000100000000000000001000000100001000000000001000	2			1	0.00	0.00	2	
H1595	002	0	1	04	01	H1595_002_0	5	3	OON - Group 3 - Same as In-Network	000100000000000000001000000100001000000000010000	2			1	0.00	0.00	2	
H1595	002	0	1	04	01	H1595_002_0	5	2	OON - Group 2- DME  Prosthetic Devices	000000000000000000000001100000000000000000000000	1	50	50	2			2	
H1595	002	0	1	04	01	H1595_002_0	5	1	OON - Group 1- General Services	011011111111111111110000011000000111111111101111	1	20	20	2			2	
H1595	002	0	1	04	01	H1595_002_0	5	4	OON - Group 4 - Ambulance Service	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
H1595	801	0	1	04	01	H1595_801_0	8	1	OON Group 1 - Medicare covered	011111111111111111111111111100001111111111101111	1	0	50	2			2	
H1595	802	0	1	04	01	H1595_802_0	8	1	OON Group 1 - Medicare covered	011111111111111111111111111100001111111111101111	1	0	50	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	1	20% Coinsurance	000000000000000100000000001000000000000011100000	1	20	20	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	30.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	40.00	275.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	2	30% Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	5	PCP	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	6	Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	3	Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H1607	004	0	1	04	01	H1607_004_0	8	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	225.00	225.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	2	25% Coinsurance	000000000000001010000001110000000000000000000000	1	25	25	2			2	
H1607	004	0	1	04	01	H1607_004_0	8	3	Labs	000000000000010000000000000000000000000000000000	1	0	25	2			2	
H1607	004	0	1	04	01	H1607_004_0	8	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	30.00	225.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	30.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	20.00	30.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	30.00	60.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	6	Specialist	010001010100000000000000000000000000000000000101	2			1	30.00	30.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	5	PCP	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H1607	004	0	1	04	01	H1607_004_0	8	1	20% Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H1607	804	0	1	04	01	H1607_804_0	8	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1607	804	0	1	04	01	H1607_804_0	8	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H1607	805	0	1	04	01	H1607_805_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1607	805	0	1	04	01	H1607_805_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H1607	806	0	1	04	01	H1607_806_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1607	806	0	1	04	01	H1607_806_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H1608	001	0	1	04	01	H1608_001_0	8	1	OON	011111111111111111111000011100001111111111101111	1	20	20	2			2	
H1608	001	0	1	04	01	H1608_001_0	8	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1608	001	0	1	04	01	H1608_001_0	8	3	DME/Pros	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H1608	003	0	1	04	01	H1608_003_0	7	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1608	003	0	1	04	01	H1608_003_0	7	1	OON	011111111111111111111000011100001111111111101111	1	20	20	2			2	
H1608	003	0	1	04	01	H1608_003_0	7	3	DME/Pros	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H1608	801	0	1	04	01	H1608_801_0	5	1		111111111111111111111111111111111111111111111111	2			2			2	
H1608	802	0	1	04	01	H1608_802_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
H1608	803	0	1	04	01	H1608_803_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
H1681	001	0	1	04	01	H1681_001_0	7	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H1681	001	0	1	04	01	H1681_001_0	7	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	001	0	1	04	01	H1681_001_0	7	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1681	001	0	1	04	01	H1681_001_0	7	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	001	0	1	04	01	H1681_001_0	7	5	DME	000000000000000000000001100000000000000000000000	1	25	25	2			2	
H1681	001	0	1	04	01	H1681_001_0	7	6	DMS	000000000000000000000000010000000000000000000000	1	20	25	2			2	
H1681	001	0	1	04	01	H1681_001_0	7	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1681	001	0	1	04	01	H1681_001_0	7	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	1		011111111111111111111001100000000011111111011101	1	30	30	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	2	Part B Drugs	000000000000000000000000010000000000000000100000	1	20	30	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1681	002	0	1	04	01	H1681_002_0	5	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	5		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1681	002	0	1	04	01	H1681_002_0	5	6		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1681	003	0	1	04	01	H1681_003_0	4	6	DMS	000000000000000000000000010000000000000000000000	1	20	25	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	5	DME	000000000000000000000001100000000000000000000000	1	25	25	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1681	003	0	1	04	01	H1681_003_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	004	0	1	04	01	H1681_004_0	5	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1681	004	0	1	04	01	H1681_004_0	5	6	DMS	000000000000000000000000010000000000000000000000	1	20	35	2			2	
H1681	004	0	1	04	01	H1681_004_0	5	5	DME	000000000000000000000001100000000000000000000000	1	35	35	2			2	
H1681	004	0	1	04	01	H1681_004_0	5	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	004	0	1	04	01	H1681_004_0	5	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1681	004	0	1	04	01	H1681_004_0	5	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	004	0	1	04	01	H1681_004_0	5	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H1681	004	0	1	04	01	H1681_004_0	5	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	5	DME	000000000000000000000001100000000000000000000000	1	35	35	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	6	DMS	000000000000000000000000010000000000000000000000	1	20	35	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1681	005	0	1	04	01	H1681_005_0	4	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	1	PCP/SPC	011111111111111111111000000000000011111111011101	1	30	30	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1681	006	0	1	04	01	H1681_006_0	4	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H1681	006	0	1	04	01	H1681_006_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	006	0	1	04	01	H1681_006_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1681	006	0	1	04	01	H1681_006_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	006	0	1	04	01	H1681_006_0	4	5	DME	000000000000000000000001100000000000000000000000	1	25	25	2			2	
H1681	006	0	1	04	01	H1681_006_0	4	6	DMS	000000000000000000000000010000000000000000000000	1	20	25	2			2	
H1681	006	0	1	04	01	H1681_006_0	4	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1681	006	0	1	04	01	H1681_006_0	4	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	007	0	1	04	01	H1681_007_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1681	007	0	1	04	01	H1681_007_0	4	5		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1681	007	0	1	04	01	H1681_007_0	4	3		000000000000000000000100000100000100000000000010	2			1	0.00	0.00	2	
H1681	007	0	1	04	01	H1681_007_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	007	0	1	04	01	H1681_007_0	4	1	PCP/SPC	011111111111111111111001110000000011111111001101	1	30	30	2			2	
H1681	801	0	1	04	01	H1681_801_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1681	801	0	1	04	01	H1681_801_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1681	801	0	1	04	01	H1681_801_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1681	802	0	1	04	01	H1681_802_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1681	802	0	1	04	01	H1681_802_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1681	802	0	1	04	01	H1681_802_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1681	803	0	1	04	01	H1681_803_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1681	803	0	1	04	01	H1681_803_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1681	803	0	1	04	01	H1681_803_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1716	001	0	1	04	01	H1716_001_0	9	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H1716	001	0	1	04	01	H1716_001_0	9	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H1716	001	0	1	04	01	H1716_001_0	9	4		000000000000000000000000001000000000000000000000	2			1	0.00	50.00	2	
H1716	001	0	1	04	01	H1716_001_0	9	3		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1716	001	0	1	04	01	H1716_001_0	9	2		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1716	001	0	1	04	01	H1716_001_0	9	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H1716	002	0	1	04	01	H1716_002_0	9	3		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1716	002	0	1	04	01	H1716_002_0	9	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H1716	002	0	1	04	01	H1716_002_0	9	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H1716	002	0	1	04	01	H1716_002_0	9	4		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H1716	002	0	1	04	01	H1716_002_0	9	2		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1716	002	0	1	04	01	H1716_002_0	9	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H1716	004	0	1	04	01	H1716_004_0	9	6		000000000000000000000000000000101000000000011000	1	50	50	2			2	
H1716	004	0	1	04	01	H1716_004_0	9	3		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1716	004	0	1	04	01	H1716_004_0	9	4		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H1716	004	0	1	04	01	H1716_004_0	9	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H1716	004	0	1	04	01	H1716_004_0	9	2		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H1716	004	0	1	04	01	H1716_004_0	9	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H1716	006	0	1	04	01	H1716_006_0	11	3		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1716	006	0	1	04	01	H1716_006_0	11	4		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H1716	006	0	1	04	01	H1716_006_0	11	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H1716	006	0	1	04	01	H1716_006_0	11	6		000000000000000000000000000000101000000000011000	1	50	50	2			2	
H1716	006	0	1	04	01	H1716_006_0	11	2		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1716	006	0	1	04	01	H1716_006_0	11	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H1716	801	0	1	04	01	H1716_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1716	801	0	1	04	01	H1716_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1716	801	0	1	04	01	H1716_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1716	802	0	1	04	01	H1716_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1716	802	0	1	04	01	H1716_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1716	802	0	1	04	01	H1716_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1716	803	0	1	04	01	H1716_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1716	803	0	1	04	01	H1716_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1716	803	0	1	04	01	H1716_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1717	001	0	1	04	01	H1717_001_0	4	1	Group 1	000010000010000000000000000000000010000000000000	2			1	35.00	35.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
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H1717	001	0	1	04	01	H1717_001_0	4	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1717	001	0	1	04	01	H1717_001_0	4	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1717	006	0	1	04	01	H1717_006_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1717	007	0	1	04	01	H1717_007_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1717	009	0	1	04	01	H1717_009_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1717	009	0	1	04	01	H1717_009_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H1717	009	0	1	04	01	H1717_009_0	4	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H1717	009	0	1	04	01	H1717_009_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1717	009	0	1	04	01	H1717_009_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H1717	009	0	1	04	01	H1717_009_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H1717	010	0	1	04	01	H1717_010_0	4	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H1717	010	0	1	04	01	H1717_010_0	4	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H1717	010	0	1	04	01	H1717_010_0	4	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H1717	010	0	1	04	01	H1717_010_0	4	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H1717	010	0	1	04	01	H1717_010_0	4	1	Group 1	010111110110101101101001110100001011111111101111	1	30	30	2			2	
H1717	010	0	1	04	01	H1717_010_0	4	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1717	010	0	1	04	01	H1717_010_0	4	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H1717	010	0	1	04	01	H1717_010_0	4	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1717	010	0	1	04	01	H1717_010_0	4	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1717	801	0	1	04	01	H1717_801_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1717	801	0	1	04	01	H1717_801_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1717	801	0	1	04	01	H1717_801_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1717	801	0	1	04	01	H1717_801_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1717	803	0	1	04	01	H1717_803_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1717	803	0	1	04	01	H1717_803_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1717	803	0	1	04	01	H1717_803_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1717	803	0	1	04	01	H1717_803_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1717	804	0	1	04	01	H1717_804_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H1717	804	0	1	04	01	H1717_804_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H1717	804	0	1	04	01	H1717_804_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1717	804	0	1	04	01	H1717_804_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H1806	001	0	1	04	01	H1806_001_0	6	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1806	001	0	1	04	01	H1806_001_0	6	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1806	001	0	1	04	01	H1806_001_0	6	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1806	001	0	1	04	01	H1806_001_0	6	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1806	001	0	1	04	01	H1806_001_0	6	6		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1806	001	0	1	04	01	H1806_001_0	6	7		000000000000000000000000000000000000000000010000	1	50	50	2			2	
H1806	001	0	1	04	01	H1806_001_0	6	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1806	002	0	1	04	01	H1806_002_0	7	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1806	002	0	1	04	01	H1806_002_0	7	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	6		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1806	002	0	1	04	01	H1806_002_0	7	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1806	005	0	1	04	01	H1806_005_0	9	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1806	005	0	1	04	01	H1806_005_0	9	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1806	005	0	1	04	01	H1806_005_0	9	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1806	005	0	1	04	01	H1806_005_0	9	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1806	005	0	1	04	01	H1806_005_0	9	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1806	005	0	1	04	01	H1806_005_0	9	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1806	005	0	1	04	01	H1806_005_0	9	6		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H1806	006	0	1	04	01	H1806_006_0	7	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H1806	006	0	1	04	01	H1806_006_0	7	6		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H1806	006	0	1	04	01	H1806_006_0	7	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H1806	006	0	1	04	01	H1806_006_0	7	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H1806	006	0	1	04	01	H1806_006_0	7	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H1806	006	0	1	04	01	H1806_006_0	7	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H1806	006	0	1	04	01	H1806_006_0	7	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H1806	801	0	1	04	01	H1806_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1806	801	0	1	04	01	H1806_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1806	801	0	1	04	01	H1806_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1806	803	0	1	04	01	H1806_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1806	803	0	1	04	01	H1806_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1806	803	0	1	04	01	H1806_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1806	804	0	1	04	01	H1806_804_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H1806	804	0	1	04	01	H1806_804_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H1806	804	0	1	04	01	H1806_804_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	9	Group # 9 Medical	000000000000000000000001100000000000000000100000	1	20	20	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	8	Group # 8 Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	7	Group #7 Outpatient Diagnostic Test	000000000000001010000000000000000000000001000000	2			1	15.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	6	Group #6 Outpatient Services	000000000000010000000000000000000001100000000000	2			1	0.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	5	Group #5 Outpatient Services	000000000000000001100000000000000000000000000000	2			1	35.00	250.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	4	Group #4 Diabetes Monitoring Supplies	000000000000000000000000010000000000000000000000	1	50	50	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	3	Group #3 Physician Specialist Services	000000010000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	2	Group #2 Primary Care Physician Services	000010000000000000000000000000000110000000000000	2			1	15.00	15.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	15	Group #15	000000000000000000000000000000000000000000000001	2			1	35.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	14	Group #14	000000000000000000000000000000000000000000001100	2			1	35.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	13	Group #13	000000000000000000000000000100000000000000000010	2			1	0.00	0.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	12	Group #12	000000100010100000000000000000001000011110000000	2			1	15.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	11	Group #11	011001001101000000011000000000000000000000000000	2			1	35.00	35.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	1	Group #1 End Stage Renal Disease	000100000000000000000000001000000000000000000000	2			1	0.00	0.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	10	Group #10 Therapeutic Radiological Ser	000000000000000100000000000000000000000000000000	2			1	75.00	75.00	2	
H1846	801	0	1	04	01	H1846_801_0	5	1	OON Medicare Covered Benefits	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H1846	801	0	1	04	01	H1846_801_0	5	2	Home Health	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1846	801	0	1	04	01	H1846_801_0	5	3	OON Mental Health	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H1846	802	0	1	04	01	H1846_802_0	5	1	OON Medicare Covered Benefits	011011110110111111111101111100001111111111111111	1	20	20	2			2	
H1846	802	0	1	04	01	H1846_802_0	5	2	Home Health	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1846	802	0	1	04	01	H1846_802_0	5	3	OON Mental Health	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H2001	001	0	1	04	01	H2001_001_0	4	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H2001	001	0	1	04	01	H2001_001_0	4	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	1	Group 1	000010000010000000000000000000000010000000000000	2			1	35.00	35.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H2001	001	0	1	04	01	H2001_001_0	4	3	Group 3	000100000000001101100001110000000001111111100010	1	30	30	2			2	
H2001	001	0	1	04	01	H2001_001_0	4	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H2001	001	0	1	04	01	H2001_001_0	4	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H2001	801	0	1	04	01	H2001_801_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H2001	801	0	1	04	01	H2001_801_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H2001	801	0	1	04	01	H2001_801_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H2001	801	0	1	04	01	H2001_801_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H2001	803	0	1	04	01	H2001_803_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H2001	803	0	1	04	01	H2001_803_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H2001	803	0	1	04	01	H2001_803_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H2001	803	0	1	04	01	H2001_803_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H2001	804	0	1	04	01	H2001_804_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H2001	804	0	1	04	01	H2001_804_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H2001	804	0	1	04	01	H2001_804_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H2001	804	0	1	04	01	H2001_804_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H2029	001	0	1	04	01	H2029_001_0	3	4	Group 4  Range $10 to $15	000000000000000001000000000000000000000000000000	2			1	10.00	15.00	2	
H2029	001	0	1	04	01	H2029_001_0	3	5	Group 5  Range 0% to 20%	000000000000000000000000010000000000000000000000	1	0	20	2			2	
H2029	001	0	1	04	01	H2029_001_0	3	2	Group 2  Range $10 to $10	011011111101100000011100000100000011100011001101	2			1	10.00	10.00	2	
H2029	001	0	1	04	01	H2029_001_0	3	1	Group 1  Range $0 to $0	100100000010000000100001101000001100000000100111	2			1	0.00	0.00	2	
H2029	001	0	1	04	01	H2029_001_0	3	3	Group 3  Range $0 to $10	000000000000011110000000000000000000011100000000	2			1	0.00	10.00	2	
H2029	001	0	1	04	01	H2029_001_0	3	7	Group 7  Range 50% to 50%	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H2029	001	0	1	04	01	H2029_001_0	3	6	Group 6  Range 20% to 50%	000000000000000000000000000000000000000000011000	1	20	50	2			2	
H2029	801	0	1	04	01	H2029_801_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H2029	801	0	1	04	01	H2029_801_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H2029	801	0	1	04	01	H2029_801_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H2029	802	0	1	04	01	H2029_802_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H2029	802	0	1	04	01	H2029_802_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H2029	802	0	1	04	01	H2029_802_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H2029	803	0	1	04	01	H2029_803_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H2029	803	0	1	04	01	H2029_803_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H2029	803	0	1	04	01	H2029_803_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H2111	001	0	1	04	01	H2111_001_0	6	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H2111	001	0	1	04	01	H2111_001_0	6	6	Group 6	000000000000000000000000000000001000000000001000	1	0	30	2			2	
H2111	001	0	1	04	01	H2111_001_0	6	1	Group 1	011101111111111111111101110100000111111111100101	1	30	30	2			2	
H2111	001	0	1	04	01	H2111_001_0	6	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H2111	001	0	1	04	01	H2111_001_0	6	3	Group 3	100000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H2111	001	0	1	04	01	H2111_001_0	6	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H2111	008	0	1	04	01	H2111_008_0	5	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H2111	008	0	1	04	01	H2111_008_0	5	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H2111	008	0	1	04	01	H2111_008_0	5	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H2111	008	0	1	04	01	H2111_008_0	5	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H2111	008	0	1	04	01	H2111_008_0	5	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H2111	008	0	1	04	01	H2111_008_0	5	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H2228	001	0	1	04	01	H2228_001_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H2228	001	0	1	04	01	H2228_001_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H2228	001	0	1	04	01	H2228_001_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H2228	001	0	1	04	01	H2228_001_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H2228	001	0	1	04	01	H2228_001_0	4	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H2228	001	0	1	04	01	H2228_001_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H2228	002	0	1	04	01	H2228_002_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H2228	002	0	1	04	01	H2228_002_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H2228	002	0	1	04	01	H2228_002_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H2228	002	0	1	04	01	H2228_002_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
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H2322	801	0	1	04	01	H2322_801_0	5	1		010111110110111111111101111100001111111111101101	1	0	20	2			2	
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H2481	003	0	1	04	01	H2481_003_0	7	5	Misc. group	000000000000000000000000001000001100000000000010	2			1	0.00	0.00	2	
H2481	003	0	1	04	01	H2481_003_0	7	2	$20 copayment group	000011101000100000011000000010010010000000000000	2			1	20.00	20.00	2	
H2481	003	0	1	04	01	H2481_003_0	7	3	$40 copayment group	000000010111000000000000000000000000000000001101	2			1	40.00	40.00	2	
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H2481	004	0	1	04	01	H2481_004_0	7	3	$40 copayment group	000000010111000000000000000000000000000000001101	2			1	40.00	40.00	2	
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H2481	004	0	1	04	01	H2481_004_0	7	1	20% Coinsurance group	011100000000011111100001110101000011111111100000	1	20	20	2			2	
H2481	004	0	1	04	01	H2481_004_0	7	5	Misc. group	000000000000000000000000001000001100000000000010	2			1	0.00	0.00	2	
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H2542	002	0	1	04	01	H2542_002_0	8	5		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
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H2542	002	0	1	04	01	H2542_002_0	8	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H2542	002	0	1	04	01	H2542_002_0	8	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H2542	801	0	1	04	01	H2542_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H2542	801	0	1	04	01	H2542_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H2542	801	0	1	04	01	H2542_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H2542	802	0	1	04	01	H2542_802_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H2542	802	0	1	04	01	H2542_802_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H2542	802	0	1	04	01	H2542_802_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H2542	803	0	1	04	01	H2542_803_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H2542	803	0	1	04	01	H2542_803_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H2542	803	0	1	04	01	H2542_803_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
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H2611	002	0	1	04	01	H2611_002_0	8	2	Group 2	010001111111100000010000000000000000000000001101	2			1	15.00	15.00	2	
H2611	002	0	1	04	01	H2611_002_0	8	1	Group 1	000010000000000000000000000000000010000000000000	2			1	5.00	5.00	2	
H2611	002	0	1	04	01	H2611_002_0	8	3	roup 3	000100000000000001101100010000000101111111000010	2			1	0.00	0.00	2	
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H2611	002	0	1	04	01	H2611_002_0	8	5	Group 5	000000000000010000000000000000000000000000000000	1	0	20	2			2	
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H2611	005	0	1	04	01	H2611_005_0	5	4	Group 4	001000000000001110000001101100001000000000100000	1	20	20	2			2	
H2611	005	0	1	04	01	H2611_005_0	5	5	Group 5	000000000000010000000000000000000000000000000000	1	0	20	2			2	
H2611	005	0	1	04	01	H2611_005_0	5	3	roup 3	000100000000000001101100010000000101111111000010	2			1	0.00	0.00	2	
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H2611	008	0	1	04	01	H2611_008_0	5	2	Group 2  OON Routine Eye Wear/Dental	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H2611	008	0	1	04	01	H2611_008_0	5	1	Group 1	011111111111111111111001111100001111111111101111	1	20	20	2			2	
H2611	008	0	1	04	01	H2611_008_0	5	3	Group 3	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H2611	012	0	1	04	01	H2611_012_0	8	2	Group 2	010001111111100000010000000000000000000000001101	2			1	30.00	30.00	2	
H2611	012	0	1	04	01	H2611_012_0	8	1	Group 1	000010000000000000000000000000000010000000000000	2			1	15.00	15.00	2	
H2611	012	0	1	04	01	H2611_012_0	8	3	Group 3	000100000000000001101100010000000101111111000010	2			1	0.00	0.00	2	
H2611	012	0	1	04	01	H2611_012_0	8	4	Group 4	001000000000011110000001101100001000000000100000	1	20	20	2			2	
H2611	016	0	1	04	01	H2611_016_0	9	9	Group 9	000000000000000000000000000000000000000000001000	2			1	25.00	25.00	2	
H2611	016	0	1	04	01	H2611_016_0	9	8	Group 8	000000000000000000100000000000000000000000000000	2			1	150.00	150.00	2	
H2611	016	0	1	04	01	H2611_016_0	9	6	Group 6	000000111011100000010000000000000000000000000000	2			1	30.00	30.00	2	
H2611	016	0	1	04	01	H2611_016_0	9	5	Group 5	000000000000000100000000000000000000000000000000	1	10	10	2			2	
H2611	016	0	1	04	01	H2611_016_0	9	4	Group 4	001000000000011110000001101100001000000000100000	1	20	20	2			2	
H2611	016	0	1	04	01	H2611_016_0	9	3	Group 3	000100000000000000001000010000000100001111000010	2			1	0.00	0.00	2	
H2611	016	0	1	04	01	H2611_016_0	9	2	Group 2	010011000100000000000000000000000001110000000101	2			1	15.00	15.00	2	
H2611	016	0	1	04	01	H2611_016_0	9	1	Group 1	000000000000000000000000000000000010000000000000	2			1	5.00	5.00	2	
H2611	016	0	1	04	01	H2611_016_0	9	7	Group 7	000000000000000001000100000000000000000000000000	2			1	100.00	100.00	2	
H2611	018	0	1	04	01	H2611_018_0	10	1	Group 1	111111111111111111111001111100001111111111101111	1	25	25	2			2	
H2611	018	0	1	04	01	H2611_018_0	10	2	Group 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H2611	801	0	1	04	01	H2611_801_0	5	1	Group 1	011111111111111111111101111100001111111111101111	1	20	20	2			2	
H2611	802	0	1	04	01	H2611_802_0	4	1	1	011111111111111111111101111100001111111111101111	1	20	20	2			2	
H2611	807	0	1	04	01	H2611_807_0	5	1	Group 1	011111111111111111111101111100001111111111101111	1	20	20	2			2	
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H2701	001	0	1	04	01	H2701_001_0	6	4	Part B Rx  ESRD	000000000000000000000000001000000000000000100000	1	20	20	2			2	
H2701	001	0	1	04	01	H2701_001_0	6	3	Outpatient Facility  Radiological	000000000000001101100000000000000000000000000000	2			1	150.00	150.00	2	
H2701	001	0	1	04	01	H2701_001_0	6	2	DME/PROS/Supplies	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H2701	001	0	1	04	01	H2701_001_0	6	1	Part B and Preventive Services	011111111111110010011000000000001111111111001111	2			1	30.00	30.00	2	
H2701	001	0	1	04	01	H2701_001_0	6	5	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H2701	001	0	1	04	01	H2701_001_0	6	6	Preventive Dental  Outpatient Blood	000000000000000000000000000100000000000000010000	2			1	0.00	0.00	2	
H2701	003	0	1	04	01	H2701_003_0	7	4	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H2701	003	0	1	04	01	H2701_003_0	7	3	Part B Rx	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H2701	003	0	1	04	01	H2701_003_0	7	2	DME/PROS/Supplies	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H2701	003	0	1	04	01	H2701_003_0	7	1	Part B and Preventive	011111111111110010011000000100001111111111001111	2			1	45.00	45.00	2	
H2701	003	0	1	04	01	H2701_003_0	7	5	Diag/Therapeutic Radiological	000000000000001100000000000000000000000000000000	2			1	200.00	200.00	2	
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H3335	002	0	1	04	01	H3335_002_0	5	5	Physician Specialist Services	000000010010000000000000000000000000000000000000	2			1	45.00	45.00	2	
H3335	002	0	1	04	01	H3335_002_0	5	6	Ambulance	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	002	0	1	04	01	H3335_002_0	5	7		000000000000000000000000001000000000000000000000	2			2			2	
H3335	005	0	1	04	01	H3335_005_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	005	0	1	04	01	H3335_005_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	005	0	1	04	01	H3335_005_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	005	0	1	04	01	H3335_005_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	005	0	1	04	01	H3335_005_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	006	0	1	04	01	H3335_006_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	006	0	1	04	01	H3335_006_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	006	0	1	04	01	H3335_006_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	006	0	1	04	01	H3335_006_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	006	0	1	04	01	H3335_006_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	008	0	1	04	01	H3335_008_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	008	0	1	04	01	H3335_008_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	008	0	1	04	01	H3335_008_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	008	0	1	04	01	H3335_008_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	008	0	1	04	01	H3335_008_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	009	0	1	04	01	H3335_009_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	009	0	1	04	01	H3335_009_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	009	0	1	04	01	H3335_009_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	009	0	1	04	01	H3335_009_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	009	0	1	04	01	H3335_009_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	014	0	1	04	01	H3335_014_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	014	0	1	04	01	H3335_014_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	014	0	1	04	01	H3335_014_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	014	0	1	04	01	H3335_014_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	014	0	1	04	01	H3335_014_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	015	0	1	04	01	H3335_015_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	015	0	1	04	01	H3335_015_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	015	0	1	04	01	H3335_015_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	015	0	1	04	01	H3335_015_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	015	0	1	04	01	H3335_015_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	017	0	1	04	01	H3335_017_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	017	0	1	04	01	H3335_017_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	017	0	1	04	01	H3335_017_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	017	0	1	04	01	H3335_017_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	017	0	1	04	01	H3335_017_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	018	0	1	04	01	H3335_018_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	018	0	1	04	01	H3335_018_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	018	0	1	04	01	H3335_018_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	018	0	1	04	01	H3335_018_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	018	0	1	04	01	H3335_018_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	020	0	1	04	01	H3335_020_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	020	0	1	04	01	H3335_020_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	020	0	1	04	01	H3335_020_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	020	0	1	04	01	H3335_020_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	020	0	1	04	01	H3335_020_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	021	0	1	04	01	H3335_021_0	6	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	021	0	1	04	01	H3335_021_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	021	0	1	04	01	H3335_021_0	6	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	021	0	1	04	01	H3335_021_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	021	0	1	04	01	H3335_021_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	032	0	1	04	01	H3335_032_0	4	4	Primary Care Physcian Services	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	032	0	1	04	01	H3335_032_0	4	3		001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	032	0	1	04	01	H3335_032_0	4	6	Ambulance	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	032	0	1	04	01	H3335_032_0	4	7		000000000000000000000000001000000000000000000000	2			2			2	
H3335	032	0	1	04	01	H3335_032_0	4	1		010101100100111111101001110100000111111111101111	1	30	30	2			2	
H3335	032	0	1	04	01	H3335_032_0	4	5	Physician Specialist Services	000000010010000000000000000000000000000000000000	2			1	45.00	45.00	2	
H3335	032	0	1	04	01	H3335_032_0	4	2	Health  Wellness	000000000000000000000000000000001000000000000000	2			1	0.00	45.00	2	
H3335	036	0	1	04	01	H3335_036_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	036	0	1	04	01	H3335_036_0	6	4	$175 Copay	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	036	0	1	04	01	H3335_036_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	036	0	1	04	01	H3335_036_0	6	2	$0 Copay	000000000000000000000000001000000000000000000000	2			2			2	
H3335	036	0	1	04	01	H3335_036_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	037	0	1	04	01	H3335_037_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	037	0	1	04	01	H3335_037_0	6	4	$175 Copay	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	037	0	1	04	01	H3335_037_0	6	2	$0 Copay	000000000000000000000000001000000000000000000000	2			2			2	
H3335	037	0	1	04	01	H3335_037_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	037	0	1	04	01	H3335_037_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	038	0	1	04	01	H3335_038_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	038	0	1	04	01	H3335_038_0	6	4	$175 Copay	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	038	0	1	04	01	H3335_038_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	038	0	1	04	01	H3335_038_0	6	2	$0 Copay	000000000000000000000000001000000000000000000000	2			2			2	
H3335	038	0	1	04	01	H3335_038_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	039	0	1	04	01	H3335_039_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	039	0	1	04	01	H3335_039_0	6	4	$175 Copay	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	039	0	1	04	01	H3335_039_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	039	0	1	04	01	H3335_039_0	6	2	$0 Copay	000000000000000000000000001000000000000000000000	2			2			2	
H3335	039	0	1	04	01	H3335_039_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	040	0	1	04	01	H3335_040_0	6	1	30% Coinsurance	010111110110111111101001110100000111111111101111	1	30	30	2			2	
H3335	040	0	1	04	01	H3335_040_0	6	2	$0 Copay	000000000000000000000000001000000000000000000000	2			2			2	
H3335	040	0	1	04	01	H3335_040_0	6	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	040	0	1	04	01	H3335_040_0	6	4	$175 Copay	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	040	0	1	04	01	H3335_040_0	6	5	Health  Wellness	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	041	0	1	04	01	H3335_041_0	5	7		000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	041	0	1	04	01	H3335_041_0	5	6	$35 Copayment	000000010010000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	041	0	1	04	01	H3335_041_0	5	5	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	041	0	1	04	01	H3335_041_0	5	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	041	0	1	04	01	H3335_041_0	5	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	041	0	1	04	01	H3335_041_0	5	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	041	0	1	04	01	H3335_041_0	5	1	30% Coinsurance	010101100100111111101001110100000111111111101111	1	30	30	2			2	
H3335	042	0	1	04	01	H3335_042_0	5	7		000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	042	0	1	04	01	H3335_042_0	5	6	$35 Copayment	000000010010000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	042	0	1	04	01	H3335_042_0	5	5	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	042	0	1	04	01	H3335_042_0	5	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	042	0	1	04	01	H3335_042_0	5	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	042	0	1	04	01	H3335_042_0	5	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	042	0	1	04	01	H3335_042_0	5	1	30% Coinsurance	010101100100111111101001110100000111111111101111	1	30	30	2			2	
H3335	043	0	1	04	01	H3335_043_0	5	1	30% Coinsurance	010101100100111111101001110100000111111111101111	1	30	30	2			2	
H3335	043	0	1	04	01	H3335_043_0	5	7		000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	043	0	1	04	01	H3335_043_0	5	6	$35 Copayment	000000010010000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	043	0	1	04	01	H3335_043_0	5	5	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	043	0	1	04	01	H3335_043_0	5	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	043	0	1	04	01	H3335_043_0	5	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	043	0	1	04	01	H3335_043_0	5	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	044	0	1	04	01	H3335_044_0	5	5	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	044	0	1	04	01	H3335_044_0	5	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	044	0	1	04	01	H3335_044_0	5	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	044	0	1	04	01	H3335_044_0	5	1	30% Coinsurance	010101100100111111101001110100000111111111101111	1	30	30	2			2	
H3335	044	0	1	04	01	H3335_044_0	5	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	044	0	1	04	01	H3335_044_0	5	6	$35 Copayment	000000010010000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	044	0	1	04	01	H3335_044_0	5	7		000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	7		000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	6	$35 Copayment	000000010010000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	5	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	4	$175 Copayment	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	2	$0 Copayment	000000000000000000000000001000000000000000000000	2			2			2	
H3335	045	0	1	04	01	H3335_045_0	5	3	50% Coinsurance	001000001001000000010000000000000000000000000000	1	50	50	2			2	
H3335	045	0	1	04	01	H3335_045_0	5	1	30% Coinsurance	010101100100111111101001110100000111111111101111	1	30	30	2			2	
H3335	801	0	1	04	01	H3335_801_0	2	1	20% Coinsurance	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H3335	801	0	1	04	01	H3335_801_0	2	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3335	801	0	1	04	01	H3335_801_0	2	3	$0 copayment	000100000000000000000000000000000000000000000000	2			2			2	
H3335	811	0	1	04	01	H3335_811_0	2	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3335	811	0	1	04	01	H3335_811_0	2	3	$0 copayment	000100000000000000000000000000000000000000000000	2			2			2	
H3335	811	0	1	04	01	H3335_811_0	2	1	20% Coinsurance	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H3335	813	0	1	04	01	H3335_813_0	2	1	20% Coinsurance	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H3335	813	0	1	04	01	H3335_813_0	2	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3335	813	0	1	04	01	H3335_813_0	2	3	$0 copayment	000100000000000000000000000000000000000000000000	2			2			2	
H3335	819	0	1	04	01	H3335_819_0	2	1	20% Coinsurance	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H3335	819	0	1	04	01	H3335_819_0	2	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3335	819	0	1	04	01	H3335_819_0	2	3	$0 copayment	000100000000000000000000000000000000000000000000	2			2			2	
H3335	820	0	1	04	01	H3335_820_0	2	1	20% Coinsurance	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H3335	820	0	1	04	01	H3335_820_0	2	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3335	820	0	1	04	01	H3335_820_0	2	3	$0 copayment	000100000000000000000000000000000000000000000000	2			2			2	
H3335	822	0	1	04	01	H3335_822_0	2	1	20% Coinsurance	011011110110111111111101111100001111111111101111	1	20	20	2			2	
H3335	822	0	1	04	01	H3335_822_0	2	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3335	822	0	1	04	01	H3335_822_0	2	3	$0 copayment	000100000000000000000000000000000000000000000000	2			2			2	
H3342	001	0	1	04	01	H3342_001_0	12	2	$30 to $50 Copayment Group	000000000000000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	13	$50 to $250 Copayment Group	000000000000000001000000000000000000000000000000	2			1	50.00	250.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	12	$100 Copayment Group	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	11	$0 Copayment Group	000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	10	$50 to $150 Copayment Group	000000000000011010000000000000000000000000000000	2			1	50.00	150.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	1	$30.00 Copayment Group	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	9	$50 to $100 Copayment Group	000000100000100000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	4	$100 Copayment Group	001000001001000000011000000000000000001100000000	2			1	100.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	5	$250 Copayment Group	000000000000000000100000000000000000000000000000	2			1	250.00	250.00	2	
H3342	001	0	1	04	01	H3342_001_0	12	6	10% Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
H3342	001	0	1	04	01	H3342_001_0	12	7	20% Coinsurance Group	000000000000000100000001110000000000000011101100	1	20	20	2			2	
H3342	001	0	1	04	01	H3342_001_0	12	8	50% Coinsurance Group	100000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	001	0	1	04	01	H3342_001_0	12	3	$50.00 Copayment Group	010101010110000000000000000100000001110000000000	2			1	50.00	50.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	2	$30 to $50 Copayment Group	000000000000000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	13	$50 to $500 Copayment Group	000000000000000001000000000000000000000000000000	2			1	50.00	500.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	12	$200 Copayment Group	000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	11	$0 Copayment Group	000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	10	$50 to $150 Copayment Group	000000000000011010000000000000000000000000000000	2			1	50.00	150.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	1	$30.00 Copayment Group	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	3	$50 Copayment Group	010101010110000000000000000100000001110000000000	2			1	50.00	50.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	9	$50 to $100 Copayment Group	000000100000100000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	8	50% Coinsurance Group	100000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	002	0	1	04	01	H3342_002_0	11	7	20% Coinsurance Group	000000000000000100000001110000000000000011101100	1	20	20	2			2	
H3342	002	0	1	04	01	H3342_002_0	11	6	10% Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
H3342	002	0	1	04	01	H3342_002_0	11	5	$500 Copayment Group	000000000000000000100000000000000000000000000000	2			1	500.00	500.00	2	
H3342	002	0	1	04	01	H3342_002_0	11	4	$100 Copayment Group	001000001001000000011000000000000000001100000000	2			1	100.00	100.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	1	$25.00 Copayment Group	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	10	$50 to $150 Copayment Group	000000000000011010000000000000000000000000000000	2			1	50.00	150.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	11	$0 Copayment Group	000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	12	$200 Copayment Group	000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	13	$50 to $450 Copayment Group	000000000000000001000000000000000000000000000000	2			1	50.00	450.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	2	$25 to $50 Copayment Group	000000000000000000000000000000000010000000000000	2			1	25.00	50.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	9	$50 to $100 Copayment Group	000000100000100000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	7	20% Coinsurance Group	000000000000000100000001110000000000000011101100	1	20	20	2			2	
H3342	004	0	1	04	01	H3342_004_0	13	6	10% Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
H3342	004	0	1	04	01	H3342_004_0	13	5	$450 Copayment Group	000000000000000000100000000000000000000000000000	2			1	450.00	450.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	4	$100 Copayment Group	001000001001000000011000000000000000001100000000	2			1	100.00	100.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	3	$50 Copayment Group	010101010110000000000000000100000001110000000000	2			1	50.00	50.00	2	
H3342	004	0	1	04	01	H3342_004_0	13	8	50% Coinsurance Group	100000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	012	0	1	04	01	H3342_012_0	12	7	20% Coinsurance Group	000000000000000100000001110000000000000011101110	1	20	20	2			2	
H3342	012	0	1	04	01	H3342_012_0	12	8	50% Coinsurance Group	100000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	012	0	1	04	01	H3342_012_0	12	9	$50 to $100 Copayment Group	000000100000100000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	1	$30.00 Copayment Group	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	10	$50 to $150 Copayment Group	000000000000011010000000000000000000000000000000	2			1	50.00	150.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	11	$0 Copayment Group	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	12	$200 Copayment Group	000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	13	$50 to $500 Copayment Group	000000000000000001000000000000000000000000000000	2			1	50.00	500.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	2	$30 to $50 Copayment Group	000000000000000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	3	$50.00 Copayment Group	010101010110000000000000000100000001110000000000	2			1	50.00	50.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	4	$100 Copayment Group	001000001001000000011000000000000000001100000000	2			1	100.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	5	$500 Copayment Group	000000000000000000100000000000000000000000000000	2			1	500.00	500.00	2	
H3342	012	0	1	04	01	H3342_012_0	12	6	10% Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
H3342	808	0	1	04	01	H3342_808_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3342	808	0	1	04	01	H3342_808_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H3342	809	0	1	04	01	H3342_809_0	5	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3342	809	0	1	04	01	H3342_809_0	5	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H3342	810	0	1	04	01	H3342_810_0	5	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H3342	810	0	1	04	01	H3342_810_0	5	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3344	001	0	1	04	01	H3344_001_0	8	1	OON Group 1 - $35 copayment	000010000000000000000000000000000010000000000100	2			1	35.00	35.00	2	
H3344	001	0	1	04	01	H3344_001_0	8	9	OON Group 9,  0 - 20%	000000000000000000000000000000000100000000100000	1	0	20	2			2	
H3344	001	0	1	04	01	H3344_001_0	8	8	OON Group 8 Health and Wellness and Imm.	000000000000000000000000000000001000000000000000	2			1	0.00	40.00	2	
H3344	001	0	1	04	01	H3344_001_0	8	7	OON Group 7 $0	000000000000000000000000001000000000000010000010	2			1	0.00	0.00	2	
H3344	001	0	1	04	01	H3344_001_0	8	2	OON Group 2 $40 copayment	000000010110000000000000000000000000000000000000	2			1	40.00	40.00	2	
H3344	001	0	1	04	01	H3344_001_0	8	5	OON Group 5 45% coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
H3344	001	0	1	04	01	H3344_001_0	8	4	OON Group 4 30% coinsurance	010101100010111111101000010100000001111101001001	1	30	30	2			2	
H3344	001	0	1	04	01	H3344_001_0	8	3	OON Group 3 $150 copayment	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H3344	001	0	1	04	01	H3344_001_0	8	6	OON Group 6 50% coinsurance	000000000000000000000001100000000000000000000000	1	50	50	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	5	OON Group 5 45% coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	1	OON Group 1 - Copayment $25	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H3344	003	0	1	04	01	H3344_003_0	8	10	OON Section 10  Prevent Dental	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	2	OON Group 2 $30 copayment	000000010100000000000000000000000000000000000100	2			1	30.00	30.00	2	
H3344	003	0	1	04	01	H3344_003_0	8	3	OON Group #3 $150 copayment	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H3344	003	0	1	04	01	H3344_003_0	8	9	OON Group 9 $0 - $30	000000000000000000000000000000001000000000000000	2			1	0.00	30.00	2	
H3344	003	0	1	04	01	H3344_003_0	8	8	OON Groups 8 Immunizations	000000000000000000000000000000000100000000100000	1	0	20	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	4	OON Group 4 30% coinsurance	010101100010111111101000010100000001111111001001	1	30	30	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	6	OON Group 6 50% coinsurance	000000000000000000000001100000000000000000000000	1	50	50	2			2	
H3344	003	0	1	04	01	H3344_003_0	8	7	OON Group 7 $0	000000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H3344	005	0	1	04	01	H3344_005_0	12	2	OON Group 2 $150 copayment	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H3344	005	0	1	04	01	H3344_005_0	12	3	OON Group 3 45% coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
H3344	005	0	1	04	01	H3344_005_0	12	4	OON Group 4 50% coinsurance	000000000000000000000001100000000000000000010000	1	50	50	2			2	
H3344	005	0	1	04	01	H3344_005_0	12	5	OON Group 5 $0	000000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H3344	005	0	1	04	01	H3344_005_0	12	6	OON Group 6  0 to 20%	000000000000000000000000000100000000000000100000	1	0	20	2			2	
H3344	005	0	1	04	01	H3344_005_0	12	7	OON Group 7 0 to 30%	000000000000000000000000000000001100000000000000	1	0	30	2			2	
H3344	005	0	1	04	01	H3344_005_0	12	1	OON Group 1 30% coinsurance	010111110110111111101000010000000011111111001101	1	30	30	2			2	
H3344	801	0	1	04	01	H3344_801_0	3	3	OON $0 copay	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3344	801	0	1	04	01	H3344_801_0	3	1	OON 20% coinsurance	010011110110111111101101111100001111111111101111	1	20	20	2			2	
H3344	801	0	1	04	01	H3344_801_0	3	2	OON 45% coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
H3344	803	0	1	04	01	H3344_803_0	4	3	OON $0 copayment	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3344	803	0	1	04	01	H3344_803_0	4	1	OON 20% coinsurance	010011110110111111101101111100001111111111101111	1	20	20	2			2	
H3344	803	0	1	04	01	H3344_803_0	4	2	OON 45% coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
H3344	804	0	1	04	01	H3344_804_0	3	3	OON $0 copayment	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3344	804	0	1	04	01	H3344_804_0	3	2	OON 45% coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
H3344	804	0	1	04	01	H3344_804_0	3	1	OON 20% coinsurance	010011110110111111101101111100001111111111101111	1	20	20	2			2	
H3346	002	0	1	04	01	H3346_002_0	12	5	$0 Copayment	000000000000000000000000001100001101111111000000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	12	3	$25 Copayment	000011010111100010011000000000000010000000001101	2			1	25.00	25.00	2	
H3346	002	0	1	04	01	H3346_002_0	12	1	20% Coinsurance	010100100000011101100001110000000000000000100000	1	20	20	2			2	
H3346	002	0	1	04	01	H3346_002_0	12	2	50% Coinsurance	001000001000000000000000000010000000000000000000	1	50	50	2			2	
H3346	002	0	1	04	01	H3346_002_0	12	6	$300 Allowance	000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	12	7	$600 Allowance	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	12	8	$100 Allowance	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	12	4	$35 Copayment	000000000000000000000100000000000000000000000000	2			1	35.00	35.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	1	20% Coinsurance	010100100000011101100001110000000000000000100000	1	20	20	2			2	
H3346	802	0	1	04	01	H3346_802_0	4	2	50% Coinsurance	001000001000000000000000000010000000000000000000	1	50	50	2			2	
H3346	802	0	1	04	01	H3346_802_0	4	7	$600 Allowance	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	6	$100 Limit	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	3	$25 Copayment	000011010111100010011000000000000010000000001101	2			1	25.00	25.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	4	$35 Copayment	000000000000000000000100000000000000000000000000	2			1	35.00	35.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	5	$0 Copayment	000000000000000000000000001100001101111111000000	2			1	0.00	0.00	2	
H3404	001	0	1	04	01	H3404_001_0	12	1	20% Coinsurance	011111111111111111111001110100000111111111101111	1	20	20	2			2	
H3404	001	0	1	04	01	H3404_001_0	12	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3404	001	0	1	04	01	H3404_001_0	12	3	No cost sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	4	No Cost Sharing	001100000000000000001000001100001111111111000000	2			1	0.00	0.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	3	$100 Copay	000000000000000000100100000000000000000000000000	2			1	100.00	100.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	2	20% Coinsurance	000000000000011110000001110000000000000000100010	1	20	20	2			2	
H3404	002	0	1	04	01	H3404_002_0	13	1	$40 Coapy Level	010011111111100000010000000000000000000000001101	2			1	40.00	40.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	5	Primary Care	000000000000000001000000000000000000000000000000	2			1	0.00	100.00	2	
H3404	801	0	1	04	01	H3404_801_0	9	2	Health Educartion / Wellness Programs	000000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
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H3404	803	0	1	04	01	H3404_803_0	10	2	Health Educartion / Wellness Programs	000000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
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H3404	807	0	1	04	01	H3404_807_0	8	2	Health Educartion / Wellness Programs	000000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
H3404	808	0	1	04	01	H3404_808_0	8	2	Health Educartion / Wellness Programs	000000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
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H3813	001	0	1	04	01	H3813_001_0	9	2	$10 copayment	000000000000000010000000110000000000000011000000	2			1	10.00	10.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	9	$30.00 copayment	000000010000000100000000000000000000000000000100	2			1	30.00	30.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	4	$10 to $400 copayment	000000000000000001100000000000000000000000000000	2			1	10.00	400.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	5	$20 copayment	011011100100100000001000000000000000001100000001	2			1	20.00	20.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	6	$20 to $30 copayment	000000001011000000010000000000000000000000000000	2			1	20.00	30.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	7	$20 to $400 copayment	000000000000000000000000000000000000000000001000	2			1	20.00	400.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	8	$50 copayment	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H3813	001	0	1	04	01	H3813_001_0	9	3	$10 - $100 copayment	000000000000001000000000000000000000000000000000	2			1	10.00	100.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	9	$30.00 copayment	000000010000000100000000000000000000000000000100	2			1	30.00	30.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	8	$50 copayment	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	7	$20 to $400 copayment	000000000000000000000000000000000000000000001000	2			1	20.00	400.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	6	$20 to $30 copayment	000000001011000000010000000000000000000000000000	2			1	20.00	30.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	5	$20 copayment	011011100100100000001000000000000000001100000001	2			1	20.00	20.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	4	$10 to $400 copayment	000000000000000001100000000000000000000000000000	2			1	10.00	400.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	3	$10 - $100 copayment	000000000000001000000000000000000000000000000000	2			1	10.00	100.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	2	$10 copayment	000000000000000010000000110000000000000011000000	2			1	10.00	10.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	12	$0 to $400 copay	000000000000000000000000000000000000010000000000	2			1	0.00	400.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	11	20% coinsurance	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3813	002	0	1	04	01	H3813_002_0	10	1	$0 copayment	000100000000010000000000000100001011100000000010	2			1	0.00	0.00	2	
H3813	002	0	1	04	01	H3813_002_0	10	10	10% coinsurance	000000000000000000000001001000000100000000000000	1	10	10	2			2	
H3813	003	0	1	04	01	H3813_003_0	9	1	$0 copayment	000100000000010000000000000100001011100000000010	2			1	0.00	0.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	10	10% coinsurance	000000000000000000000001001000000100000000000000	1	10	10	2			2	
H3813	003	0	1	04	01	H3813_003_0	9	11	20% coinsurance	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3813	003	0	1	04	01	H3813_003_0	9	12	$0 to $400 copay	000000000000000000000000000000000000010000000000	2			1	0.00	400.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	2	$10 copayment	000000000000000010000000110000000000000011000000	2			1	10.00	10.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	9	$30.00 copayment	000000010000000100000000000000000000000000000100	2			1	30.00	30.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	4	$10 to $400 copayment	000000000000000001100000000000000000000000000000	2			1	10.00	400.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	5	$20 copayment	011011100100100000001000000000000000001100000001	2			1	20.00	20.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	6	$20 to $30 copayment	000000001011000000010000000000000000000000000000	2			1	20.00	30.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	7	$20 to $400 copayment	000000000000000000000000000000000000000000001000	2			1	20.00	400.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	8	$50 copayment	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H3813	003	0	1	04	01	H3813_003_0	9	3	$10 - $100 copayment	000000000000001000000000000000000000000000000000	2			1	10.00	100.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	1	$0 copayment	000100000000010000000000000100001011100000000010	2			1	0.00	0.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	9	$30.00 copayment	000000010000000100000000000000000000000000000100	2			1	30.00	30.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	10	10% coinsurance	000000000000000000000001001000000100000000000000	1	10	10	2			2	
H3813	801	0	1	04	01	H3813_801_0	4	11	20% coinsurance	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3813	801	0	1	04	01	H3813_801_0	4	12	$0 to $400 copay	000000000000000000000000000000000000010000000000	2			1	0.00	400.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	2	$10 copayment	000000000000000010000000110000000000000011000000	2			1	10.00	10.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	3	$10 - $100 copayment	000000000000001000000000000000000000000000000000	2			1	10.00	100.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	4	$10 to $400 copayment	000000000000000001100000000000000000000000000000	2			1	10.00	400.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	5	$20 copayment	011011100100100000001000000000000000001100000001	2			1	20.00	20.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	6	$20 to $30 copayment	000000001011000000010000000000000000000000000000	2			1	20.00	30.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	7	$20 to $400 copayment	000000000000000000000000000000000000000000001000	2			1	20.00	400.00	2	
H3813	801	0	1	04	01	H3813_801_0	4	8	$50 copayment	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	9	$30.00 copayment	000000010000000100000000000000000000000000000100	2			1	30.00	30.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	8	$50 copayment	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	7	$20 to $400 copayment	000000000000000000000000000000000000000000001000	2			1	20.00	400.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	6	$20 to $30 copayment	000000001011000000010000000000000000000000000000	2			1	20.00	30.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	5	$20 copayment	011011100100100000001000000000000000001100000001	2			1	20.00	20.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	1	$0 copayment	000100000000010000000000000100001011100000000010	2			1	0.00	0.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	3	$10 - $100 copayment	000000000000001000000000000000000000000000000000	2			1	10.00	100.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	2	$10 copayment	000000000000000010000000110000000000000011000000	2			1	10.00	10.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	12	$0 to $400 copay	000000000000000000000000000000000000010000000000	2			1	0.00	400.00	2	
H3813	802	0	1	04	01	H3813_802_0	4	11	20% coinsurance	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3813	802	0	1	04	01	H3813_802_0	4	10	10% coinsurance	000000000000000000000001001000000100000000000000	1	10	10	2			2	
H3813	802	0	1	04	01	H3813_802_0	4	4	$10 to $400 copayment	000000000000000001100000000000000000000000000000	2			1	10.00	400.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H3817	001	0	1	04	01	H3817_001_0	3	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H3817	001	0	1	04	01	H3817_001_0	3	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3817	001	0	1	04	01	H3817_001_0	3	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	4	20% coinsurance	000100000000001110000001100000000000000000000000	1	20	20	2			2	
H3817	002	0	1	04	01	H3817_002_0	7	5	10% coinsurance	000000000000000000000000001000000000000000100000	1	10	10	2			2	
H3817	002	0	1	04	01	H3817_002_0	7	6	$0 cost sharing	011000000000000000000000010100000101111111000000	2			1	0.00	0.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	7	$0 to 20% cost sharing	000000000000010000000000000000000000000000000000	1	0	20	2			2	
H3817	002	0	1	04	01	H3817_002_0	7	8	$0 to $300	000000000000000001000000000000000000000000000000	2			1	0.00	300.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	9	Misc. flat benefit amount.  no in-out	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	1	$35.00 copay	000011111111100000011000000000000010000000001101	2			1	35.00	35.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	10	$0 to $35	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	2	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3817	002	0	1	04	01	H3817_002_0	7	3	$300 copay	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H3817	003	0	1	04	01	H3817_003_0	6	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H3817	003	0	1	04	01	H3817_003_0	6	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H3909	001	0	1	04	01	H3909_001_0	7	3	Group 3	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3909	001	0	1	04	01	H3909_001_0	7	2	Group 2	000000000000000000000000001000001000000000000000	2			2			2	
H3909	001	0	1	04	01	H3909_001_0	7	1	Group 1	011111111111111111111001110100000111111111101111	1	30	30	2			1	500.00
H3909	007	0	1	04	01	H3909_007_0	6	1	Group 1	011111111111111111111001110100000111111111101111	1	30	30	2			1	500.00
H3909	007	0	1	04	01	H3909_007_0	6	2	Group 2	000000000000000000000000001000001000000000000000	2			2			2	
H3909	007	0	1	04	01	H3909_007_0	6	3	Group 3	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H3909	801	0	1	04	01	H3909_801_0	3	1	Group 1	011111111111111111111101111100001111111111101111	1	30	30	2			1	500.00
H3909	802	0	1	04	01	H3909_802_0	3	1	Group 1	011111111111111111111101111100001111111111101111	1	30	30	2			1	500.00
H3912	001	0	1	04	01	H3912_001_0	3	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3912	001	0	1	04	01	H3912_001_0	3	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
H3912	001	0	1	04	01	H3912_001_0	3	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H3912	001	0	1	04	01	H3912_001_0	3	3	Group 3	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3912	001	0	1	04	01	H3912_001_0	3	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H3912	001	0	1	04	01	H3912_001_0	3	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H3912	005	0	1	04	01	H3912_005_0	3	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H3912	005	0	1	04	01	H3912_005_0	3	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H3912	005	0	1	04	01	H3912_005_0	3	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3912	005	0	1	04	01	H3912_005_0	3	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H3912	005	0	1	04	01	H3912_005_0	3	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H3912	005	0	1	04	01	H3912_005_0	3	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H3912	008	0	1	04	01	H3912_008_0	5	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H3912	008	0	1	04	01	H3912_008_0	5	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H3912	008	0	1	04	01	H3912_008_0	5	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H3912	008	0	1	04	01	H3912_008_0	5	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H3912	008	0	1	04	01	H3912_008_0	5	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H3912	008	0	1	04	01	H3912_008_0	5	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H3912	008	0	1	04	01	H3912_008_0	5	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H3912	008	0	1	04	01	H3912_008_0	5	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H3912	008	0	1	04	01	H3912_008_0	5	1	Group 1	010111110110101101101001110100001011111111101111	1	30	30	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	100.00	100.00	2	
H3916	001	0	1	04	01	H3916_001_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	001	0	1	04	01	H3916_001_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	001	0	1	04	01	H3916_001_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	001	0	1	04	01	H3916_001_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	001	0	1	04	01	H3916_001_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	001	0	1	04	01	H3916_001_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	002	0	1	04	01	H3916_002_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3916	002	0	1	04	01	H3916_002_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	002	0	1	04	01	H3916_002_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	002	0	1	04	01	H3916_002_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	002	0	1	04	01	H3916_002_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	002	0	1	04	01	H3916_002_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H3916	002	0	1	04	01	H3916_002_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	100.00	100.00	2	
H3916	002	0	1	04	01	H3916_002_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	002	0	1	04	01	H3916_002_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H3916	005	0	1	04	01	H3916_005_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	005	0	1	04	01	H3916_005_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3916	005	0	1	04	01	H3916_005_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	005	0	1	04	01	H3916_005_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	005	0	1	04	01	H3916_005_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	50.00	50.00	2	
H3916	005	0	1	04	01	H3916_005_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	012	0	1	04	01	H3916_012_0	4	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	012	0	1	04	01	H3916_012_0	4	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H3916	012	0	1	04	01	H3916_012_0	4	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	012	0	1	04	01	H3916_012_0	4	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H3916	012	0	1	04	01	H3916_012_0	4	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	012	0	1	04	01	H3916_012_0	4	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	012	0	1	04	01	H3916_012_0	4	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	015	0	1	04	01	H3916_015_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	015	0	1	04	01	H3916_015_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	015	0	1	04	01	H3916_015_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	015	0	1	04	01	H3916_015_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	015	0	1	04	01	H3916_015_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	75.00	75.00	2	
H3916	015	0	1	04	01	H3916_015_0	5	1	Group 1	011111111111111111111000001100000000000000001111	1	20	20	2			2	
H3916	015	0	1	04	01	H3916_015_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3916	018	0	1	04	01	H3916_018_0	5	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H3916	018	0	1	04	01	H3916_018_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	018	0	1	04	01	H3916_018_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	018	0	1	04	01	H3916_018_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	018	0	1	04	01	H3916_018_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	019	0	1	04	01	H3916_019_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	019	0	1	04	01	H3916_019_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	019	0	1	04	01	H3916_019_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	019	0	1	04	01	H3916_019_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H3916	019	0	1	04	01	H3916_019_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	019	0	1	04	01	H3916_019_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	019	0	1	04	01	H3916_019_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	2			2	
H3916	019	0	1	04	01	H3916_019_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	30	50	2			2	
H3916	019	0	1	04	01	H3916_019_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	30	30	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	020	0	1	04	01	H3916_020_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	30	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	30	30	2			2	
H3916	022	0	1	04	01	H3916_022_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	022	0	1	04	01	H3916_022_0	5	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H3916	022	0	1	04	01	H3916_022_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	100.00	100.00	2	
H3916	022	0	1	04	01	H3916_022_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	022	0	1	04	01	H3916_022_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	022	0	1	04	01	H3916_022_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	022	0	1	04	01	H3916_022_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	024	0	1	04	01	H3916_024_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	100.00	100.00	2	
H3916	024	0	1	04	01	H3916_024_0	5	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H3916	024	0	1	04	01	H3916_024_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	024	0	1	04	01	H3916_024_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	1	Group 1	011111111111111111111000001100000000000000000111	1	30	30	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	025	0	1	04	01	H3916_025_0	6	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	025	0	1	04	01	H3916_025_0	6	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	9	Group 9	000000000000000000000000000000000000000000001000	1	30	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	6	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H3916	026	0	1	04	01	H3916_026_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	25.00	25.00	2	
H3916	026	0	1	04	01	H3916_026_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	026	0	1	04	01	H3916_026_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	026	0	1	04	01	H3916_026_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3916	026	0	1	04	01	H3916_026_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	026	0	1	04	01	H3916_026_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	027	0	1	04	01	H3916_027_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H3916	027	0	1	04	01	H3916_027_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	25.00	25.00	2	
H3916	027	0	1	04	01	H3916_027_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	027	0	1	04	01	H3916_027_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H3916	027	0	1	04	01	H3916_027_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	027	0	1	04	01	H3916_027_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H3916	027	0	1	04	01	H3916_027_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H3916	027	0	1	04	01	H3916_027_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	027	0	1	04	01	H3916_027_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	500.00
H3916	801	0	1	04	01	H3916_801_0	3	3	Group 3	000000000000000000000000000000001000000000000000	1	20	20	2			2	
H3916	801	0	1	04	01	H3916_801_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H3916	801	0	1	04	01	H3916_801_0	3	1	Group 1	011111110110111111111101111100000111111111101111	1	20	20	2			2	
H3916	802	0	1	04	01	H3916_802_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H3916	802	0	1	04	01	H3916_802_0	3	3	Group 3	000000000000000000000000000000001000000000000000	1	20	20	2			2	
H3916	802	0	1	04	01	H3916_802_0	3	1	Group 1	011111110110111111111101111100000111111111101111	1	20	20	2			2	
H3916	804	0	1	04	01	H3916_804_0	3	1	Group 1	011111110110111111111101111100000111111111101111	1	20	20	2			2	
H3916	804	0	1	04	01	H3916_804_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H3916	804	0	1	04	01	H3916_804_0	3	3	Group 3	000000000000000000000000000000001000000000000000	1	20	20	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	1	Group 1	000010000010000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	11	Group 11	000000000000000000000001110000000000000000100000	1	30	30	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	12	Group 12	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	2	Group 2	010001110100100000001000000000000000000000001101	2			1	30.00	30.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H3921	001	0	1	04	01	H3921_001_0	5	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	5	Group 5	000000000000010000000000000000000000000000000000	1	25	25	1	10.00	10.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H3921	001	0	1	04	01	H3921_001_0	5	3	Group 3	000100000000001101100000000000000001111111000010	1	25	25	2			2	
H3921	008	0	1	04	01	H3921_008_0	5	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H3921	008	0	1	04	01	H3921_008_0	5	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	5	Group 5	000000000000010000000000000000000000000000000000	1	25	25	1	10.00	10.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	3	Group 3	000100000000001101100000000000000001111111000010	1	25	25	2			2	
H3921	008	0	1	04	01	H3921_008_0	5	2	Group 2	010001110100100000001000000000000000000000001101	2			1	30.00	30.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	12	Group 12	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H3921	008	0	1	04	01	H3921_008_0	5	11	Group 11	000000000000000000000001110000000000000000100000	1	30	30	2			2	
H3921	008	0	1	04	01	H3921_008_0	5	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H3921	008	0	1	04	01	H3921_008_0	5	1	Group 1	000010000010000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3921	801	0	1	04	01	H3921_801_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H3921	801	0	1	04	01	H3921_801_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H3921	801	0	1	04	01	H3921_801_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3921	801	0	1	04	01	H3921_801_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H3921	803	0	1	04	01	H3921_803_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H3921	803	0	1	04	01	H3921_803_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3921	803	0	1	04	01	H3921_803_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H3921	803	0	1	04	01	H3921_803_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H3921	804	0	1	04	01	H3921_804_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H3921	804	0	1	04	01	H3921_804_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H3921	804	0	1	04	01	H3921_804_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H3921	804	0	1	04	01	H3921_804_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3923	013	0	1	04	01	H3923_013_0	9	2	health ed	000000000000000000000000000000001000000000000000	1	100	100	2			2	
H3923	013	0	1	04	01	H3923_013_0	9	1	Medicare Covered	111111111111111111111111111111110111111111111111	1	25	25	2			2	
H3923	017	0	1	04	01	H3923_017_0	8	1	Medicare Covered	111111111111111111111111111111110111111111111111	1	20	20	2			2	
H3923	017	0	1	04	01	H3923_017_0	8	2	health ed	000000000000000000000000000000001000000000000000	1	100	100	2			2	
H3923	021	0	1	04	01	H3923_021_0	8	1	Medicare Covered	111111111111111111111111111111110111111111111111	1	30	30	2			2	
H3923	021	0	1	04	01	H3923_021_0	8	2	health ed	000000000000000000000000000000001000000000000000	1	100	100	2			2	
H3923	801	0	1	04	01	H3923_801_0	6	3	Fitness	000000000000000000000000000000001000000000000000	1	80	80	2			2	
H3923	801	0	1	04	01	H3923_801_0	6	1	Medicare Covered	011111110110111111111111111111110111111111101111	1	20	20	2			2	
H3923	801	0	1	04	01	H3923_801_0	6	2	Mental Health	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3923	802	0	1	04	01	H3923_802_0	6	2	Mental Health	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3923	802	0	1	04	01	H3923_802_0	6	3	Fitness	000000000000000000000000000000001000000000000000	1	80	80	2			2	
H3923	802	0	1	04	01	H3923_802_0	6	1	Medicare Covered	011111110110111111111111111111110111111111101111	1	20	20	2			2	
H3923	803	0	1	04	01	H3923_803_0	6	3	Fitness	000000000000000000000000000000001000000000000000	1	80	80	2			2	
H3923	803	0	1	04	01	H3923_803_0	6	2	Mental Health	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H3923	803	0	1	04	01	H3923_803_0	6	1	Medicare Covered	011111110110111111111111111111110111111111101111	1	20	20	2			2	
H3924	001	0	1	04	01	H3924_001_0	3	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	001	0	1	04	01	H3924_001_0	3	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	001	0	1	04	01	H3924_001_0	3	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	001	0	1	04	01	H3924_001_0	3	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	001	0	1	04	01	H3924_001_0	3	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	002	0	1	04	01	H3924_002_0	4	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	002	0	1	04	01	H3924_002_0	4	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	002	0	1	04	01	H3924_002_0	4	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	002	0	1	04	01	H3924_002_0	4	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	002	0	1	04	01	H3924_002_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	003	0	1	04	01	H3924_003_0	4	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	003	0	1	04	01	H3924_003_0	4	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	003	0	1	04	01	H3924_003_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	003	0	1	04	01	H3924_003_0	4	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	003	0	1	04	01	H3924_003_0	4	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	017	0	1	04	01	H3924_017_0	3	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	017	0	1	04	01	H3924_017_0	3	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	017	0	1	04	01	H3924_017_0	3	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	017	0	1	04	01	H3924_017_0	3	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	017	0	1	04	01	H3924_017_0	3	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	018	0	1	04	01	H3924_018_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	018	0	1	04	01	H3924_018_0	4	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	018	0	1	04	01	H3924_018_0	4	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	018	0	1	04	01	H3924_018_0	4	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	018	0	1	04	01	H3924_018_0	4	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	019	0	1	04	01	H3924_019_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	019	0	1	04	01	H3924_019_0	4	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	019	0	1	04	01	H3924_019_0	4	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	019	0	1	04	01	H3924_019_0	4	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	019	0	1	04	01	H3924_019_0	4	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	021	0	1	04	01	H3924_021_0	3	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	021	0	1	04	01	H3924_021_0	3	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	021	0	1	04	01	H3924_021_0	3	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	021	0	1	04	01	H3924_021_0	3	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	021	0	1	04	01	H3924_021_0	3	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	022	0	1	04	01	H3924_022_0	4	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	022	0	1	04	01	H3924_022_0	4	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	022	0	1	04	01	H3924_022_0	4	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	022	0	1	04	01	H3924_022_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	022	0	1	04	01	H3924_022_0	4	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	023	0	1	04	01	H3924_023_0	4	3	All other OON Services	011100101011111111110101111100001100000001100000	1	20	20	2			2	
H3924	023	0	1	04	01	H3924_023_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	023	0	1	04	01	H3924_023_0	4	5	Eyewear and Hearing Aids OON	100000000000000000000000000000000000000000000010	2			2			2	
H3924	023	0	1	04	01	H3924_023_0	4	1	Primary Care Physician Services	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	023	0	1	04	01	H3924_023_0	4	2	Specialty OON Services	000001010100000000001000000000000001111110001101	2			1	30.00	30.00	2	
H3924	801	0	1	04	01	H3924_801_0	1	1	OON Medicare Covered Services	011111111111111111111101111100001111111111101111	1	20	20	2			2	
H3924	802	0	1	04	01	H3924_802_0	1	1	OON Medicare Covered Services	011111111111111111111101111100001111111111101111	1	20	20	2			2	
H4005	001	0	1	04	01	H4005_001_0	4	1	Group 1	000110010011011111100101110100000111111100111111	1	20	20	2			2	
H4005	001	0	1	04	01	H4005_001_0	4	2	Group 2	010001101100100000011000000000000000000011000000	1	25	25	2			2	
H4005	001	0	1	04	01	H4005_001_0	4	3	Group 3	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H4005	001	0	1	04	01	H4005_001_0	4	4	Group 4	100000000000000000000000001000001000000000000000	1	0	0	2			2	
H4005	003	0	1	04	01	H4005_003_0	4	3	Group 3	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H4005	003	0	1	04	01	H4005_003_0	4	4	Group 4	100000000000000000000000001000001000000000000000	1	0	0	2			2	
H4005	003	0	1	04	01	H4005_003_0	4	2	Group 2	010001101100100000011000000000000000000011000000	1	25	25	2			2	
H4005	003	0	1	04	01	H4005_003_0	4	1	Group 1	000110010011011111100101110100000111111100111111	1	20	20	2			2	
H4005	004	0	1	04	01	H4005_004_0	4	1	Group 1	000110010011011111100101110100000111111100111111	1	20	20	2			2	
H4005	004	0	1	04	01	H4005_004_0	4	2	Group 2	010001101100100000011000000000000000000011000000	1	25	25	2			2	
H4005	004	0	1	04	01	H4005_004_0	4	3	Group 3	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H4005	004	0	1	04	01	H4005_004_0	4	4	Group 4	100000000000000000000000001000001000000000000000	1	0	0	2			2	
H4005	801	0	1	04	01	H4005_801_0	5	1	Group 1	011111111111111111111111111100001111111111101111	1	20	20	2			2	
H4005	802	0	1	04	01	H4005_802_0	5	1	Group 1	011111111111111111111111111100001111111111101111	1	20	20	2			2	
H4005	804	0	1	04	01	H4005_804_0	5	1	Group 1	011111111111111111111111111100001111111111101111	1	20	20	2			2	
H4005	807	0	1	04	01	H4005_807_0	5	1	Group 1	011111111111111111111111111100001111111111101111	1	20	20	2			2	
H4011	001	0	1	04	01	H4011_001_0	4	1	Out of Network Benefits	011111110110111111101101111100001111111111111101	1	20	20	2			2	
H4011	001	0	1	04	01	H4011_001_0	4	2	Out of Network Benefits	100000000000000000000010000000000000000000000010	2			2			2	
H4011	001	0	1	04	01	H4011_001_0	4	3	Out of Network benefits	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	003	0	1	04	01	H4011_003_0	6	1	Out of Network Benefits	011111110110111111101101111100001111111111111101	1	20	20	2			2	
H4011	003	0	1	04	01	H4011_003_0	6	2	Out of Network Benefits	100000000000000000000010000001000000000000000010	2			2			2	
H4011	003	0	1	04	01	H4011_003_0	6	3	Out of Network benefits	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	004	0	1	04	01	H4011_004_0	6	1	Out of Network Benefits	011111110110111111101101111100001111111111111101	1	20	20	2			2	
H4011	004	0	1	04	01	H4011_004_0	6	2	Out of Network Benefits	100000000000000000000010000001010000000000000010	2			2			2	
H4011	004	0	1	04	01	H4011_004_0	6	3	Out of Network benefits	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	801	0	1	04	01	H4011_801_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	801	0	1	04	01	H4011_801_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	802	0	1	04	01	H4011_802_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	802	0	1	04	01	H4011_802_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	803	0	1	04	01	H4011_803_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	803	0	1	04	01	H4011_803_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	805	0	1	04	01	H4011_805_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	805	0	1	04	01	H4011_805_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	806	0	1	04	01	H4011_806_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	806	0	1	04	01	H4011_806_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	807	0	1	04	01	H4011_807_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	807	0	1	04	01	H4011_807_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	809	0	1	04	01	H4011_809_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	809	0	1	04	01	H4011_809_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	810	0	1	04	01	H4011_810_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	810	0	1	04	01	H4011_810_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	811	0	1	04	01	H4011_811_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	811	0	1	04	01	H4011_811_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	813	0	1	04	01	H4011_813_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	813	0	1	04	01	H4011_813_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	814	0	1	04	01	H4011_814_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	814	0	1	04	01	H4011_814_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	815	0	1	04	01	H4011_815_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	815	0	1	04	01	H4011_815_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	817	0	1	04	01	H4011_817_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	817	0	1	04	01	H4011_817_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	818	0	1	04	01	H4011_818_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4011	818	0	1	04	01	H4011_818_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	819	0	1	04	01	H4011_819_0	5	1	Group #1	000000001001000000010000000000000000000000000000	1	50	50	2			2	
H4011	819	0	1	04	01	H4011_819_0	5	2	Group #2	111111110110111111101101111100001111111111111111	1	20	20	2			2	
H4036	001	0	1	04	01	H4036_001_0	12	9	OON Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	8	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	7	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	1	20% OON Coinsurance	000000000000000100000000001000000000000011100000	1	20	20	2			2	
H4036	001	0	1	04	01	H4036_001_0	12	10	OON No Copayment	000100000000000000001000000100001111111100000000	2			2			2	
H4036	001	0	1	04	01	H4036_001_0	12	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	12	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	25.00	40.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	2	30% OON Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H4036	001	0	1	04	01	H4036_001_0	12	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H4036	001	0	1	04	01	H4036_001_0	12	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	40.00	275.00	2	
H4036	001	0	1	04	01	H4036_001_0	12	11	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	8	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	9	OON Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	7	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	30.00	60.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	30.00	30.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	30.00	225.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	1	20% OON Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H4036	003	0	1	04	01	H4036_003_0	11	10	OON No Copayment	000100000000000000001000000100001111111100000000	2			2			2	
H4036	003	0	1	04	01	H4036_003_0	11	11	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	12	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	30.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	15.00	30.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	225.00	225.00	2	
H4036	003	0	1	04	01	H4036_003_0	11	2	25% OON Coinsurance	000000000000001010000001110000000000000000000000	1	25	25	2			2	
H4036	003	0	1	04	01	H4036_003_0	11	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	25	2			2	
H4036	801	0	1	04	01	H4036_801_0	9	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H4036	801	0	1	04	01	H4036_801_0	9	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H4036	802	0	1	04	01	H4036_802_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H4036	802	0	1	04	01	H4036_802_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H4036	803	0	1	04	01	H4036_803_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H4036	803	0	1	04	01	H4036_803_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H4209	001	0	1	04	01	H4209_001_0	6	4	Vision - See OON General Notes	000000000000000000000000000000000000000000000110	1	0	100	2			2	
H4209	001	0	1	04	01	H4209_001_0	6	3	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4209	001	0	1	04	01	H4209_001_0	6	2	Primary Care	000010000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4209	001	0	1	04	01	H4209_001_0	6	1	Thirty Percent Coinsurance Group	011101111111111111111001111100001111111111101001	1	30	30	2			2	
H4209	003	0	1	04	01	H4209_003_0	6	2	Primary Care	000010000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4209	003	0	1	04	01	H4209_003_0	6	3	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4209	003	0	1	04	01	H4209_003_0	6	4	Vision - See OON General Notes	000000000000000000000000000000000000000000000110	1	0	100	2			2	
H4209	003	0	1	04	01	H4209_003_0	6	1	Thirty Percent Coinsurance Group	011101111111111111111001111100001111111111101001	1	30	30	2			2	
H4209	004	0	1	04	01	H4209_004_0	6	3	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4209	004	0	1	04	01	H4209_004_0	6	5	Preventive Dental	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H4209	004	0	1	04	01	H4209_004_0	6	6	Vision - See OON General Notes	000000000000000000000000000000000000000000000110	1	0	100	2			2	
H4209	004	0	1	04	01	H4209_004_0	6	4	DME, Prosthetics, Supplies	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H4209	004	0	1	04	01	H4209_004_0	6	2	Primary Care	000010000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4209	004	0	1	04	01	H4209_004_0	6	1	Twenty Percent Coinsurance Group	011101111111111111111000011100001111111111101001	1	20	20	2			2	
H4209	006	0	1	04	01	H4209_006_0	6	4	DME, Prosthetics, Supplies	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H4209	006	0	1	04	01	H4209_006_0	6	5	Preventive Dental	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H4209	006	0	1	04	01	H4209_006_0	6	6	Vision - See OON General Notes	000000000000000000000000000000000000000000000110	1	0	100	2			2	
H4209	006	0	1	04	01	H4209_006_0	6	3	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4209	006	0	1	04	01	H4209_006_0	6	2	Primary Care	000010000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4209	006	0	1	04	01	H4209_006_0	6	1	Twenty Percent Coinsurance Group	011101111111111111111000011100001111111111101001	1	20	20	2			2	
H4209	809	0	1	04	01	H4209_809_0	4	1	Group 1	011111111111111111111101111100001111111111101111	1	20	50	2			2	
H4209	810	0	1	04	01	H4209_810_0	4	1	Group 1	011111111111111111111101111100001111111111101111	1	20	50	2			2	
H4209	811	0	1	04	01	H4209_811_0	4	1	Group 1	011111111111111111111101111100001111111111101111	1	20	50	2			2	
H4209	812	0	1	04	01	H4209_812_0	4	1	Group 1	011111111111111111111101111100001111111111101111	1	20	50	2			2	
H4213	001	0	1	09	04	H4213_001_0	4	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	001	0	1	09	04	H4213_001_0	4	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	001	0	1	09	04	H4213_001_0	4	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	001	0	1	09	04	H4213_001_0	4	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	002	0	1	09	04	H4213_002_0	5	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	002	0	1	09	04	H4213_002_0	5	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	002	0	1	09	04	H4213_002_0	5	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	002	0	1	09	04	H4213_002_0	5	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	003	0	1	09	04	H4213_003_0	5	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	003	0	1	09	04	H4213_003_0	5	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	003	0	1	09	04	H4213_003_0	5	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	003	0	1	09	04	H4213_003_0	5	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	004	0	1	09	04	H4213_004_0	6	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	004	0	1	09	04	H4213_004_0	6	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	004	0	1	09	04	H4213_004_0	6	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	004	0	1	09	04	H4213_004_0	6	2	All other covered services	011111111111111111111001111100010111111111101111	1	30	30	2			2	
H4213	005	0	1	09	04	H4213_005_0	5	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	005	0	1	09	04	H4213_005_0	5	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	005	0	1	09	04	H4213_005_0	5	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	005	0	1	09	04	H4213_005_0	5	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	006	0	1	09	04	H4213_006_0	5	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	006	0	1	09	04	H4213_006_0	5	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	006	0	1	09	04	H4213_006_0	5	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	006	0	1	09	04	H4213_006_0	5	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	007	0	1	09	04	H4213_007_0	6	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	007	0	1	09	04	H4213_007_0	6	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	007	0	1	09	04	H4213_007_0	6	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4213	007	0	1	09	04	H4213_007_0	6	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	008	0	1	09	04	H4213_008_0	6	4	Health Education/Wellness Programs	000000000000000000000000000000001000000000000000	1	30	100	2			2	
H4213	008	0	1	09	04	H4213_008_0	6	1	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	150.00	300.00	2	
H4213	008	0	1	09	04	H4213_008_0	6	2	All other covered services	011111111111111111111001111100010011111111101111	1	30	30	2			2	
H4213	008	0	1	09	04	H4213_008_0	6	3	Immunizations	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4408	001	0	1	04	01	H4408_001_0	4	6		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	5		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4408	001	0	1	04	01	H4408_001_0	4	4		000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	3		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4408	001	0	1	04	01	H4408_001_0	4	2		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4408	001	0	1	04	01	H4408_001_0	4	1	PCP/SPC	011111111111111111111001100000000011111111011101	1	30	30	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4408	002	0	1	04	01	H4408_002_0	4	6	DMS	000000000000000000000000010000000000000000000000	1	20	25	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	5	DME	000000000000000000000001100000000000000000000000	1	25	25	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4408	002	0	1	04	01	H4408_002_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4408	002	0	1	04	01	H4408_002_0	4	1	PCP/SPC	011111111111111111111000000000000011111111011101	1	30	30	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4408	006	0	1	04	01	H4408_006_0	4	6	DMS	000000000000000000000000010000000000000000000000	1	20	40	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	5	DME	000000000000000000000001100000000000000000000000	1	40	40	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4408	006	0	1	04	01	H4408_006_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4408	006	0	1	04	01	H4408_006_0	4	1	PCP/SPC	011111111111111111111000000000000011111111011101	1	30	30	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	6	DMS	000000000000000000000000010000000000000000000000	1	20	40	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	5	DME	000000000000000000000001100000000000000000000000	1	40	40	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	4	ESRD	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4408	007	0	1	04	01	H4408_007_0	4	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	1	PCP/SPC	011111111111111111111000000000000011111111011101	1	30	30	2			2	
H4408	007	0	1	04	01	H4408_007_0	4	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4408	801	0	1	04	01	H4408_801_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4408	801	0	1	04	01	H4408_801_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4408	801	0	1	04	01	H4408_801_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4408	803	0	1	04	01	H4408_803_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4408	803	0	1	04	01	H4408_803_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4408	803	0	1	04	01	H4408_803_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4408	804	0	1	04	01	H4408_804_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4408	804	0	1	04	01	H4408_804_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4408	804	0	1	04	01	H4408_804_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4520	001	0	1	04	01	H4520_001_0	5	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H4520	001	0	1	04	01	H4520_001_0	5	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H4520	001	0	1	04	01	H4520_001_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	001	0	1	04	01	H4520_001_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	001	0	1	04	01	H4520_001_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	001	0	1	04	01	H4520_001_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	002	0	1	04	01	H4520_002_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	002	0	1	04	01	H4520_002_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	002	0	1	04	01	H4520_002_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	002	0	1	04	01	H4520_002_0	5	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4520	002	0	1	04	01	H4520_002_0	5	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H4520	002	0	1	04	01	H4520_002_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	003	0	1	04	01	H4520_003_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	003	0	1	04	01	H4520_003_0	5	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H4520	003	0	1	04	01	H4520_003_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	003	0	1	04	01	H4520_003_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	003	0	1	04	01	H4520_003_0	5	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4520	003	0	1	04	01	H4520_003_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	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	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4520	005	0	1	04	01	H4520_005_0	5	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H4520	005	0	1	04	01	H4520_005_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	006	0	1	04	01	H4520_006_0	4	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H4520	006	0	1	04	01	H4520_006_0	4	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	006	0	1	04	01	H4520_006_0	4	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	006	0	1	04	01	H4520_006_0	4	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	006	0	1	04	01	H4520_006_0	4	5		000000000000000000000000000001101000000000011000	1	50	50	2			2	
H4520	006	0	1	04	01	H4520_006_0	4	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	016	0	1	04	01	H4520_016_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	016	0	1	04	01	H4520_016_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	016	0	1	04	01	H4520_016_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	016	0	1	04	01	H4520_016_0	5	5		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H4520	016	0	1	04	01	H4520_016_0	5	4		000000000000000000000000000100000100000000000010	2			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	018	0	1	04	01	H4520_018_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	018	0	1	04	01	H4520_018_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	018	0	1	04	01	H4520_018_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	018	0	1	04	01	H4520_018_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	018	0	1	04	01	H4520_018_0	5	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H4520	018	0	1	04	01	H4520_018_0	5	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H4520	020	0	1	04	01	H4520_020_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	020	0	1	04	01	H4520_020_0	5	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H4520	020	0	1	04	01	H4520_020_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	020	0	1	04	01	H4520_020_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	020	0	1	04	01	H4520_020_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	020	0	1	04	01	H4520_020_0	5	5		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H4520	021	0	1	04	01	H4520_021_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H4520	021	0	1	04	01	H4520_021_0	5	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H4520	021	0	1	04	01	H4520_021_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H4520	021	0	1	04	01	H4520_021_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4520	021	0	1	04	01	H4520_021_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H4520	021	0	1	04	01	H4520_021_0	5	5		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H4520	801	0	1	04	01	H4520_801_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4520	801	0	1	04	01	H4520_801_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4520	801	0	1	04	01	H4520_801_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4520	804	0	1	04	01	H4520_804_0	6	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4520	804	0	1	04	01	H4520_804_0	6	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4520	804	0	1	04	01	H4520_804_0	6	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4520	805	0	1	04	01	H4520_805_0	6	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4520	805	0	1	04	01	H4520_805_0	6	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4520	805	0	1	04	01	H4520_805_0	6	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	8	Group 8	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	6	Group 6	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	10	Group 10	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	11	Group 11	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	12	Group 12	000000000000000000000000000000000000000000000010	1	30	50	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	13	Group 13	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	9	Group 9	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	1	Group 1	000010000010000000000000000000000010000000000000	2			1	25.00	25.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	5	Group 5	000000000000010000000000000000000000000000000000	1	40	40	1	10.00	10.00	2	
H4522	001	0	1	04	01	H4522_001_0	6	4	Group 4	000100000000001101100000000000000001111111000000	1	40	40	2			2	
H4522	001	0	1	04	01	H4522_001_0	6	3	Group 3	000000000000000000000001110000000000000000100000	1	30	30	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	5	Group 5	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4522	007	0	1	04	01	H4522_007_0	4	6	Group 6	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H4522	008	0	1	04	01	H4522_008_0	5	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
H4522	008	0	1	04	01	H4522_008_0	5	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H4522	008	0	1	04	01	H4522_008_0	5	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H4522	008	0	1	04	01	H4522_008_0	5	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4522	008	0	1	04	01	H4522_008_0	5	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H4522	008	0	1	04	01	H4522_008_0	5	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H4522	008	0	1	04	01	H4522_008_0	5	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H4522	008	0	1	04	01	H4522_008_0	5	1	Group 1	010111110110101101101001110100001011111111101111	1	30	30	2			2	
H4522	008	0	1	04	01	H4522_008_0	5	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H4522	801	0	1	04	01	H4522_801_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H4522	801	0	1	04	01	H4522_801_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H4522	801	0	1	04	01	H4522_801_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H4522	801	0	1	04	01	H4522_801_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4522	803	0	1	04	01	H4522_803_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H4522	803	0	1	04	01	H4522_803_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4522	803	0	1	04	01	H4522_803_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H4522	803	0	1	04	01	H4522_803_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H4522	804	0	1	04	01	H4522_804_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4522	804	0	1	04	01	H4522_804_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H4522	804	0	1	04	01	H4522_804_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H4522	804	0	1	04	01	H4522_804_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H4522	806	0	2	04	01	H4522_806_0	5	1	Group 1	010011110111101111111101111100001010111111101111	1	20	20	2			2	
H4522	806	0	2	04	01	H4522_806_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4522	806	0	2	04	01	H4522_806_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H4522	806	0	2	04	01	H4522_806_0	5	4	Group 4	001000001000000000000000000000000000000000000000	1	45	45	2			2	
H4522	807	0	2	04	01	H4522_807_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H4522	807	0	2	04	01	H4522_807_0	5	4	Group 4	001000001000000000000000000000000000000000000000	1	45	45	2			2	
H4522	807	0	2	04	01	H4522_807_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4522	807	0	2	04	01	H4522_807_0	5	1	Group 1	010011110111101111111101111100001010111111101111	1	20	20	2			2	
H4522	808	0	2	04	01	H4522_808_0	5	1	Group 1	010011110111101111111101111100001010111111101111	1	20	20	2			2	
H4522	808	0	2	04	01	H4522_808_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4522	808	0	2	04	01	H4522_808_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H4522	808	0	2	04	01	H4522_808_0	5	4	Group 4	001000001000000000000000000000000000000000000000	1	45	45	2			2	
H4524	001	0	1	04	01	H4524_001_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H4524	001	0	1	04	01	H4524_001_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4524	001	0	1	04	01	H4524_001_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	20	20	2			2	
H4524	001	0	1	04	01	H4524_001_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H4524	001	0	1	04	01	H4524_001_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	002	0	1	04	01	H4524_002_0	7	1	Tier 1	011111111111111111111001110100000111111111101101	1	20	20	2			2	
H4524	002	0	1	04	01	H4524_002_0	7	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	002	0	1	04	01	H4524_002_0	7	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H4524	002	0	1	04	01	H4524_002_0	7	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H4524	002	0	1	04	01	H4524_002_0	7	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H4524	007	0	1	04	01	H4524_007_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H4524	007	0	1	04	01	H4524_007_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4524	007	0	1	04	01	H4524_007_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	20	20	2			2	
H4524	007	0	1	04	01	H4524_007_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	007	0	1	04	01	H4524_007_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H4524	008	0	1	04	01	H4524_008_0	7	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	008	0	1	04	01	H4524_008_0	7	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H4524	008	0	1	04	01	H4524_008_0	7	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4524	008	0	1	04	01	H4524_008_0	7	1	Tier 1	011111111111111111111001110100000111111111101101	1	20	20	2			2	
H4524	008	0	1	04	01	H4524_008_0	7	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H4524	013	0	1	04	01	H4524_013_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	013	0	1	04	01	H4524_013_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	20	20	2			2	
H4524	013	0	1	04	01	H4524_013_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4524	013	0	1	04	01	H4524_013_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H4524	013	0	1	04	01	H4524_013_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H4524	014	0	1	04	01	H4524_014_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	014	0	1	04	01	H4524_014_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H4524	014	0	1	04	01	H4524_014_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H4524	014	0	1	04	01	H4524_014_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	20	20	2			2	
H4524	014	0	1	04	01	H4524_014_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4524	801	0	1	04	01	H4524_801_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4524	801	0	1	04	01	H4524_801_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	801	0	1	04	01	H4524_801_0	2	1	Tier 1	011111110110111111101101111100001111111111101111	1	20	20	2			2	
H4524	802	0	1	04	01	H4524_802_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4524	802	0	1	04	01	H4524_802_0	2	1	Tier 1	011111110110111111101101111100001111111111101111	1	20	20	2			2	
H4524	802	0	1	04	01	H4524_802_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	804	0	1	04	01	H4524_804_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4524	804	0	1	04	01	H4524_804_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	804	0	1	04	01	H4524_804_0	2	1	Tier 1	011111110110111111101101111100001111111111101111	1	20	20	2			2	
H4524	805	0	2	04	01	H4524_805_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H4524	805	0	2	04	01	H4524_805_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4524	805	0	2	04	01	H4524_805_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	806	0	2	04	01	H4524_806_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H4524	806	0	2	04	01	H4524_806_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4524	806	0	2	04	01	H4524_806_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	807	0	2	04	01	H4524_807_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H4524	807	0	2	04	01	H4524_807_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4524	807	0	2	04	01	H4524_807_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H4605	001	0	1	04	01	H4605_001_0	2	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	2	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H4605	001	0	1	04	01	H4605_001_0	2	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	8	$0 to $300	000000000000000001000000000000000000000000000000	2			1	0.00	300.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	9	Misc. flat benefit amount.  no in-out	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	7	$0 to 20% cost sharing	000000000000010000000000000000000000000000000000	1	0	20	2			2	
H4605	002	0	1	04	01	H4605_002_0	5	6	$0 cost sharing	011000000000000000000000010100000101111111000000	2			1	0.00	0.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	1	$35.00 copay	000011111111100000011000000000000010000000001101	2			1	35.00	35.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	4	20% coinsurance	000100000000001110000001100000000000000000000000	1	20	20	2			2	
H4605	002	0	1	04	01	H4605_002_0	5	3	$300 copay	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	2	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	10	$0 to $35	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H4605	002	0	1	04	01	H4605_002_0	5	5	10% coinsurance	000000000000000000000000001000000000000000100000	1	10	10	2			2	
H4605	004	0	1	04	01	H4605_004_0	5	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H4605	004	0	1	04	01	H4605_004_0	5	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4605	004	0	1	04	01	H4605_004_0	5	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H4605	004	0	1	04	01	H4605_004_0	5	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H4605	004	0	1	04	01	H4605_004_0	5	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H4605	004	0	1	04	01	H4605_004_0	5	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H4605	004	0	1	04	01	H4605_004_0	5	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H4605	004	0	1	04	01	H4605_004_0	5	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H4605	004	0	1	04	01	H4605_004_0	5	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
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H4754	001	0	1	04	01	H4754_001_0	5	5	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H4754	001	0	1	04	01	H4754_001_0	5	4	Eyewear and hearing aids	100000000000000000000000000000000000000000000010	2			2			2	
H4754	001	0	1	04	01	H4754_001_0	5	3	Physician Specialist	000000010000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H4754	001	0	1	04	01	H4754_001_0	5	2	PCP,  Chiro, ESRD	000011000000000000000000001000000000000000000000	2			1	30.00	30.00	2	
H4754	001	0	1	04	01	H4754_001_0	5	1	Out of network services	011100101111111111111000010100001111111111101101	1	15	15	2			2	
H4754	001	0	1	04	01	H4754_001_0	5	6	Durable Medical Equipment and Prostetics	000000000000000000000001100000000000000000000000	1	20	20	2			2	
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H4875	001	0	1	04	01	H4875_001_0	7	9	Hearing Aids	100000000000000000000000000000000000000000000000	2			2			2	
H4875	001	0	1	04	01	H4875_001_0	7	7	10% Coinsurance	000000000000000000000000000000000000000000100000	1	10	10	2			2	
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H4875	001	0	1	04	01	H4875_001_0	7	5	$5 Copay	000000000000000000000000001000000000000000000000	2			1	5.00	5.00	2	
H4875	001	0	1	04	01	H4875_001_0	7	4	$10 Copay	000000000000000000001000010000000101111111000000	2			1	10.00	10.00	2	
H4875	001	0	1	04	01	H4875_001_0	7	3	$15 copay	010011111111111111110000000000001010000000001101	2			1	15.00	15.00	2	
H4875	001	0	1	04	01	H4875_001_0	7	2	20% coinsurance	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H4875	001	0	1	04	01	H4875_001_0	7	10	$0 Copay	000100000000000000000000000100010000000000000000	2			2			2	
H4875	001	0	1	04	01	H4875_001_0	7	1	$50 Copay	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
H4875	001	0	1	04	01	H4875_001_0	7	8	Vision Wear	000000000000000000000000000000000000000000000010	2			2			2	
H4875	003	0	1	04	01	H4875_003_0	7	7	10% Coinsurance	000000000000000000000000000000000000000000100000	1	10	10	2			2	
H4875	003	0	1	04	01	H4875_003_0	7	6	15% Coinsurance	001000000000000000000000000000000000000000000000	1	15	15	2			2	
H4875	003	0	1	04	01	H4875_003_0	7	5	$5 Copay	000000000000000000000000001000000000000000000000	2			1	5.00	5.00	2	
H4875	003	0	1	04	01	H4875_003_0	7	4	$10 Copay	000000000000000000001000010000000101111111000000	2			1	10.00	10.00	2	
H4875	003	0	1	04	01	H4875_003_0	7	8	Vision Wear	000000000000000000000000000000000000000000000010	2			2			2	
H4875	003	0	1	04	01	H4875_003_0	7	2	20% coinsurance	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H4875	003	0	1	04	01	H4875_003_0	7	10	$0 Copay	000100000000000000000000000100010000000000000000	2			2			2	
H4875	003	0	1	04	01	H4875_003_0	7	1	$50 Copay	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
H4875	003	0	1	04	01	H4875_003_0	7	9	Hearing Aids	100000000000000000000000000000000000000000000000	2			2			2	
H4875	003	0	1	04	01	H4875_003_0	7	3	$15 copay	010011111111111111110000000000001010000000001101	2			1	15.00	15.00	2	
H4875	005	0	1	04	01	H4875_005_0	6	9	Hearing Aids	100000000000000000000000000000000000000000000000	2			2			2	
H4875	005	0	1	04	01	H4875_005_0	6	8	Vision Wear	000000000000000000000000000000000000000000000010	2			2			2	
H4875	005	0	1	04	01	H4875_005_0	6	7	10% Coinsurance	000000000000000000000000000000000000000000100000	1	10	10	2			2	
H4875	005	0	1	04	01	H4875_005_0	6	6	15% Coinsurance	001000000000000000000000000000000000000000000000	1	15	15	2			2	
H4875	005	0	1	04	01	H4875_005_0	6	5	$5 Copay	000000000000000000000000001000000000000000000000	2			1	5.00	5.00	2	
H4875	005	0	1	04	01	H4875_005_0	6	4	$10 Copay	000000000000000000001000010000000101111111000000	2			1	10.00	10.00	2	
H4875	005	0	1	04	01	H4875_005_0	6	3	$15 copay	010011111111111111110000000000001010000000001101	2			1	15.00	15.00	2	
H4875	005	0	1	04	01	H4875_005_0	6	2	20% coinsurance	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H4875	005	0	1	04	01	H4875_005_0	6	10	$0 Copay	000100000000000000000000000100010000000000000000	2			2			2	
H4875	005	0	1	04	01	H4875_005_0	6	1	$50 Copay	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
H4875	007	0	1	04	01	H4875_007_0	6	9	Hearing Aids	100000000000000000000000000000000000000000000000	2			2			2	
H4875	007	0	1	04	01	H4875_007_0	6	8	Vision Wear	000000000000000000000000000000000000000000000010	2			2			2	
H4875	007	0	1	04	01	H4875_007_0	6	7	10% Coinsurance	000000000000000000000000000000000000000000100000	1	10	10	2			2	
H4875	007	0	1	04	01	H4875_007_0	6	6	15% Coinsurance	001000000000000000000000000000000000000000000000	1	15	15	2			2	
H4875	007	0	1	04	01	H4875_007_0	6	5	$5 Copay	000000000000000000000000001000000000000000000000	2			1	5.00	5.00	2	
H4875	007	0	1	04	01	H4875_007_0	6	4	$10 Copay	000000000000000000001000010000000101111111000000	2			1	10.00	10.00	2	
H4875	007	0	1	04	01	H4875_007_0	6	3	$15 copay	010011111111111111110000000000001010000000001101	2			1	15.00	15.00	2	
H4875	007	0	1	04	01	H4875_007_0	6	2	20% coinsurance	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H4875	007	0	1	04	01	H4875_007_0	6	10	$0 Copay	000100000000000000000000000100010000000000000000	2			2			2	
H4875	007	0	1	04	01	H4875_007_0	6	1	$50 Copay	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
H4875	009	0	1	04	01	H4875_009_0	6	1	$50 Copay	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
H4875	009	0	1	04	01	H4875_009_0	6	10	$0 Copay	000100000000000000000000000100010000000000000000	2			2			2	
H4875	009	0	1	04	01	H4875_009_0	6	2	20% coinsurance	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H4875	009	0	1	04	01	H4875_009_0	6	3	$15 copay	010011111111111111110000000000001010000000001101	2			1	15.00	15.00	2	
H4875	009	0	1	04	01	H4875_009_0	6	9	Hearing Aids	100000000000000000000000000000000000000000000000	2			2			2	
H4875	009	0	1	04	01	H4875_009_0	6	5	$5 Copay	000000000000000000000000001000000000000000000000	2			1	5.00	5.00	2	
H4875	009	0	1	04	01	H4875_009_0	6	6	15% Coinsurance	001000000000000000000000000000000000000000000000	1	15	15	2			2	
H4875	009	0	1	04	01	H4875_009_0	6	7	10% Coinsurance	000000000000000000000000000000000000000000100000	1	10	10	2			2	
H4875	009	0	1	04	01	H4875_009_0	6	8	Vision Wear	000000000000000000000000000000000000000000000010	2			2			2	
H4875	009	0	1	04	01	H4875_009_0	6	4	$10 Copay	000000000000000000001000010000000101111111000000	2			1	10.00	10.00	2	
H4875	801	0	1	04	01	H4875_801_0	5	2	Behavioral Health Services	000000001001000000010000000000000000000000000000	1	45	50	2			2	
H4875	801	0	1	04	01	H4875_801_0	5	1	Group 1	111111110110111111101101111100001111111111101111	1	20	40	2			2	
H4875	802	0	1	04	01	H4875_802_0	5	1	Group 1	111111110110111111101101111100001111111111101111	1	20	40	2			2	
H4875	802	0	1	04	01	H4875_802_0	5	2	Behavioral Health Services	000000001001000000010000000000000000000000000000	1	45	50	2			2	
H4908	001	0	1	04	01	H4908_001_0	5	7	$0 copay	000000000000000000000000000000000101111110000001	2			1	0.00	0.00	2	
H4908	001	0	1	04	01	H4908_001_0	5	8	15% Coinsurance	000000000000000000000000010000000000000000000000	1	15	15	2			2	
H4908	001	0	1	04	01	H4908_001_0	5	9	$10 Copay	000000000000000000000000001000000000000000000000	2			1	10.00	10.00	2	
H4908	001	0	1	04	01	H4908_001_0	5	1	20% Coinsurance	000000000000000000000000000000001000000000001000	1	20	20	2			2	
H4908	001	0	1	04	01	H4908_001_0	5	6	20% coinsurance	000000000000000000000001100000000000000000100110	1	20	20	2			2	
H4908	001	0	1	04	01	H4908_001_0	5	3	50.00 copay	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H4908	001	0	1	04	01	H4908_001_0	5	4	15.00 copay	011111111111110110011000000100000010000001000000	2			1	15.00	15.00	2	
H4908	001	0	1	04	01	H4908_001_0	5	5	$15-$100	000000000000001000000000000000000000000000000000	2			1	15.00	100.00	2	
H4908	001	0	1	04	01	H4908_001_0	5	2	250.00 copay	000000000000000001100000000000000000000000000000	2			1	250.00	250.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	9	$10 Copay	000000000000000000000000001000000000000000000000	2			1	10.00	10.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	1	20% Coinsurance	000000000000000000000000000000001000000000001000	1	20	20	2			2	
H4908	002	0	1	04	01	H4908_002_0	5	2	250.00 copay	000000000000000001100000000000000000000000000000	2			1	250.00	250.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	3	50.00 copay	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	8	15% Coinsurance	000000000000000000000000010000000000000000000000	1	15	15	2			2	
H4908	002	0	1	04	01	H4908_002_0	5	7	$0 copay	000000000000000000000000000000000101111110000001	2			1	0.00	0.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	6	20% coinsurance	000000000000000000000001100000000000000000100110	1	20	20	2			2	
H4908	002	0	1	04	01	H4908_002_0	5	5	$15-$100	000000000000001000000000000000000000000000000000	2			1	15.00	100.00	2	
H4908	002	0	1	04	01	H4908_002_0	5	4	15.00 copay	011111111111110110011000000100000010000001000000	2			1	15.00	15.00	2	
H4908	005	0	1	04	01	H4908_005_0	7	3	$0	000000000000000000000000000000000101111110000000	2			1	0.00	0.00	2	
H4908	005	0	1	04	01	H4908_005_0	7	1	$15 copay	000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4908	005	0	1	04	01	H4908_005_0	7	2	30%	011011111111111111111101111100001010000001101111	1	30	30	2			2	
H4908	006	0	1	04	01	H4908_006_0	8	3	$0	000000000000000000000000000000000101111110000000	2			1	0.00	0.00	2	
H4908	006	0	1	04	01	H4908_006_0	8	1	$15 copay	000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4908	006	0	1	04	01	H4908_006_0	8	2	30%	011011111111111111111101111100001010000001101111	1	30	30	2			2	
H4909	001	0	1	04	01	H4909_001_0	9	1	20% Coinsurance	000000000000000100000000001000000000000011100000	1	20	20	2			2	
H4909	001	0	1	04	01	H4909_001_0	9	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	6	Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	5	PCP	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	250.00	250.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	3	Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H4909	001	0	1	04	01	H4909_001_0	9	2	30% Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H4909	001	0	1	04	01	H4909_001_0	9	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	40.00	250.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	25.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	9	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	20.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	35.00	250.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	2	30% Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	3	Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	5	PCP	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	6	Specialist	010001010100000000000000000000000000000000000101	2			1	35.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	35.00	70.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	1	20% Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	250.00	250.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	5	PCP	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	6	Specialist	010001010100000000000000000000000000000000000101	2			1	35.00	35.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	35.00	70.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	1	20% Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H4909	007	0	1	04	01	H4909_007_0	5	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	25.00	35.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	35.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	35.00	225.00	2	
H4909	007	0	1	04	01	H4909_007_0	5	2	30% Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H4909	007	0	1	04	01	H4909_007_0	5	3	Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H4909	007	0	1	04	01	H4909_007_0	5	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	225.00	225.00	2	
H4909	804	0	1	04	01	H4909_804_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H4909	804	0	1	04	01	H4909_804_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H4909	805	0	1	04	01	H4909_805_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H4909	805	0	1	04	01	H4909_805_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H4909	806	0	1	04	01	H4909_806_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H4909	806	0	1	04	01	H4909_806_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H4956	001	0	1	04	01	H4956_001_0	3	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4956	001	0	1	04	01	H4956_001_0	3	6	DMS	000000000000000000000000010000000000000000000000	1	20	40	2			2	
H4956	001	0	1	04	01	H4956_001_0	3	5	DME	000000000000000000000001100000000000000000000000	1	40	40	2			2	
H4956	001	0	1	04	01	H4956_001_0	3	4	ESRD	000000000000000000000000001000000000000000000000	2			1	0.00	75.00	2	
H4956	001	0	1	04	01	H4956_001_0	3	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4956	001	0	1	04	01	H4956_001_0	3	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H4956	001	0	1	04	01	H4956_001_0	3	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	001	0	1	04	01	H4956_001_0	3	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4956	002	0	1	04	01	H4956_002_0	3	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H4956	002	0	1	04	01	H4956_002_0	3	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4956	002	0	1	04	01	H4956_002_0	3	4	ESRD	000000000000000000000000001000000000000000000000	2			1	0.00	75.00	2	
H4956	002	0	1	04	01	H4956_002_0	3	5	DME	000000000000000000000001100000000000000000000000	1	40	40	2			2	
H4956	002	0	1	04	01	H4956_002_0	3	6	DMS	000000000000000000000000010000000000000000000000	1	20	40	2			2	
H4956	002	0	1	04	01	H4956_002_0	3	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4956	002	0	1	04	01	H4956_002_0	3	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	002	0	1	04	01	H4956_002_0	3	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4956	003	0	1	04	01	H4956_003_0	3	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4956	003	0	1	04	01	H4956_003_0	3	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4956	003	0	1	04	01	H4956_003_0	3	6	DMS	000000000000000000000000010000000000000000000000	1	20	40	2			2	
H4956	003	0	1	04	01	H4956_003_0	3	5	DME	000000000000000000000001100000000000000000000000	1	40	40	2			2	
H4956	003	0	1	04	01	H4956_003_0	3	4	ESRD	000000000000000000000000001000000000000000000000	2			1	0.00	75.00	2	
H4956	003	0	1	04	01	H4956_003_0	3	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4956	003	0	1	04	01	H4956_003_0	3	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H4956	003	0	1	04	01	H4956_003_0	3	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	004	0	1	04	01	H4956_004_0	3	8	Smoking Cessation	000000000000000000000000000000101000000000000000	1	50	50	2			2	
H4956	004	0	1	04	01	H4956_004_0	3	1	PCP/SPC	011111111111111111111000000000000011111111001101	1	30	30	2			2	
H4956	004	0	1	04	01	H4956_004_0	3	2	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	004	0	1	04	01	H4956_004_0	3	3	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H4956	004	0	1	04	01	H4956_004_0	3	4	ESRD	000000000000000000000000001000000000000000000000	2			1	0.00	75.00	2	
H4956	004	0	1	04	01	H4956_004_0	3	5	DME	000000000000000000000001100000000000000000000000	1	40	40	2			2	
H4956	004	0	1	04	01	H4956_004_0	3	6	DMS	000000000000000000000000010000000000000000000000	1	20	40	2			2	
H4956	004	0	1	04	01	H4956_004_0	3	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H4956	801	0	1	04	01	H4956_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4956	801	0	1	04	01	H4956_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4956	801	0	1	04	01	H4956_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4956	802	0	1	04	01	H4956_802_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4956	802	0	1	04	01	H4956_802_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4956	802	0	1	04	01	H4956_802_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H4956	803	0	1	04	01	H4956_803_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H4956	803	0	1	04	01	H4956_803_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H4956	803	0	1	04	01	H4956_803_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5009	001	0	1	04	01	H5009_001_0	2	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H5009	001	0	1	04	01	H5009_001_0	2	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H5009	001	0	1	04	01	H5009_001_0	2	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H5009	001	0	1	04	01	H5009_001_0	2	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H5009	001	0	1	04	01	H5009_001_0	2	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H5009	001	0	1	04	01	H5009_001_0	2	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H5009	001	0	1	04	01	H5009_001_0	2	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H5009	001	0	1	04	01	H5009_001_0	2	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5009	001	0	1	04	01	H5009_001_0	2	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	8	$0 to $300	000000000000000001000000000000000000000000000000	2			1	0.00	300.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	9	Misc. flat benefit amount.  no in-out	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	7	$0 to 20% cost sharing	000000000000010000000000000000000000000000000000	1	0	20	2			2	
H5009	002	0	1	04	01	H5009_002_0	4	6	$0 cost sharing	011000000000000000000000010100000101111111000000	2			1	0.00	0.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	5	10% coinsurance	000000000000000000000000001000000000000000100000	1	10	10	2			2	
H5009	002	0	1	04	01	H5009_002_0	4	4	20% coinsurance	000100000000001110000001100000000000000000000000	1	20	20	2			2	
H5009	002	0	1	04	01	H5009_002_0	4	3	$300 copay	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	2	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	10	$0 to $35	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H5009	002	0	1	04	01	H5009_002_0	4	1	$35.00 copay	000011111111100000011000000000000010000000001101	2			1	35.00	35.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H5009	004	0	1	04	01	H5009_004_0	5	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H5009	004	0	1	04	01	H5009_004_0	5	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H5009	004	0	1	04	01	H5009_004_0	5	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H5010	001	0	1	04	01	H5010_001_0	2	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H5010	001	0	1	04	01	H5010_001_0	2	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5010	001	0	1	04	01	H5010_001_0	2	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	1	$35.00 copay	000011111111100000011000000000000010000000001101	2			1	35.00	35.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	9	Misc. flat benefit amount.  no in-out	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	8	$0 to $300	000000000000000001000000000000000000000000000000	2			1	0.00	300.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	7	$0 to 20% cost sharing	000000000000010000000000000000000000000000000000	1	0	20	2			2	
H5010	002	0	1	04	01	H5010_002_0	4	6	$0 cost sharing	011000000000000000000000010100000101111111000000	2			1	0.00	0.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	5	10% coinsurance	000000000000000000000000001000000000000000100000	1	10	10	2			2	
H5010	002	0	1	04	01	H5010_002_0	4	4	20% coinsurance	000100000000001110000001100000000000000000000000	1	20	20	2			2	
H5010	002	0	1	04	01	H5010_002_0	4	3	$300 copay	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	2	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5010	002	0	1	04	01	H5010_002_0	4	10	$0 to $35	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	3	10% coinsurance	000100000000001110000001100000000000000000000000	1	10	10	2			2	
H5010	004	0	1	04	01	H5010_004_0	5	2	$200.00 copay	000000000000000000100000000000000000000000000000	2			1	200.00	200.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	1	$25.00 copay	000011111111100000011000000000000010000000001101	2			1	25.00	25.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	4	$0 cost sharing	011000000000000000000000011100000101111111100000	2			1	0.00	0.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	6	0 to 10% coinsurance	000000000000010000000000000000000000000000000000	1	0	10	2			2	
H5010	004	0	1	04	01	H5010_004_0	5	9	$0 to $25 copay	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	8	$100 copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	7	Misc. flat benefit amount	000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H5010	004	0	1	04	01	H5010_004_0	5	5	$0 to $200	000000000000000001000000000000000000000000000000	2			1	0.00	200.00	2	
H5041	001	0	1	04	01	H5041_001_0	5	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H5041	001	0	1	04	01	H5041_001_0	5	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5041	001	0	1	04	01	H5041_001_0	5	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5041	001	0	1	04	01	H5041_001_0	5	4		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5041	001	0	1	04	01	H5041_001_0	5	5		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H5041	001	0	1	04	01	H5041_001_0	5	7		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H5041	001	0	1	04	01	H5041_001_0	5	6		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H5041	002	0	1	04	01	H5041_002_0	5	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H5041	002	0	1	04	01	H5041_002_0	5	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5041	002	0	1	04	01	H5041_002_0	5	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H5041	002	0	1	04	01	H5041_002_0	5	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5041	002	0	1	04	01	H5041_002_0	5	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H5041	002	0	1	04	01	H5041_002_0	5	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5041	801	0	1	04	01	H5041_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5041	801	0	1	04	01	H5041_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5041	801	0	1	04	01	H5041_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5041	802	0	1	04	01	H5041_802_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5041	802	0	1	04	01	H5041_802_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5041	802	0	1	04	01	H5041_802_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5041	803	0	1	04	01	H5041_803_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5041	803	0	1	04	01	H5041_803_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5041	803	0	1	04	01	H5041_803_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5042	001	0	1	04	01	H5042_001_0	7	3	$25 Copayment	001001111111111110011000001000000000000001000101	2			1	25.00	25.00	2	
H5042	001	0	1	04	01	H5042_001_0	7	4	$75 Copayment	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5042	001	0	1	04	01	H5042_001_0	7	5	$150 Copayment	000000000000000001100000000000000000000000000000	2			1	150.00	150.00	2	
H5042	001	0	1	04	01	H5042_001_0	7	6	$0 to $25 Copayment	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H5042	001	0	1	04	01	H5042_001_0	7	8	$0 to $20 Copayment	000100000000000000000000000000000000000000000000	2			1	0.00	20.00	2	
H5042	001	0	1	04	01	H5042_001_0	7	2	$15 Copayment	000010000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	001	0	1	04	01	H5042_001_0	7	7	20% Copayment	000000000000000000000001110000000000000000000010	1	20	20	2			2	
H5042	001	0	1	04	01	H5042_001_0	7	1	$0 Copayment	110000000000000000000010000100000111111110011000	2			1	0.00	0.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	9	30% Copayment	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H5042	002	0	1	04	01	H5042_002_0	10	1	$0 Copayment	010000000000000000000010000100000111111110011000	2			1	0.00	0.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	10	$15 Copayment	000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	2	$20 Copayment	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	3	$35 Copayment	001001111111111110011000001000000000000001000101	2			1	35.00	35.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	4	$125 Copayment	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	5	$200 Copayment	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	6	$0-$35 Copayment	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	7	$0-$25 Copayment	000100000000000000000000000000000000000000000000	2			1	0.00	25.00	2	
H5042	002	0	1	04	01	H5042_002_0	10	8	20% Copayment	000000000000000000000000010000000000000000000010	1	20	20	2			2	
H5042	004	0	1	04	01	H5042_004_0	7	8	$0 to $20 Copayment	000100000000000000000000000000000000000000000000	2			1	0.00	20.00	2	
H5042	004	0	1	04	01	H5042_004_0	7	7	20% Copayment	000000000000000000000001110000000000000000000010	1	20	20	2			2	
H5042	004	0	1	04	01	H5042_004_0	7	6	$0 to $25 Copayment	000000000000000000000000000000001000000000000000	2			1	0.00	25.00	2	
H5042	004	0	1	04	01	H5042_004_0	7	5	$150 Copayment	000000000000000001100000000000000000000000000000	2			1	150.00	150.00	2	
H5042	004	0	1	04	01	H5042_004_0	7	4	$75 Copayment	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5042	004	0	1	04	01	H5042_004_0	7	3	$25 Copayment	001001111111111110011000001000000000000001000101	2			1	25.00	25.00	2	
H5042	004	0	1	04	01	H5042_004_0	7	2	$15 Copayment	000010000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	004	0	1	04	01	H5042_004_0	7	1	$0 Copayment	110000000000000000000010000100000111111110011000	2			1	0.00	0.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	7	$0-$25 Copayment	000100000000000000000000000000000000000000000000	2			1	0.00	25.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	6	$0-$35 Copayment	000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	5	$200 Copayment	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	4	$125 Copayment	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	3	$35 Copayment	001001111111111110011000001000000000000001000101	2			1	35.00	35.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	2	$20 Copayment	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	10	$15 Copayment	000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	1	$0 Copayment	010000000000000000000010000100000111111110011000	2			1	0.00	0.00	2	
H5042	005	0	1	04	01	H5042_005_0	11	8	20% Copayment	000000000000000000000000010000000000000000000010	1	20	20	2			2	
H5042	005	0	1	04	01	H5042_005_0	11	9	30% Copayment	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H5042	006	0	1	04	01	H5042_006_0	6	1	$0 Copayment	111010000000011110000010000100000111111110011000	2			1	0.00	0.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	2	$10 Copayment	000001111111100000011000001000000000000001000101	2			1	10.00	10.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	3	$50 Copayment	000000000000000001100100000000000000000000000000	2			1	50.00	50.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	4	$0-$10 Copayment	000100000000000000000000000000001000000000000000	2			1	0.00	10.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	5	$15 Copayment	000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	006	0	1	04	01	H5042_006_0	6	6	20% Copayment	000000000000000000000001110000000000000000000010	1	20	20	2			2	
H5042	007	0	1	04	01	H5042_007_0	9	1	$0 Copayment	111010000000011110000010000100000111111110011000	2			1	0.00	0.00	2	
H5042	007	0	1	04	01	H5042_007_0	9	2	$10 Copayment	000001111111100000011000001000000000000001000101	2			1	10.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	9	6	20% Copayment	000000000000000000000001110000000000000000000010	1	20	20	2			2	
H5042	007	0	1	04	01	H5042_007_0	9	5	$15 Copayment	000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	007	0	1	04	01	H5042_007_0	9	3	$50 Copayment	000000000000000001100100000000000000000000000000	2			1	50.00	50.00	2	
H5042	007	0	1	04	01	H5042_007_0	9	4	$0-$10 Copayment	000100000000000000000000000000001000000000000000	2			1	0.00	10.00	2	
H5042	801	0	1	04	01	H5042_801_0	5	1	0%-50% Coinsurance	011111111111111111111101111100001111111111101111	1	0	50	2			2	
H5042	802	0	1	04	01	H5042_802_0	5	1	0%-50% Coinsurance	011111111111111111111101111100001111111111101111	1	0	50	2			2	
H5042	803	0	1	04	01	H5042_803_0	5	1	0%-50% Coinsurance	011111111111111111111101111100001111111111101111	1	0	50	2			2	
H5106	013	0	1	04	01	H5106_013_0	5	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H5106	013	0	1	04	01	H5106_013_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	013	0	1	04	01	H5106_013_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5106	013	0	1	04	01	H5106_013_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H5106	013	0	1	04	01	H5106_013_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	013	0	1	04	01	H5106_013_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H5106	013	0	1	04	01	H5106_013_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	75.00	75.00	2	
H5106	014	0	1	04	01	H5106_014_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	014	0	1	04	01	H5106_014_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	75.00	75.00	2	
H5106	014	0	1	04	01	H5106_014_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H5106	014	0	1	04	01	H5106_014_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H5106	014	0	1	04	01	H5106_014_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5106	014	0	1	04	01	H5106_014_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	014	0	1	04	01	H5106_014_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H5106	014	0	1	04	01	H5106_014_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H5106	014	0	1	04	01	H5106_014_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5106	015	0	1	04	01	H5106_015_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	015	0	1	04	01	H5106_015_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5106	015	0	1	04	01	H5106_015_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H5106	015	0	1	04	01	H5106_015_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	015	0	1	04	01	H5106_015_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H5106	015	0	1	04	01	H5106_015_0	5	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H5106	015	0	1	04	01	H5106_015_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	75.00	75.00	2	
H5106	016	0	1	04	01	H5106_016_0	5	6	Group 6	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5106	016	0	1	04	01	H5106_016_0	5	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H5106	016	0	1	04	01	H5106_016_0	5	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	016	0	1	04	01	H5106_016_0	5	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H5106	016	0	1	04	01	H5106_016_0	5	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	016	0	1	04	01	H5106_016_0	5	9	Group 9	000000000000000000000000000000000000000000001000	1	20	50	2			2	
H5106	016	0	1	04	01	H5106_016_0	5	1	Group 1	011111111111111111111000001100000000000000000111	1	20	20	2			2	
H5106	016	0	1	04	01	H5106_016_0	5	2	Group 2	000000000000000000000110000000000000000000000000	1	20	20	1	75.00	75.00	2	
H5106	016	0	1	04	01	H5106_016_0	5	8	Group 8	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5106	017	0	1	04	01	H5106_017_0	4	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	017	0	1	04	01	H5106_017_0	4	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5106	017	0	1	04	01	H5106_017_0	4	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H5106	017	0	1	04	01	H5106_017_0	4	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	017	0	1	04	01	H5106_017_0	4	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H5106	017	0	1	04	01	H5106_017_0	4	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H5106	017	0	1	04	01	H5106_017_0	4	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	100.00	100.00	2	
H5106	018	0	1	04	01	H5106_018_0	4	5	Group 5	000000000000000000000000000000001000000000000000	1	50	50	2			1	250.00
H5106	018	0	1	04	01	H5106_018_0	4	4	Group 4	000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	4	3	Group 3	000000000000000000000001110000000000000000000000	1	50	50	2			1	750.00
H5106	018	0	1	04	01	H5106_018_0	4	2	Group 2	000000000000000000000110000000000000000000000000	1	30	30	1	100.00	100.00	2	
H5106	018	0	1	04	01	H5106_018_0	4	1	Group 1	011111111111111111111000001100000000000000001111	1	30	30	2			2	
H5106	018	0	1	04	01	H5106_018_0	4	7	Group 7	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	4	6	Group 6	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5106	806	0	1	04	01	H5106_806_0	4	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5106	806	0	1	04	01	H5106_806_0	4	3	Group 3	000000000000000000000000000000001000000000000000	1	20	20	2			2	
H5106	806	0	1	04	01	H5106_806_0	4	1	Group 1	011111110110111111111101111100000111111111101111	1	20	20	2			2	
H5106	807	0	1	04	01	H5106_807_0	4	3	Group 3	000000000000000000000000000000001000000000000000	1	20	20	2			2	
H5106	807	0	1	04	01	H5106_807_0	4	1	Group 1	011111110110111111111101111100000111111111101111	1	20	20	2			2	
H5106	807	0	1	04	01	H5106_807_0	4	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5106	808	0	1	04	01	H5106_808_0	4	1	Group 1	011111110110111111111101111100000111111111101111	1	20	20	2			2	
H5106	808	0	1	04	01	H5106_808_0	4	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5106	808	0	1	04	01	H5106_808_0	4	3	Group 3	000000000000000000000000000000001000000000000000	1	20	20	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H5162	001	0	1	04	01	H5162_001_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H5162	001	0	1	04	01	H5162_001_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	001	0	1	04	01	H5162_001_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H5162	001	0	1	04	01	H5162_001_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H5162	001	0	1	04	01	H5162_001_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5162	001	0	1	04	01	H5162_001_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	002	0	1	04	01	H5162_002_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H5162	002	0	1	04	01	H5162_002_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	002	0	1	04	01	H5162_002_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5162	002	0	1	04	01	H5162_002_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H5162	002	0	1	04	01	H5162_002_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5162	002	0	1	04	01	H5162_002_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H5162	002	0	1	04	01	H5162_002_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H5162	002	0	1	04	01	H5162_002_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H5162	002	0	1	04	01	H5162_002_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H5162	002	0	1	04	01	H5162_002_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H5162	002	0	1	04	01	H5162_002_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	002	0	1	04	01	H5162_002_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	003	0	1	04	01	H5162_003_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5162	003	0	1	04	01	H5162_003_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H5162	003	0	1	04	01	H5162_003_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5162	003	0	1	04	01	H5162_003_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	003	0	1	04	01	H5162_003_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H5162	003	0	1	04	01	H5162_003_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H5162	003	0	1	04	01	H5162_003_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	003	0	1	04	01	H5162_003_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H5162	003	0	1	04	01	H5162_003_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H5162	003	0	1	04	01	H5162_003_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H5162	003	0	1	04	01	H5162_003_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H5162	003	0	1	04	01	H5162_003_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	004	0	1	04	01	H5162_004_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5162	004	0	1	04	01	H5162_004_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H5162	004	0	1	04	01	H5162_004_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5162	004	0	1	04	01	H5162_004_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	004	0	1	04	01	H5162_004_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H5162	004	0	1	04	01	H5162_004_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	004	0	1	04	01	H5162_004_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	004	0	1	04	01	H5162_004_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H5162	004	0	1	04	01	H5162_004_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H5162	004	0	1	04	01	H5162_004_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H5162	004	0	1	04	01	H5162_004_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H5162	004	0	1	04	01	H5162_004_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H5162	005	0	1	04	01	H5162_005_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H5162	005	0	1	04	01	H5162_005_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H5162	005	0	1	04	01	H5162_005_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H5162	005	0	1	04	01	H5162_005_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5162	005	0	1	04	01	H5162_005_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H5162	005	0	1	04	01	H5162_005_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	005	0	1	04	01	H5162_005_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	005	0	1	04	01	H5162_005_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H5162	005	0	1	04	01	H5162_005_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H5162	006	0	1	04	01	H5162_006_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H5162	006	0	1	04	01	H5162_006_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5162	006	0	1	04	01	H5162_006_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H5162	006	0	1	04	01	H5162_006_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H5162	006	0	1	04	01	H5162_006_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	006	0	1	04	01	H5162_006_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H5162	006	0	1	04	01	H5162_006_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	006	0	1	04	01	H5162_006_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	006	0	1	04	01	H5162_006_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H5162	006	0	1	04	01	H5162_006_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H5162	006	0	1	04	01	H5162_006_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H5162	006	0	1	04	01	H5162_006_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
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H5214	003	0	1	04	01	H5214_003_0	5	1		011111111111111111111000000000000011111111011101	1	30	30	2			2	
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H5215	001	0	1	04	01	H5215_001_0	4	8	$100 Cost Share Group	000000000000001000000000000000000000000000000000	2			1	100.00	100.00	2	
H5215	001	0	1	04	01	H5215_001_0	4	7	$75 Cost Share Group	000000000000000001100000000000000000000000000000	2			1	75.00	75.00	2	
H5215	001	0	1	04	01	H5215_001_0	4	6	50% Cost Share Group	000000000000000000000000000000001000000000000000	1	50	50	2			2	
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H5215	001	0	1	04	01	H5215_001_0	4	2	$0 Cost Share Group	000000000000000000000000000000000100000010000000	2			1	0.00	0.00	2	
H5215	001	0	1	04	01	H5215_001_0	4	1	20% Cost Share Group	000000000000000000000001110000000000000000100000	1	20	20	2			2	
H5215	001	0	1	04	01	H5215_001_0	4	10	$20 Cost Share Group	000001111111100000000000000000000000000000001111	2			1	20.00	20.00	2	
H5215	002	0	1	04	01	H5215_002_0	4	8	$100 Cost Share Group	000000000000001000000000000000000000000000000000	2			1	100.00	100.00	2	
H5215	002	0	1	04	01	H5215_002_0	4	7	$75 Cost Share Group	000000000000000001100000000000000000000000000000	2			1	75.00	75.00	2	
H5215	002	0	1	04	01	H5215_002_0	4	6	50% Cost Share Group	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H5215	002	0	1	04	01	H5215_002_0	4	5	$25 Cost Share Group	000000000000000000000100000000000000000000000000	2			1	25.00	25.00	2	
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H5215	002	0	1	04	01	H5215_002_0	4	3	$10 Cost Share Group	000010000000010010000000000100010011111100000000	2			1	10.00	10.00	2	
H5215	002	0	1	04	01	H5215_002_0	4	2	$0 Cost Share Group	000000000000000000000000000000000100000010000000	2			1	0.00	0.00	2	
H5215	002	0	1	04	01	H5215_002_0	4	10	$20 Cost Share Group	000001111111100000000000000000000000000000001111	2			1	20.00	20.00	2	
H5215	002	0	1	04	01	H5215_002_0	4	1	20% Cost Share Group	000000000000000000000001110000000000000000100000	1	20	20	2			2	
H5215	002	0	1	04	01	H5215_002_0	4	4	$15 Cost Share Group	011100000000000000011000001000000000000001000000	2			1	15.00	15.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	1	$0 Cost Share Goup	100000000000000000000100000000000100000000000000	2			1	0.00	0.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	2	$5 Cost Share Group	000010000000011010000000000000000000000000001000	2			1	5.00	5.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	3	$10 Cost Share Group	011001111111100100011000001100010011111111000111	2			1	10.00	10.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	4	$15 Cost Share Group	000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	5	$25 Cost Share Group	000000000000001000000000000000000000000000000000	2			1	25.00	25.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	6	$75 Cost Share Group	000000000000000001100000000000000000000000000000	2			1	75.00	75.00	2	
H5215	005	0	1	04	01	H5215_005_0	4	7	10% Cost Share Group	000000000000000000000001110000000000000000100000	1	10	10	2			2	
H5215	005	0	1	04	01	H5215_005_0	4	8	50% Cost Share Group	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H5215	006	0	1	04	01	H5215_006_0	3	2	$5 Cost Share Group	000010000000011010000000000000000000000000001000	2			1	5.00	5.00	2	
H5215	006	0	1	04	01	H5215_006_0	3	1	$0 Cost Share Goup	100000000000000000000100000000000100000000000000	2			1	0.00	0.00	2	
H5215	006	0	1	04	01	H5215_006_0	3	8	50% Cost Share Group	000000000000000000000000000000001000000000000000	1	50	50	2			2	
H5215	006	0	1	04	01	H5215_006_0	3	7	10% Cost Share Group	000000000000000000000001110000000000000000100000	1	10	10	2			2	
H5215	006	0	1	04	01	H5215_006_0	3	6	$75 Cost Share Group	000000000000000001100000000000000000000000000000	2			1	75.00	75.00	2	
H5215	006	0	1	04	01	H5215_006_0	3	5	$25 Cost Share Group	000000000000001000000000000000000000000000000000	2			1	25.00	25.00	2	
H5215	006	0	1	04	01	H5215_006_0	3	3	$10 Cost Share Group	011001111111100100011000001100010011111111000111	2			1	10.00	10.00	2	
H5215	006	0	1	04	01	H5215_006_0	3	4	$15 Cost Share Group	000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H5215	007	0	1	04	01	H5215_007_0	5	2	45% Cost Share Group	000000001001000000010000000000000000000000000000	1	0	45	2			2	
H5215	007	0	1	04	01	H5215_007_0	5	3	50% Cost Share Group	000000000000000000000000000000000000000000001000	1	0	50	2			2	
H5215	007	0	1	04	01	H5215_007_0	5	1	20% Cost Share Group	011111110110111111101101111100011111111111110111	1	0	20	2			2	
H5215	008	0	1	04	01	H5215_008_0	6	4	$20 Cost Share Group	000010000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H5215	008	0	1	04	01	H5215_008_0	6	3	$10 Cost Share Group	000000000000010000000000000000000000000000000000	2			1	10.00	10.00	2	
H5215	008	0	1	04	01	H5215_008_0	6	2	$0 Cost Share Group	000000000000000000000000000000000000000010000000	2			1	0.00	0.00	2	
H5215	008	0	1	04	01	H5215_008_0	6	13	$40 Cost Share Group	010001111111100000011000000000000000000000001111	2			1	40.00	40.00	2	
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H5215	008	0	1	04	01	H5215_008_0	6	11	$200 Cost Share Group	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
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H5215	008	0	1	04	01	H5215_008_0	6	7	$75 Cost Share Group	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5215	008	0	1	04	01	H5215_008_0	6	8	$110 Cost Share Group	000000000000001000000000000000000000000000000000	2			1	110.00	110.00	2	
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H5215	008	0	1	04	01	H5215_008_0	6	6	$35 Cost Share Group	001000000000000000000000011100010000000000000000	2			1	35.00	35.00	2	
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H5215	804	0	1	04	01	H5215_804_0	6	1	20% Cost Share Group	011111110110111111101101111100001111111111101111	1	0	20	2			2	
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H5424	005	0	1	04	01	H5424_005_0	3	3	Group 3	000000000000000000000000000000001000000000000000	1	0	30	2			2	
H5424	005	0	1	04	01	H5424_005_0	3	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
H5424	005	0	1	04	01	H5424_005_0	3	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
H5424	005	0	1	04	01	H5424_005_0	3	6	Group 6	000000000000000000000010000000000000000000010000	1	50	50	2			2	
H5424	801	0	1	04	01	H5424_801_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5424	801	0	1	04	01	H5424_801_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5424	801	0	1	04	01	H5424_801_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5424	801	0	1	04	01	H5424_801_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5424	803	0	1	04	01	H5424_803_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5424	803	0	1	04	01	H5424_803_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5424	804	0	1	04	01	H5424_804_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5424	804	0	1	04	01	H5424_804_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5424	804	0	1	04	01	H5424_804_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5424	804	0	1	04	01	H5424_804_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5429	001	0	1	04	01	H5429_001_0	6	1	OON Group 1	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5429	001	0	1	04	01	H5429_001_0	6	2	OON Group 2	111100100010111111101101111100001111111111111111	1	30	30	2			2	
H5429	001	0	1	04	01	H5429_001_0	6	3		000001011111000000010000000000000000000000000000	2			1	45.00	45.00	2	
H5429	005	0	1	04	01	H5429_005_0	6	1	OON Group 1	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5429	005	0	1	04	01	H5429_005_0	6	2	OON Group 2	111000100010111111101101111100001111111111111111	1	30	30	2			2	
H5429	005	0	1	04	01	H5429_005_0	6	3		000101011111000000010000000000000000000000000000	2			1	45.00	45.00	2	
H5429	020	0	1	04	01	H5429_020_0	7	3		000001011111000000010000000000000000000000000000	2			1	45.00	45.00	2	
H5429	020	0	1	04	01	H5429_020_0	7	1	OON Group 1	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5429	020	0	1	04	01	H5429_020_0	7	2	OON Group 2	111100100010111111101101111100001111111111111111	1	30	30	2			2	
H5429	053	0	1	04	01	H5429_053_0	6	1	OON Group 1	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5429	053	0	1	04	01	H5429_053_0	6	2	OON Group 2	111100100010111111101101111100001111111111111111	1	30	30	2			2	
H5429	053	0	1	04	01	H5429_053_0	6	3		000001011111000000010000000000000000000000000000	2			1	45.00	45.00	2	
H5429	059	0	1	04	01	H5429_059_0	4	1	OON Group 1	111111111111111111111101111100001111111111111111	1	30	30	2			2	
H5429	060	0	1	04	01	H5429_060_0	4	1	OON Group 1	111111111111111111111101111100001111111111111111	1	30	30	2			2	
H5429	061	0	1	04	01	H5429_061_0	4	1	OON Group 1	111111111111111111111101111100001111111111111111	1	30	30	2			2	
H5429	062	0	1	04	01	H5429_062_0	6	2	OON Group 2	111100100010111111101101111100001111111111111111	1	30	30	2			2	
H5429	062	0	1	04	01	H5429_062_0	6	1	OON Group 1	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5429	062	0	1	04	01	H5429_062_0	6	3		000001011111000000010000000000000000000000000000	2			1	45.00	45.00	2	
H5434	002	0	1	04	01	H5434_002_0	6	3	Renal Dialysis	000000000000000000000000001000000000000000000000	2			1	30.00	30.00	2	
H5434	002	0	1	04	01	H5434_002_0	6	4	No Copayment	000000000000000000000000000000001000000000000000	2			2			2	
H5434	002	0	1	04	01	H5434_002_0	6	1	30% Coinsurance	011111111111111111111001110100000111111111101111	1	30	30	2			2	
H5434	002	0	1	04	01	H5434_002_0	6	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5434	801	0	1	04	01	H5434_801_0	5	1	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5434	801	0	1	04	01	H5434_801_0	5	2	All Others	011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5434	802	0	1	04	01	H5434_802_0	5	1	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5434	802	0	1	04	01	H5434_802_0	5	2	All Others	011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5439	001	0	1	04	01	H5439_001_0	6	1	Coinsurance 10%	000010010010011111100000000100000111111111001101	1	10	10	2			2	
H5439	001	0	1	04	01	H5439_001_0	6	2	Copay $100	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	3	Copayment $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	4	No Cost	000100000000000000000000000000001000000000000010	2			1	0.00	0.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	5	Copayment $15	000000000000000000000000001000000000000000000000	2			1	15.00	15.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	6	Copayment $50	001001001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5439	001	0	1	04	01	H5439_001_0	6	7	Coinsurance 20%	000000000000000000000001110000000000000000100000	1	20	20	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	10		000000000000000000000000010000000000000000000000	1	20	25	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	1		011100000000000001100000000000000000000000000000	1	30	30	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	3		000000101000111110011000000100000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	002	0	1	04	01	H5470_002_0	5	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5470	002	0	1	04	01	H5470_002_0	5	7		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	5		000000000000000000000000000000000000000000100000	1	20	30	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	9		000000000000000000000001100000000000000000000000	1	25	25	2			2	
H5470	002	0	1	04	01	H5470_002_0	5	8		000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5470	002	0	1	04	01	H5470_002_0	5	2		000011010111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5470	004	0	1	04	01	H5470_004_0	4	8		000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5470	004	0	1	04	01	H5470_004_0	4	7		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5470	004	0	1	04	01	H5470_004_0	4	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H5470	004	0	1	04	01	H5470_004_0	4	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5470	004	0	1	04	01	H5470_004_0	4	3		000000101000111110011000000100000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	004	0	1	04	01	H5470_004_0	4	2		000011010111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5470	004	0	1	04	01	H5470_004_0	4	1		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H5470	004	0	1	04	01	H5470_004_0	4	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H5470	005	0	1	04	01	H5470_005_0	4	8		000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5470	005	0	1	04	01	H5470_005_0	4	2		000011010111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5470	005	0	1	04	01	H5470_005_0	4	3		000000101000111110011000000100000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	005	0	1	04	01	H5470_005_0	4	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5470	005	0	1	04	01	H5470_005_0	4	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H5470	005	0	1	04	01	H5470_005_0	4	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H5470	005	0	1	04	01	H5470_005_0	4	7		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5470	005	0	1	04	01	H5470_005_0	4	1		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H5470	007	0	1	04	01	H5470_007_0	4	8		000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5470	007	0	1	04	01	H5470_007_0	4	7		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5470	007	0	1	04	01	H5470_007_0	4	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H5470	007	0	1	04	01	H5470_007_0	4	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H5470	007	0	1	04	01	H5470_007_0	4	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5470	007	0	1	04	01	H5470_007_0	4	2		000011010111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5470	007	0	1	04	01	H5470_007_0	4	3		000000101000111110011000000100000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	007	0	1	04	01	H5470_007_0	4	1		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H5470	801	0	1	04	01	H5470_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5470	801	0	1	04	01	H5470_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5470	801	0	1	04	01	H5470_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5470	802	0	1	04	01	H5470_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5470	802	0	1	04	01	H5470_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5470	802	0	1	04	01	H5470_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5470	803	0	1	04	01	H5470_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5470	803	0	1	04	01	H5470_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5470	803	0	1	04	01	H5470_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	8	Group 8	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	9	Group 9	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	1	Group 1	010111110110101101101001110000000011111111101111	1	30	30	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5507	801	0	1	04	01	H5507_801_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5507	801	0	1	04	01	H5507_801_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5507	801	0	1	04	01	H5507_801_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5507	801	0	1	04	01	H5507_801_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5507	802	0	1	04	01	H5507_802_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5507	802	0	1	04	01	H5507_802_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5507	802	0	1	04	01	H5507_802_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5507	802	0	1	04	01	H5507_802_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5507	803	0	1	04	01	H5507_803_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5507	803	0	1	04	01	H5507_803_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5507	803	0	1	04	01	H5507_803_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5507	803	0	1	04	01	H5507_803_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5508	001	0	1	04	01	H5508_001_0	7	2	Group 2	000100000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	001	0	1	04	01	H5508_001_0	7	3	Group 3	000000001000000000000000000000000000000000000000	1	50	50	2			2	
H5508	001	0	1	04	01	H5508_001_0	7	1	Group 1	011011110111111111111101111100000000000011101111	1	20	20	2			2	
H5508	001	0	1	04	01	H5508_001_0	7	4		000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	002	0	1	04	01	H5508_002_0	6	1	Group 1	011011110111111111111101111100000000000011101111	1	20	20	2			2	
H5508	002	0	1	04	01	H5508_002_0	6	2	Group 2	000100000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	002	0	1	04	01	H5508_002_0	6	3	Group 3	000000001000000000000000000000000000000000000000	1	50	50	2			2	
H5508	002	0	1	04	01	H5508_002_0	6	4		000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	003	0	1	04	01	H5508_003_0	5	3	Group 3	000000001000000000000000000000000000000000000000	1	50	50	2			2	
H5508	003	0	1	04	01	H5508_003_0	5	1	Group 1	011011110111111111111101111100000000000011101111	1	20	20	2			2	
H5508	003	0	1	04	01	H5508_003_0	5	2	Group 2	000100000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	003	0	1	04	01	H5508_003_0	5	4		000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	004	0	1	04	01	H5508_004_0	6	3	Group 3	000000001000000000000000000000000000000000000000	1	50	50	2			2	
H5508	004	0	1	04	01	H5508_004_0	6	2	Group 2	000100000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	004	0	1	04	01	H5508_004_0	6	1	Group 1	011011110111111111111101111100000000000011101111	1	20	20	2			2	
H5508	004	0	1	04	01	H5508_004_0	6	4		000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	801	0	1	04	01	H5508_801_0	5	2	Group 2	000100000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	801	0	1	04	01	H5508_801_0	5	1	Group 1	011011110111111111111101111100000000000011101111	1	20	20	2			2	
H5508	801	0	1	04	01	H5508_801_0	5	3	Group 3	000000001000000000000000000000000000000000000000	1	50	50	2			2	
H5508	801	0	1	04	01	H5508_801_0	5	4		000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5509	001	0	1	04	01	H5509_001_0	10	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	001	0	1	04	01	H5509_001_0	10	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	001	0	1	04	01	H5509_001_0	10	1		011011111111111111111001111100001111111111101111	1	25	25	2			2	
H5509	003	0	1	04	01	H5509_003_0	8	1		011011111111111111111001111100001111111111101111	1	20	20	2			2	
H5509	003	0	1	04	01	H5509_003_0	8	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	003	0	1	04	01	H5509_003_0	8	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	010	0	1	04	01	H5509_010_0	9	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	010	0	1	04	01	H5509_010_0	9	1		011011111111111111111001111100001111111111101111	1	25	25	2			2	
H5509	010	0	1	04	01	H5509_010_0	9	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	011	0	1	04	01	H5509_011_0	9	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	011	0	1	04	01	H5509_011_0	9	1		011011111111111111111001111100001111111111101111	1	25	25	2			2	
H5509	011	0	1	04	01	H5509_011_0	9	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	012	0	1	04	01	H5509_012_0	8	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	012	0	1	04	01	H5509_012_0	8	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	012	0	1	04	01	H5509_012_0	8	1		011011111111111111111001111100001111111111101111	1	20	20	2			2	
H5509	013	0	1	04	01	H5509_013_0	9	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	013	0	1	04	01	H5509_013_0	9	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	013	0	1	04	01	H5509_013_0	9	1		011011111111111111111001111100001111111111101111	1	30	30	2			2	
H5509	014	0	1	04	01	H5509_014_0	11	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	014	0	1	04	01	H5509_014_0	11	1		011011111111111111111001111100001111111111101111	1	20	20	2			2	
H5509	014	0	1	04	01	H5509_014_0	11	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	015	0	1	04	01	H5509_015_0	8	3	Home Health	000100000000000000000000000000000000000000000000	2			2			2	
H5509	015	0	1	04	01	H5509_015_0	8	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5509	015	0	1	04	01	H5509_015_0	8	1		011011111111111111111001111100001111111111101111	1	20	20	2			2	
H5509	801	0	1	04	01	H5509_801_0	5	1		011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5509	801	0	1	04	01	H5509_801_0	5	2		000100000000000000000000000000000000000000000000	2			2			2	
H5509	802	0	1	04	01	H5509_802_0	5	2		000100000000000000000000000000000000000000000000	2			2			2	
H5509	802	0	1	04	01	H5509_802_0	5	1		011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5509	803	0	1	04	01	H5509_803_0	5	1		011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5509	803	0	1	04	01	H5509_803_0	5	2		000100000000000000000000000000000000000000000000	2			2			2	
H5516	001	0	1	04	01	H5516_001_0	3	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	1	Group 1	000010000010000000000000000000000010000000000000	2			1	30.00	30.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H5516	001	0	1	04	01	H5516_001_0	3	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H5516	001	0	1	04	01	H5516_001_0	3	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	2	Group 2	010001110100100000001000000000000000000000001101	2			1	45.00	45.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H5516	001	0	1	04	01	H5516_001_0	3	3	Group 3	000100000000001101100001110000000001111111100010	1	30	30	2			2	
H5516	001	0	1	04	01	H5516_001_0	3	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5516	801	0	1	04	01	H5516_801_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5516	801	0	1	04	01	H5516_801_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5516	801	0	1	04	01	H5516_801_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5516	801	0	1	04	01	H5516_801_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5516	802	0	1	04	01	H5516_802_0	3	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5516	802	0	1	04	01	H5516_802_0	3	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5516	802	0	1	04	01	H5516_802_0	3	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5516	802	0	1	04	01	H5516_802_0	3	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5516	803	0	1	04	01	H5516_803_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5516	803	0	1	04	01	H5516_803_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5516	803	0	1	04	01	H5516_803_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5516	803	0	1	04	01	H5516_803_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5520	001	0	1	04	01	H5520_001_0	6	2	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	11	Group $0	001100000000000000000000010100001111111111000010	2			1	0.00	0.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	10	Group $200	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	1	Group $20	000010010010000010000000000000000000000000000101	2			1	20.00	20.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	9	Group $0 - $900	000000000000010000000000000000000000000000000000	2			1	0.00	900.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	3	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	7	Group $75	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	6	Group $20 - $50	000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	5	Group 20% coinsurance	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	001	0	1	04	01	H5520_001_0	6	4	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	001	0	1	04	01	H5520_001_0	6	8	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	9	Group $150	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	8	Group 8	000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	7	Group 20%	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	002	0	1	04	01	H5520_002_0	6	6	Group $0	001100000000000000000000010100001111111111000010	2			2			2	
H5520	002	0	1	04	01	H5520_002_0	6	5	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	4	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	3	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	2	Group $20	000010010010000010000000000000000000000000000101	2			1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	11	Group $20 - $900	000000000000010000000000000000000000000000000000	2			1	20.00	900.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	1	Group $200	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	10	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	6	Group $20 - $50	000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	7	Group $75	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	8	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	9	Group $0 - $900	000000000000010000000000000000000000000000000000	2			1	0.00	900.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	1	Group $20	000010010010000010000000000000000000000000000101	2			1	20.00	20.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	10	Group $200	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	11	Group $0	001100000000000000000000010100001111111111000010	2			1	0.00	0.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	2	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	3	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	4	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	003	0	1	04	01	H5520_003_0	5	5	Group 20% coinsurance	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	004	0	1	04	01	H5520_004_0	6	4	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	3	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	2	Group $20	000010010010000010000000000000000000000000000101	2			1	20.00	20.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	11	Group $20 - $900	000000000000010000000000000000000000000000000000	2			1	20.00	900.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	10	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	9	Group $150	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	5	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	6	Group $0	001100000000000000000000010100001111111111000010	2			2			2	
H5520	004	0	1	04	01	H5520_004_0	6	7	Group 20%	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	004	0	1	04	01	H5520_004_0	6	8	Group 8	000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	1	Group $200	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	5	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	9	Group 0%	001100000000000000000000010100001111111111000000	2			1	0.00	0.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	8	Group $200	000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	7	Group 15%	000000000000000001100000000000000000000000000000	1	15	15	2			2	
H5520	005	0	1	04	01	H5520_005_0	8	6	Group $20 - $900	000000000000010000000000000000000000000000000000	2			1	20.00	900.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	1	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	10	Group 20%	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	005	0	1	04	01	H5520_005_0	8	11	Group 40%	000000000000000000000000000000000000000000000010	1	40	40	2			2	
H5520	005	0	1	04	01	H5520_005_0	8	12	Group $20 - $50	000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	4	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	3	Group $20	000010010010000010000000000000000000000000000101	2			1	20.00	20.00	2	
H5520	005	0	1	04	01	H5520_005_0	8	2	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	9	Group 0%	001100000000000000000000010100001111111111000000	2			1	0.00	0.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	8	Group $200	000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	7	Group 15%	000000000000000001100000000000000000000000000000	1	15	15	2			2	
H5520	006	0	1	04	01	H5520_006_0	7	6	Group $20 - $900	000000000000010000000000000000000000000000000000	2			1	20.00	900.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	5	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	3	Group $20	000010010010000010000000000000000000000000000101	2			1	20.00	20.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	2	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	12	Group $20 - $50	000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	11	Group 40%	000000000000000000000000000000000000000000000010	1	40	40	2			2	
H5520	006	0	1	04	01	H5520_006_0	7	10	Group 20%	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	006	0	1	04	01	H5520_006_0	7	1	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	006	0	1	04	01	H5520_006_0	7	4	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	9	Group $75	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	1	Group $100	000000000000000001100000000000000000000000000000	2			1	100.00	100.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	10	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	11	Group $0 - $900	000000000000010000000000000000000000000000000000	2			1	0.00	900.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	2	Group $10	000010010010000000000000000000000000000000000101	2			1	10.00	10.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	8	Group $10 - $50	000000000000000000000000000000000000000000001000	2			1	10.00	50.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	4	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	5	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	6	Group $0	101100000000000010000000010100001111111111000010	2			2			2	
H5520	009	0	1	04	01	H5520_009_0	5	7	Group 20%	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	009	0	1	04	01	H5520_009_0	5	3	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	1	Group $100	000000000000000001100000000000000000000000000000	2			1	100.00	100.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	10	Group $50	000000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	11	Group $0 - $900	000000000000010000000000000000000000000000000000	2			1	0.00	900.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	2	Group $10	000010010010000000000000000000000000000000000101	2			1	10.00	10.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	3	Group $35	010000100100100000001000000000000000000000000000	2			1	35.00	35.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	4	Group $30 - $900	000000000000001100000001101000000000000000100000	2			1	30.00	900.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	5	Group $15	000001000000000000000000000010001000000000000000	2			1	15.00	15.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	6	Group $0	101100000000000010000000010100001111111111000010	2			2			2	
H5520	010	0	1	04	01	H5520_010_0	7	7	Group 20%	000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	010	0	1	04	01	H5520_010_0	7	8	Group $10 - $50	000000000000000000000000000000000000000000001000	2			1	10.00	50.00	2	
H5520	010	0	1	04	01	H5520_010_0	7	9	Group $75	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5521	011	0	1	04	01	H5521_011_0	5	1	Tier 1	011111111111111111111001110100001111111111101101	1	30	30	2			2	
H5521	011	0	1	04	01	H5521_011_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	011	0	1	04	01	H5521_011_0	5	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	011	0	1	04	01	H5521_011_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	011	0	1	04	01	H5521_011_0	5	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	012	0	1	04	01	H5521_012_0	5	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	012	0	1	04	01	H5521_012_0	5	1	Tier 1	011111111111111111111001110100001111111111101101	1	20	20	2			2	
H5521	012	0	1	04	01	H5521_012_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	012	0	1	04	01	H5521_012_0	5	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	012	0	1	04	01	H5521_012_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	013	0	1	04	01	H5521_013_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	013	0	1	04	01	H5521_013_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	013	0	1	04	01	H5521_013_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	013	0	1	04	01	H5521_013_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	013	0	1	04	01	H5521_013_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	014	0	1	04	01	H5521_014_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	014	0	1	04	01	H5521_014_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	014	0	1	04	01	H5521_014_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	014	0	1	04	01	H5521_014_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	20.00	20.00	2	
H5521	014	0	1	04	01	H5521_014_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	015	0	1	04	01	H5521_015_0	6	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	015	0	1	04	01	H5521_015_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	015	0	1	04	01	H5521_015_0	6	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	015	0	1	04	01	H5521_015_0	6	1	Tier 1	011111111111111111111001110100001111111111101101	1	20	20	2			2	
H5521	015	0	1	04	01	H5521_015_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	016	0	1	04	01	H5521_016_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	016	0	1	04	01	H5521_016_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	016	0	1	04	01	H5521_016_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	016	0	1	04	01	H5521_016_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	35	35	2			2	
H5521	016	0	1	04	01	H5521_016_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	017	0	1	04	01	H5521_017_0	4	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	017	0	1	04	01	H5521_017_0	4	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	017	0	1	04	01	H5521_017_0	4	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	017	0	1	04	01	H5521_017_0	4	1	Tier 1	011111111111111111111001110100000111111111101101	1	35	35	2			2	
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H5521	020	0	1	04	01	H5521_020_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	020	0	1	04	01	H5521_020_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
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H5521	021	0	1	04	01	H5521_021_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	021	0	1	04	01	H5521_021_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	021	0	1	04	01	H5521_021_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	021	0	1	04	01	H5521_021_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	021	0	1	04	01	H5521_021_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
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H5521	022	0	1	04	01	H5521_022_0	3	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	022	0	1	04	01	H5521_022_0	3	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	022	0	1	04	01	H5521_022_0	3	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	022	0	1	04	01	H5521_022_0	3	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
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H5521	026	0	1	04	01	H5521_026_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	026	0	1	04	01	H5521_026_0	5	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	026	0	1	04	01	H5521_026_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	026	0	1	04	01	H5521_026_0	5	1	Tier 1	011111111111111111111001110100001111111111101101	1	20	20	2			2	
H5521	027	0	1	04	01	H5521_027_0	8	1	Tier 1	011111111111111111111001110100001111111111101101	1	30	30	2			2	
H5521	027	0	1	04	01	H5521_027_0	8	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	027	0	1	04	01	H5521_027_0	8	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	027	0	1	04	01	H5521_027_0	8	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	027	0	1	04	01	H5521_027_0	8	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	028	0	1	04	01	H5521_028_0	4	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	028	0	1	04	01	H5521_028_0	4	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	028	0	1	04	01	H5521_028_0	4	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	028	0	1	04	01	H5521_028_0	4	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	028	0	1	04	01	H5521_028_0	4	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	029	0	1	04	01	H5521_029_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	029	0	1	04	01	H5521_029_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	029	0	1	04	01	H5521_029_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	029	0	1	04	01	H5521_029_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	029	0	1	04	01	H5521_029_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	030	0	1	04	01	H5521_030_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	030	0	1	04	01	H5521_030_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	030	0	1	04	01	H5521_030_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	030	0	1	04	01	H5521_030_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	030	0	1	04	01	H5521_030_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	031	0	1	04	01	H5521_031_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	031	0	1	04	01	H5521_031_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	031	0	1	04	01	H5521_031_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	031	0	1	04	01	H5521_031_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	031	0	1	04	01	H5521_031_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	032	0	1	04	01	H5521_032_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	032	0	1	04	01	H5521_032_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	032	0	1	04	01	H5521_032_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	032	0	1	04	01	H5521_032_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	032	0	1	04	01	H5521_032_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	033	0	1	04	01	H5521_033_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	033	0	1	04	01	H5521_033_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	033	0	1	04	01	H5521_033_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	033	0	1	04	01	H5521_033_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	033	0	1	04	01	H5521_033_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	034	0	1	04	01	H5521_034_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	034	0	1	04	01	H5521_034_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	034	0	1	04	01	H5521_034_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	034	0	1	04	01	H5521_034_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	034	0	1	04	01	H5521_034_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	035	0	1	04	01	H5521_035_0	7	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	035	0	1	04	01	H5521_035_0	7	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	035	0	1	04	01	H5521_035_0	7	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	035	0	1	04	01	H5521_035_0	7	1	Tier 1	011111111111111111111001110100001111111111101101	1	20	20	2			2	
H5521	035	0	1	04	01	H5521_035_0	7	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	036	0	1	04	01	H5521_036_0	6	1	Tier 1	011111111111111111111001110100001111111111101101	1	30	30	2			2	
H5521	036	0	1	04	01	H5521_036_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	036	0	1	04	01	H5521_036_0	6	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H5521	036	0	1	04	01	H5521_036_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	036	0	1	04	01	H5521_036_0	6	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	037	0	1	04	01	H5521_037_0	5	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	037	0	1	04	01	H5521_037_0	5	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	037	0	1	04	01	H5521_037_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	037	0	1	04	01	H5521_037_0	5	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	037	0	1	04	01	H5521_037_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	038	0	1	04	01	H5521_038_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	038	0	1	04	01	H5521_038_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	038	0	1	04	01	H5521_038_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	038	0	1	04	01	H5521_038_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	038	0	1	04	01	H5521_038_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	039	0	1	04	01	H5521_039_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	039	0	1	04	01	H5521_039_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	10.00	10.00	2	
H5521	039	0	1	04	01	H5521_039_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	039	0	1	04	01	H5521_039_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	039	0	1	04	01	H5521_039_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	040	0	1	04	01	H5521_040_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	040	0	1	04	01	H5521_040_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	040	0	1	04	01	H5521_040_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	040	0	1	04	01	H5521_040_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	040	0	1	04	01	H5521_040_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	041	0	1	04	01	H5521_041_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	041	0	1	04	01	H5521_041_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	041	0	1	04	01	H5521_041_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	041	0	1	04	01	H5521_041_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	041	0	1	04	01	H5521_041_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	043	0	1	04	01	H5521_043_0	4	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	043	0	1	04	01	H5521_043_0	4	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	043	0	1	04	01	H5521_043_0	4	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	043	0	1	04	01	H5521_043_0	4	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	043	0	1	04	01	H5521_043_0	4	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	044	0	1	04	01	H5521_044_0	6	1	Tier 1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	044	0	1	04	01	H5521_044_0	6	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5521	044	0	1	04	01	H5521_044_0	6	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	044	0	1	04	01	H5521_044_0	6	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	044	0	1	04	01	H5521_044_0	6	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	045	0	1	04	01	H5521_045_0	4	1	Tier1	011111111111111111111001110100000111111111101101	1	30	30	2			2	
H5521	045	0	1	04	01	H5521_045_0	4	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5521	045	0	1	04	01	H5521_045_0	4	3	Tier 3	000000000000000000000010000011101000000000010000	2			2			2	
H5521	045	0	1	04	01	H5521_045_0	4	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H5521	045	0	1	04	01	H5521_045_0	4	5	Tier 5	100000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	801	0	1	04	01	H5521_801_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	801	0	1	04	01	H5521_801_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H5521	801	0	1	04	01	H5521_801_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5521	802	0	1	04	01	H5521_802_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5521	802	0	1	04	01	H5521_802_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H5521	802	0	1	04	01	H5521_802_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	804	0	1	04	01	H5521_804_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H5521	804	0	1	04	01	H5521_804_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5521	804	0	1	04	01	H5521_804_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	805	0	2	04	01	H5521_805_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	805	0	2	04	01	H5521_805_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H5521	805	0	2	04	01	H5521_805_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5521	806	0	2	04	01	H5521_806_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	806	0	2	04	01	H5521_806_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5521	806	0	2	04	01	H5521_806_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H5521	807	0	2	04	01	H5521_807_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H5521	807	0	2	04	01	H5521_807_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5521	807	0	2	04	01	H5521_807_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5522	001	0	1	04	01	H5522_001_0	7	5	50% Coinsurance OON	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H5522	001	0	1	04	01	H5522_001_0	7	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	001	0	1	04	01	H5522_001_0	7	3	0% Coinsurance OON	000100000000000000000000000000000100000000010000	2			2			2	
H5522	001	0	1	04	01	H5522_001_0	7	1	20% Coinsurance OON	010011110110111111101001111100000011111111101111	1	20	20	2			2	
H5522	001	0	1	04	01	H5522_001_0	7	4	Ambulance OON	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5522	002	0	1	04	01	H5522_002_0	7	5	50% Coinsurance OON	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H5522	002	0	1	04	01	H5522_002_0	7	4	Ambulance OON	000000000000000000000100000000000000000000000000	2			1	60.00	60.00	2	
H5522	002	0	1	04	01	H5522_002_0	7	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	002	0	1	04	01	H5522_002_0	7	1	20% Coinsurance OON	010011110110111111101001111100000011111111101111	1	20	20	2			2	
H5522	002	0	1	04	01	H5522_002_0	7	3	0% Coinsurance OON	000100000000000000000000000000000100000000010000	2			2			2	
H5522	003	0	1	04	01	H5522_003_0	8	5	50% Coinsurance OON	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H5522	003	0	1	04	01	H5522_003_0	8	4	Ambulance OON	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5522	003	0	1	04	01	H5522_003_0	8	3	0% Coinsurance OON	000100000000000000000000000000000100000000010000	2			2			2	
H5522	003	0	1	04	01	H5522_003_0	8	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	003	0	1	04	01	H5522_003_0	8	1	20% Coinsurance OON	010011110110111111101001111100000011111111101111	1	20	20	2			2	
H5522	004	0	1	04	01	H5522_004_0	6	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	004	0	1	04	01	H5522_004_0	6	3	0% Coinsurance OON	000100000000000000000000000000000100000000000000	2			2			2	
H5522	004	0	1	04	01	H5522_004_0	6	1	20% Coinsurance OON	010011110110111111101001111100000011111111101111	1	20	20	2			2	
H5522	004	0	1	04	01	H5522_004_0	6	4	Ambulance OON	000000000000000000000100000000000000000000000000	2			1	60.00	60.00	2	
H5522	005	0	1	04	01	H5522_005_0	6	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	005	0	1	04	01	H5522_005_0	6	4	Ambulance OON	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5522	005	0	1	04	01	H5522_005_0	6	3	0% Coinsurance OON	000100000000000000000000000000000100000000000000	2			2			2	
H5522	005	0	1	04	01	H5522_005_0	6	1	20% Coinsurance OON	010011110110111111101001111100000011111111101111	1	20	20	2			2	
H5522	007	0	1	04	01	H5522_007_0	6	1	30% Coinsurance OON	010011110110111111101001111100000011111111101111	1	30	30	2			2	
H5522	007	0	1	04	01	H5522_007_0	6	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	007	0	1	04	01	H5522_007_0	6	3	0% Coinsurance OON	000100000000000000000100000000000100000000000000	2			2			2	
H5522	008	0	1	04	01	H5522_008_0	6	1	30% Coinsurance OON	010011110110111111101001111100000011111111101111	1	30	30	2			2	
H5522	008	0	1	04	01	H5522_008_0	6	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	008	0	1	04	01	H5522_008_0	6	3	0% Coinsurance OON	000100000000000000000100000000000100000000000000	2			2			2	
H5522	009	0	1	04	01	H5522_009_0	6	2	45% Coinsurance OON	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H5522	009	0	1	04	01	H5522_009_0	6	1	30% Coinsurance OON	010011110110111111101001111100000011111111101111	1	30	30	2			2	
H5522	009	0	1	04	01	H5522_009_0	6	3	0% Coinsurance OON	000100000000000000000100000000000100000000000000	2			2			2	
H5522	802	0	1	04	01	H5522_802_0	4	1	0% Coinsurance OON	000100000000000000000000000000000000000000000000	2			2			2	
H5522	802	0	1	04	01	H5522_802_0	4	2	23% Coinsurance OON	011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5522	803	0	1	04	01	H5522_803_0	4	1	0% Coinsurance OON	000100000000000000000000000000000000000000000000	2			2			2	
H5522	803	0	1	04	01	H5522_803_0	4	2	23% Coinsurance OON	011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5522	805	0	1	04	01	H5522_805_0	4	2	23% Coinsurance OON	011011111111111111111101111100001111111111101111	1	23	23	2			2	
H5522	805	0	1	04	01	H5522_805_0	4	1	0% Coinsurance OON	000100000000000000000000000000000000000000000000	2			2			2	
H5525	004	0	1	04	01	H5525_004_0	7	1		011100000000000001100001110000000000000000000000	1	30	30	2			2	
H5525	004	0	1	04	01	H5525_004_0	7	2		000011010111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	7	3		000000101000111110011000000100000000011111000000	1	30	30	1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	7	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5525	004	0	1	04	01	H5525_004_0	7	5		000000000000000000000000000000000000000000100000	1	20	30	2			2	
H5525	004	0	1	04	01	H5525_004_0	7	6		000000000000000000000000000000101000000000010000	1	50	50	2			2	
H5525	004	0	1	04	01	H5525_004_0	7	7		000000000000000000000000001000000000000000000000	2			1	0.00	50.00	2	
H5525	004	0	1	04	01	H5525_004_0	7	8		000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5525	801	0	1	04	01	H5525_801_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5525	801	0	1	04	01	H5525_801_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5525	801	0	1	04	01	H5525_801_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5525	802	0	1	04	01	H5525_802_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5525	802	0	1	04	01	H5525_802_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5525	802	0	1	04	01	H5525_802_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5525	805	0	1	04	01	H5525_805_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5525	805	0	1	04	01	H5525_805_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5525	805	0	1	04	01	H5525_805_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5526	001	0	1	04	01	H5526_001_0	5	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H5526	001	0	1	04	01	H5526_001_0	5	6	Comp Dental / Health Educ / Eye Wear	000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	001	0	1	04	01	H5526_001_0	5	5	Primary Care /Specialist Services	010111110110111110001010001100000111111111001111	2			1	25.00	25.00	2	
H5526	001	0	1	04	01	H5526_001_0	5	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	001	0	1	04	01	H5526_001_0	5	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	001	0	1	04	01	H5526_001_0	5	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5526	001	0	1	04	01	H5526_001_0	5	1	Part B Drugs / Outpatient Surgery	000000000000000001100000000000000000000000100000	1	20	20	2			2	
H5526	001	0	1	04	01	H5526_001_0	5	8		000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H5526	002	0	1	04	01	H5526_002_0	6	9		000010000000000000000000000000000110000000000010	2			1	30.00	30.00	2	
H5526	002	0	1	04	01	H5526_002_0	6	8		000000000000000001100000000000000000000000000000	1	20	20	2			2	
H5526	002	0	1	04	01	H5526_002_0	6	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	35	35	2			2	
H5526	002	0	1	04	01	H5526_002_0	6	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	002	0	1	04	01	H5526_002_0	6	5	Primary Care /Specialist Services	010101110110111110001010001100000001111111001101	2			1	30.00	30.00	2	
H5526	002	0	1	04	01	H5526_002_0	6	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	002	0	1	04	01	H5526_002_0	6	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	002	0	1	04	01	H5526_002_0	6	1	Part B Drugs / Outpatient Surgery	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	002	0	1	04	01	H5526_002_0	6	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5526	003	0	1	04	01	H5526_003_0	9	1	Part B Drugs / Outpatient Surgery	000000000000000001100000000000000000000000100000	1	20	20	2			2	
H5526	003	0	1	04	01	H5526_003_0	9	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H5526	003	0	1	04	01	H5526_003_0	9	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	003	0	1	04	01	H5526_003_0	9	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	003	0	1	04	01	H5526_003_0	9	5	Primary Care /Specialist Services	010111110110111110001010001100000111111111001111	2			1	25.00	25.00	2	
H5526	003	0	1	04	01	H5526_003_0	9	6	Comp Dental / Health Educ / Eye Wear	000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	003	0	1	04	01	H5526_003_0	9	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H5526	003	0	1	04	01	H5526_003_0	9	8		000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	1	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	10		000000000000000000000000000000000000000000010000	2			2			2	
H5526	004	0	1	04	01	H5526_004_0	9	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	5	Primary Care /Specialist Services	010101110110111110001010001100000001111111000101	2			1	25.00	25.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	6	Comp Dental / Health Educ / Eye Wear	000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	004	0	1	04	01	H5526_004_0	9	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	35	35	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	8		000000000000000001100000000000000000000000000000	1	20	20	2			2	
H5526	004	0	1	04	01	H5526_004_0	9	9		000010000000000000000000000000000110000000001010	2			1	25.00	25.00	2	
H5526	007	0	1	04	01	H5526_007_0	8	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	007	0	1	04	01	H5526_007_0	8	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	007	0	1	04	01	H5526_007_0	8	5	Primary Care /Specialist Services	010111110110111110001010001100000111111111001111	2			1	30.00	30.00	2	
H5526	007	0	1	04	01	H5526_007_0	8	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	007	0	1	04	01	H5526_007_0	8	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H5526	007	0	1	04	01	H5526_007_0	8	8		000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H5526	007	0	1	04	01	H5526_007_0	8	1	Part B Drugs / Outpatient Surgery	000000000000000001100000000000000000000000100000	1	20	20	2			2	
H5526	007	0	1	04	01	H5526_007_0	8	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H5526	008	0	1	04	01	H5526_008_0	12	9		000010000000000000000010000000000110000000001011	2			1	20.00	20.00	2	
H5526	008	0	1	04	01	H5526_008_0	12	8	Outpatient Hospital and ASC	000000000000000001100000000000000000000000000000	1	20	20	2			2	
H5526	008	0	1	04	01	H5526_008_0	12	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	35	35	2			2	
H5526	008	0	1	04	01	H5526_008_0	12	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	008	0	1	04	01	H5526_008_0	12	5	Primary Care /Specialist Services	010101110110111110001000001100000001111111000100	2			1	20.00	20.00	2	
H5526	008	0	1	04	01	H5526_008_0	12	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	008	0	1	04	01	H5526_008_0	12	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	008	0	1	04	01	H5526_008_0	12	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5526	008	0	1	04	01	H5526_008_0	12	10		000000000000000000000000000000000000000000010000	2			2			2	
H5526	008	0	1	04	01	H5526_008_0	12	1	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	010	0	1	04	01	H5526_010_0	10	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H5526	010	0	1	04	01	H5526_010_0	10	3	Mental Health/Substance Abuse	001000001000000000010000000000000000000000000000	1	55	55	2			2	
H5526	010	0	1	04	01	H5526_010_0	10	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	010	0	1	04	01	H5526_010_0	10	5		010101110110111110001000001100000001111111000101	2			1	25.00	25.00	2	
H5526	010	0	1	04	01	H5526_010_0	10	10		000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H5526	010	0	1	04	01	H5526_010_0	10	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	35	35	2			2	
H5526	010	0	1	04	01	H5526_010_0	10	8		000000000000000001100000000000000000000000000000	1	20	20	2			2	
H5526	010	0	1	04	01	H5526_010_0	10	9		000010000000000000000010000000000110000000001010	2			1	25.00	25.00	2	
H5526	010	0	1	04	01	H5526_010_0	10	1	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	010	0	1	04	01	H5526_010_0	10	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	011	0	1	04	01	H5526_011_0	10	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H5526	011	0	1	04	01	H5526_011_0	10	10		000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H5526	011	0	1	04	01	H5526_011_0	10	1	Part B Drugs	000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	011	0	1	04	01	H5526_011_0	10	9		000010000000000000000010000000000110000000001010	2			1	15.00	15.00	2	
H5526	011	0	1	04	01	H5526_011_0	10	8		000000000000000001100000000000000000000000000000	1	20	20	2			2	
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H5526	011	0	1	04	01	H5526_011_0	10	4	Mental Health Psychiatric	000000000001000000000000000000000000000000000000	1	50	50	2			2	
H5526	011	0	1	04	01	H5526_011_0	10	5		010101110110111110001000001100000001111111000101	2			1	15.00	15.00	2	
H5526	806	0	1	04	01	H5526_806_0	8	1	Outpatient Surgery	000000000000000001100000000000000000000000000000	1	25	25	2			2	
H5526	806	0	1	04	01	H5526_806_0	8	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5526	806	0	1	04	01	H5526_806_0	8	3	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	1	55	55	2			2	
H5526	806	0	1	04	01	H5526_806_0	8	4		010000000000000000001000000000000000000000000000	1	55	55	2			2	
H5526	806	0	1	04	01	H5526_806_0	8	9	Med Part B Drugs	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5526	806	0	1	04	01	H5526_806_0	8	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	806	0	1	04	01	H5526_806_0	8	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H5526	806	0	1	04	01	H5526_806_0	8	8	Other	000110000000000000000000001000000110000000000000	2			1	30.00	30.00	2	
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H5526	808	0	1	04	01	H5526_808_0	7	8	Other	000110000000000000000000001000000110000000000000	2			1	30.00	30.00	2	
H5526	808	0	1	04	01	H5526_808_0	7	9	Med Part B Drugs	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5526	808	0	1	04	01	H5526_808_0	7	7	DME / Prosthetics	000000000000000000000001110000000000000000000000	1	50	50	2			2	
H5526	808	0	1	04	01	H5526_808_0	7	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	808	0	1	04	01	H5526_808_0	7	5		000001110110111110000010000100000001111111001111	2			1	45.00	45.00	2	
H5526	808	0	1	04	01	H5526_808_0	7	4		010000000000000000001000000000000000000000000000	1	55	55	2			2	
H5526	808	0	1	04	01	H5526_808_0	7	3	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	1	55	55	2			2	
H5526	808	0	1	04	01	H5526_808_0	7	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5526	808	0	1	04	01	H5526_808_0	7	1	Outpatient Surgery	000000000000000001100000000000000000000000000000	1	25	25	2			2	
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H5526	810	0	1	04	01	H5526_810_0	7	6		000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	810	0	1	04	01	H5526_810_0	7	5		000001110110111110000010000100000001111111001111	2			1	45.00	45.00	2	
H5526	810	0	1	04	01	H5526_810_0	7	4		010000000000000000001000000000000000000000000000	1	55	55	2			2	
H5526	810	0	1	04	01	H5526_810_0	7	8	Other	000110000000000000000000001000000110000000000000	2			1	30.00	30.00	2	
H5526	810	0	1	04	01	H5526_810_0	7	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5526	810	0	1	04	01	H5526_810_0	7	1	Outpatient Surgery	000000000000000001100000000000000000000000000000	1	25	25	2			2	
H5526	810	0	1	04	01	H5526_810_0	7	9	Med Part B Drugs	000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5526	810	0	1	04	01	H5526_810_0	7	3	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	1	55	55	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	1	25% Cost Sharing	000010010010011110000000000100000011111111001000	1	25	25	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	7	$200 Cost Sharing Group	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	8	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	6	$75 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	3	50% Cost Sharing	011000101001100000011001110000000000000000110110	1	50	50	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	5	$175 Max OTC Benefit	000000000000000000000000000001000000000000000000	2			1	0.00	0.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	4	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	7	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	002	0	1	04	01	H5528_002_0	4	6	$150 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	4	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	3	50% Cost Sharing	011000101001100000011001110000000000000000110110	1	50	50	2			2	
H5528	002	0	1	04	01	H5528_002_0	4	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	002	0	1	04	01	H5528_002_0	4	1	25% Cost Sharing	000010010010011110000000000100000011111111001000	1	25	25	2			2	
H5528	002	0	1	04	01	H5528_002_0	4	5	$200 cost sharing group	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	5	$100 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	3	50% Cost Sharing	001000001001000000010001110000000000000000110110	1	50	50	2			2	
H5528	003	0	1	04	01	H5528_003_0	4	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	003	0	1	04	01	H5528_003_0	4	1	25% Cost Sharing	010010110010111111101000000100000011111111001000	1	25	25	2			2	
H5528	003	0	1	04	01	H5528_003_0	4	6	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	003	0	1	04	01	H5528_003_0	4	4	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H5528	004	0	1	04	01	H5528_004_0	2	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	004	0	1	04	01	H5528_004_0	2	3	50% Cost Sharing	011000101001100000011001110000000000000000110110	1	50	50	2			2	
H5528	004	0	1	04	01	H5528_004_0	2	4	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H5528	004	0	1	04	01	H5528_004_0	2	7	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	004	0	1	04	01	H5528_004_0	2	6	$75 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5528	004	0	1	04	01	H5528_004_0	2	1	25% Cost Sharing	000010010010011110000000000100000011111111001000	1	25	25	2			2	
H5528	004	0	1	04	01	H5528_004_0	2	5	$200 Cost Sharing	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5528	005	0	1	04	01	H5528_005_0	5	7	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	005	0	1	04	01	H5528_005_0	5	6	$200 Cost Sharing	000000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H5528	005	0	1	04	01	H5528_005_0	5	5	$150 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5528	005	0	1	04	01	H5528_005_0	5	4	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H5528	005	0	1	04	01	H5528_005_0	5	3	50% Cost Sharing	011000101001100000011001110000000000000000110110	1	50	50	2			2	
H5528	005	0	1	04	01	H5528_005_0	5	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	005	0	1	04	01	H5528_005_0	5	1	25% Cost Sharing	000010010010011110000000000100000011111111001000	1	25	25	2			2	
H5528	008	0	1	04	01	H5528_008_0	5	4	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			1	0.00	0.00	2	
H5528	008	0	1	04	01	H5528_008_0	5	3	50% Cost Sharing	001000001001000000010001110000000000000000110110	1	50	50	2			2	
H5528	008	0	1	04	01	H5528_008_0	5	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	008	0	1	04	01	H5528_008_0	5	1	25% Cost Sharing	010010110010111111101000000100000011111111001000	1	25	25	2			2	
H5528	008	0	1	04	01	H5528_008_0	5	5	$100 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5528	008	0	1	04	01	H5528_008_0	5	6	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	6	$30 Cost Sharing	001000000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	7	$75 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	75.00	75.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	8	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			2			2	
H5528	009	0	1	04	01	H5528_009_0	2	9	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	1	25% Cost Sharing	000010010010000000000000000000000011111111001000	1	25	25	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	3	50% Cost Sharing	000000001001000000010001110000000000000000110110	1	50	50	2			2	
H5528	009	0	1	04	01	H5528_009_0	2	4	$20 Cost Sharing	010000100000110010001000000100000000000000000000	2			1	20.00	20.00	2	
H5528	009	0	1	04	01	H5528_009_0	2	5	$50 Cost Sharing	000000000000001101100000000000000000000000000000	2			1	50.00	50.00	2	
H5528	010	0	1	04	01	H5528_010_0	7	6	$25 Cost Sharing	001000000000010010000000000100000000000000000000	2			1	25.00	25.00	2	
H5528	010	0	1	04	01	H5528_010_0	7	5	$50 Cost Sharing	000000000000001100000000000000000000000000000000	2			1	50.00	50.00	2	
H5528	010	0	1	04	01	H5528_010_0	7	4	$20 Cost Sharing	010000100000100000001000000000000000000000000000	2			1	20.00	20.00	2	
H5528	010	0	1	04	01	H5528_010_0	7	3	50% Cost Sharing	000000001001000000010001110000000000000000110110	1	50	50	2			2	
H5528	010	0	1	04	01	H5528_010_0	7	9	$100 Cost Sharing	000000000000000001100000000000000000000000000000	2			1	100.00	100.00	2	
H5528	010	0	1	04	01	H5528_010_0	7	10	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	010	0	1	04	01	H5528_010_0	7	1	25% Cost Sharing	000010010010000000000000000000000011111111001000	1	25	25	2			2	
H5528	010	0	1	04	01	H5528_010_0	7	7	$150 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5528	010	0	1	04	01	H5528_010_0	7	8	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			2			2	
H5528	010	0	1	04	01	H5528_010_0	7	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	7	$100 Cost Sharing	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	6	$10 Cost Sharing	000000000000010010000000000100000000000000000000	2			1	10.00	10.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	5	$50 Cost Sharing	000000000000001101100000000000000000000000000000	2			1	50.00	50.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	4	$20 Cost Sharing	011000100000100000001000000000000000000000000000	2			1	20.00	20.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	3	50% Cost Sharing	000000001001000000010001110000000000000000110110	1	50	50	2			2	
H5528	011	0	1	04	01	H5528_011_0	4	2	$40 Cost Sharing	000101000100000000000000000000000000000000000001	2			1	40.00	40.00	2	
H5528	011	0	1	04	01	H5528_011_0	4	1	25% Cost Sharing	000010010010000000000000000000000011111111001000	1	25	25	2			2	
H5528	011	0	1	04	01	H5528_011_0	4	8	$0 Cost Sharing	000000000000000000000000001000001000000000000000	2			2			2	
H5528	011	0	1	04	01	H5528_011_0	4	9	0 - 25%	000000000000000000000000000000000100000000000000	1	0	25	2			2	
H5528	013	0	1	04	01	H5528_013_0	3	1	$0 Cost Sharing	100110000000011111100101111100001111111111111011	2			1	0.00	0.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	4	$0 - $30 Cost Sharing	000000000000000000000000000000000000000000000100	2			1	0.00	30.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	3	$0 - $20 Cost Sharing	001000001001000000010000000000000000000000000000	2			1	0.00	20.00	2	
H5528	013	0	1	04	01	H5528_013_0	3	2	$0 - $10 Cost Sharing	010001110110100000001000000000000000000000000000	2			1	0.00	10.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	1	$0 Cost Sharing	100110000000011111100101111100001111111111111011	2			1	0.00	0.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	2	$0 - $10 Cost Sharing	010001110110100000001000000000000000000000000000	2			1	0.00	10.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	3	$0 - $20 Cost Sharing	001000001001000000010000000000000000000000000000	2			1	0.00	20.00	2	
H5528	014	0	1	04	01	H5528_014_0	3	4	$0 - $30 Cost Sharing	000000000000000000000000000000000000000000000100	2			1	0.00	30.00	2	
H5528	018	0	1	04	01	H5528_018_0	4	1	$0 Cost Sharing	111111111111111111111101111100001111111111111111	2			2			2	
H5528	804	0	1	04	01	H5528_804_0	5	3	0% Cost Sharing	000100000000010000000000000000000000000000000000	1	0	0	2			2	
H5528	804	0	1	04	01	H5528_804_0	5	4	0 - 20%	000000000000000000000000000000000100000000000000	1	0	20	2			2	
H5528	804	0	1	04	01	H5528_804_0	5	2	45% Cost Sharing	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5528	804	0	1	04	01	H5528_804_0	5	1	20% Cost Sharing	011011110110101111111101111100001011111111101111	1	20	20	2			2	
H5528	807	0	1	04	01	H5528_807_0	6	1	20% Cost Sharing	011011110110101111111101111100001011111111101111	1	20	20	2			2	
H5528	807	0	1	04	01	H5528_807_0	6	2	45% Cost Sharing	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5528	807	0	1	04	01	H5528_807_0	6	3	0% Cost Sharing	000100000000010000000000000000000000000000000000	1	0	0	2			2	
H5528	807	0	1	04	01	H5528_807_0	6	4	0 - 20%	000000000000000000000000000000000100000000000000	1	0	20	2			2	
H5529	001	0	1	04	01	H5529_001_0	12	9	OON Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	8	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	1	20% OON Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H5529	001	0	1	04	01	H5529_001_0	12	10	OON No Copayment	000100000000000000001000000100001111111100000000	2			2			2	
H5529	001	0	1	04	01	H5529_001_0	12	11	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	12	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	7	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	45.00	90.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	2	30% OON Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H5529	001	0	1	04	01	H5529_001_0	12	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H5529	001	0	1	04	01	H5529_001_0	12	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	45.00	275.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	45.00	45.00	2	
H5529	001	0	1	04	01	H5529_001_0	12	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	30.00	45.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	8	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	9	OON Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	1	20% OON Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H5529	004	0	1	04	01	H5529_004_0	9	10	OON No Copayment	000100000000000000001000000100001111111100000000	2			2			2	
H5529	004	0	1	04	01	H5529_004_0	9	11	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	12	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	25.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	15.00	25.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	225.00	225.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	2	25% OON Coinsurance	000000000000001010000001110000000000000000000000	1	25	25	2			2	
H5529	004	0	1	04	01	H5529_004_0	9	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	25	2			2	
H5529	004	0	1	04	01	H5529_004_0	9	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	25.00	225.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	25.00	25.00	2	
H5529	004	0	1	04	01	H5529_004_0	9	7	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	25.00	50.00	2	
H5529	804	0	1	04	01	H5529_804_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H5529	804	0	1	04	01	H5529_804_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5529	805	0	1	04	01	H5529_805_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H5529	805	0	1	04	01	H5529_805_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5529	806	0	1	04	01	H5529_806_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H5529	806	0	1	04	01	H5529_806_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5530	001	0	1	04	01	H5530_001_0	10	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	20.00	40.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	1	20% Coinsurance	000000000000000100000000001000000000000011100000	1	20	20	2			2	
H5530	001	0	1	04	01	H5530_001_0	10	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	40.00	275.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	5	PCP	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	2	30% Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
H5530	001	0	1	04	01	H5530_001_0	10	3	Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
H5530	001	0	1	04	01	H5530_001_0	10	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5530	001	0	1	04	01	H5530_001_0	10	6	Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	25.00	50.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	6	Specialist	010001010100000000000000000000000000000000000101	2			1	25.00	25.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	225.00	225.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	3	Labs	000000000000010000000000000000000000000000000000	1	0	25	2			2	
H5530	004	0	1	04	01	H5530_004_0	9	2	25% Coinsurance	000000000000001010000001110000000000000000000000	1	25	25	2			2	
H5530	004	0	1	04	01	H5530_004_0	9	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	25.00	225.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	25.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	15.00	25.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
H5530	004	0	1	04	01	H5530_004_0	9	1	20% Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
H5530	004	0	1	04	01	H5530_004_0	9	5	PCP	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H5530	804	0	1	04	01	H5530_804_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H5530	804	0	1	04	01	H5530_804_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5530	805	0	1	04	01	H5530_805_0	5	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H5530	805	0	1	04	01	H5530_805_0	5	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5530	806	0	1	04	01	H5530_806_0	5	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H5530	806	0	1	04	01	H5530_806_0	5	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H5532	001	0	1	04	01	H5532_001_0	3	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5532	001	0	1	04	01	H5532_001_0	3	7	Group 7	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
H5532	001	0	1	04	01	H5532_001_0	3	8	Group 8	000000000000000000000000001000000000000000000000	1	20	20	2			2	
H5532	001	0	1	04	01	H5532_001_0	3	9	Group 9	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
H5532	001	0	1	04	01	H5532_001_0	3	1	Group 1	010011110110100000001000000000000010000000001101	2			1	40.00	40.00	2	
H5532	001	0	1	04	01	H5532_001_0	3	10	Group 10	100000000000000000000000000000000000000000000000	1	50	50	2			2	
H5532	001	0	1	04	01	H5532_001_0	3	2	Group 2	000100000000001101100001110000000001111111100010	1	30	30	2			2	
H5532	001	0	1	04	01	H5532_001_0	3	3	Group 3	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5532	001	0	1	04	01	H5532_001_0	3	4	Group 4	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
H5532	001	0	1	04	01	H5532_001_0	3	5	Group 5	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5532	801	0	1	04	01	H5532_801_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5532	801	0	1	04	01	H5532_801_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5532	801	0	1	04	01	H5532_801_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5532	801	0	1	04	01	H5532_801_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5532	802	0	1	04	01	H5532_802_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5532	802	0	1	04	01	H5532_802_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5532	802	0	1	04	01	H5532_802_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5532	802	0	1	04	01	H5532_802_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5532	803	0	1	04	01	H5532_803_0	2	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
H5532	803	0	1	04	01	H5532_803_0	2	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5532	803	0	1	04	01	H5532_803_0	2	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H5532	803	0	1	04	01	H5532_803_0	2	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
H5533	002	0	1	04	01	H5533_002_0	10	4	OON - 50% coinsurance group	100000000000000000000001110000001000000011000000	1	50	50	2			2	
H5533	002	0	1	04	01	H5533_002_0	10	1	OON - $45 copay grouping	000011011111000000010000000000000010000000001101	2			1	45.00	45.00	2	
H5533	002	0	1	04	01	H5533_002_0	10	5	Non-covered grouping	000000000000000000000010000010000000000000010000	1	100	100	2			2	
H5533	002	0	1	04	01	H5533_002_0	10	3	OON - 20% coinsurance group	011100100000111111101100001100000001111100100010	1	20	20	2			2	
H5533	002	0	1	04	01	H5533_002_0	10	2	OON - $0 copay grouping	000000000000000000000000000000000100000000000000	2			2			2	
H5533	003	0	1	04	01	H5533_003_0	7	1	OON 20 % grouping	011111111111111111111100001100000011111100101111	1	20	20	2			2	
H5533	003	0	1	04	01	H5533_003_0	7	2	OON 50 % grouping	000000000000000000000001110000001000000011000000	1	50	50	2			2	
H5533	003	0	1	04	01	H5533_003_0	7	3	OON - $0 copay grouping	000000000000000000000000000000000100000000000000	2			2			2	
H5533	003	0	1	04	01	H5533_003_0	7	4	OON - Non covered grouping	100000000000000000000010000011110000000000010000	1	100	100	2			2	
H5533	801	0	1	04	01	H5533_801_0	3	4	100% member paid (non-covered)	000000000000000000000010000011110000000000000000	1	100	100	2			2	
H5533	801	0	1	04	01	H5533_801_0	3	2	20% coinsurance group	011111111111111111111100011100000011111111101101	1	20	20	2			2	
H5533	801	0	1	04	01	H5533_801_0	3	3	50% coinsurance group	100000000000000000000001100000001000000000010010	1	50	50	2			2	
H5533	801	0	1	04	01	H5533_801_0	3	1	100% Covered Group	000000000000000000000000000000000100000000000000	2			2			2	
H5533	802	0	1	04	01	H5533_802_0	3	3	50% coinsurance group	100000000000000000000001100000001000000000010010	1	50	50	2			2	
H5533	802	0	1	04	01	H5533_802_0	3	4	100% member paid (non-covered)	000000000000000000000010000011110000000000000000	1	100	100	2			2	
H5533	802	0	1	04	01	H5533_802_0	3	2	20% coinsurance group	011111111111111111111100011100000011111111101101	1	20	20	2			2	
H5533	802	0	1	04	01	H5533_802_0	3	1	100% Covered Group	000000000000000000000000000000000100000000000000	2			2			2	
H5533	803	0	1	04	01	H5533_803_0	3	4	100% member paid (non-covered)	000000000000000000000010000011110000000000000000	1	100	100	2			2	
H5533	803	0	1	04	01	H5533_803_0	3	2	20% coinsurance group	011111111111111111111100011100000011111111101101	1	20	20	2			2	
H5533	803	0	1	04	01	H5533_803_0	3	1	100% Covered Group	000000000000000000000000000000000100000000000000	2			2			2	
H5533	803	0	1	04	01	H5533_803_0	3	3	50% coinsurance group	100000000000000000000001100000001000000000010010	1	50	50	2			2	
H5606	001	0	1	38	05	H5606_001_0	1	1	Renal Dialysis	000000000000000000000000001000000000000000000000	1	20	35	2			2	
H5839	001	0	1	09	04	H5839_001_0	8	1	Outpatient Hospital	000000000000000001000000000000000000000000000000	1	20	20	2			2	
H5868	001	0	1	04	01	H5868_001_0	7	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H5868	001	0	1	04	01	H5868_001_0	7	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H5868	001	0	1	04	01	H5868_001_0	7	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5868	001	0	1	04	01	H5868_001_0	7	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H5868	001	0	1	04	01	H5868_001_0	7	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5868	001	0	1	04	01	H5868_001_0	7	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H5868	001	0	1	04	01	H5868_001_0	7	8		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H5868	001	0	1	04	01	H5868_001_0	7	9		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H5868	001	0	1	04	01	H5868_001_0	7	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5868	004	0	1	04	01	H5868_004_0	5	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H5868	004	0	1	04	01	H5868_004_0	5	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H5868	004	0	1	04	01	H5868_004_0	5	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H5868	004	0	1	04	01	H5868_004_0	5	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H5868	004	0	1	04	01	H5868_004_0	5	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H5868	004	0	1	04	01	H5868_004_0	5	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5868	004	0	1	04	01	H5868_004_0	5	9		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H5868	004	0	1	04	01	H5868_004_0	5	8		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H5868	004	0	1	04	01	H5868_004_0	5	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H5868	801	0	1	04	01	H5868_801_0	4	3	#3	000100000000010000000000000000000001000000000000	1	0	20	2			2	
H5868	801	0	1	04	01	H5868_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5868	801	0	1	04	01	H5868_801_0	4	1	#1	011011110110101111101101111100001110111111101111	1	20	20	2			2	
H5868	802	0	1	04	01	H5868_802_0	4	1	#1	011011110110101111101101111100001110111111101111	1	20	20	2			2	
H5868	802	0	1	04	01	H5868_802_0	4	3	#3	000100000000010000000000000000000001000000000000	1	0	20	2			2	
H5868	802	0	1	04	01	H5868_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5868	803	0	1	04	01	H5868_803_0	4	3	#3	000100000000010000000000000000000001000000000000	1	0	20	2			2	
H5868	803	0	1	04	01	H5868_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5868	803	0	1	04	01	H5868_803_0	4	1	#1	011011110110101111101101111100001110111111101111	1	20	20	2			2	
H5909	001	0	1	38	05	H5909_001_0	1	1		000000000000000000000000001000000000000000000000	1	20	35	2			2	
H5909	005	0	1	38	05	H5909_005_0	1	1		000000000000000000000000001000000000000000000000	1	20	35	2			2	
H5962	001	0	1	38	05	H5962_001_0	1	1	Renal Dialysis	000000000000000000000000001000000000000000000000	1	20	35	2			2	
H5970	001	0	1	04	01	H5970_001_0	5	6		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H5970	001	0	1	04	01	H5970_001_0	5	7		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H5970	001	0	1	04	01	H5970_001_0	5	5		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H5970	001	0	1	04	01	H5970_001_0	5	4		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5970	001	0	1	04	01	H5970_001_0	5	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5970	001	0	1	04	01	H5970_001_0	5	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5970	001	0	1	04	01	H5970_001_0	5	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H5970	002	0	1	04	01	H5970_002_0	5	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H5970	002	0	1	04	01	H5970_002_0	5	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H5970	002	0	1	04	01	H5970_002_0	5	6		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H5970	002	0	1	04	01	H5970_002_0	5	5		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H5970	002	0	1	04	01	H5970_002_0	5	4		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5970	002	0	1	04	01	H5970_002_0	5	7		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H5970	002	0	1	04	01	H5970_002_0	5	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H5970	801	0	1	04	01	H5970_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5970	801	0	1	04	01	H5970_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5970	801	0	1	04	01	H5970_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5970	802	0	1	04	01	H5970_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H5970	802	0	1	04	01	H5970_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5970	802	0	1	04	01	H5970_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5970	803	0	1	04	01	H5970_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H5970	803	0	1	04	01	H5970_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H5970	803	0	1	04	01	H5970_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6328	001	0	1	04	01	H6328_001_0	9	14	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	001	0	1	04	01	H6328_001_0	9	2	$30 Copayment	010000010110000000001000000000001111111100000000	2			1	30.00	30.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	3	$35 Copayment	000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	4	$40 Copayment	000100000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	5	$50 Copayment	000000001001000000010000001000000000000000000000	2			1	50.00	50.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	6	$100 Copayment	001000000000000000100100000000000000000000000000	2			1	100.00	100.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	7	$150 Copayment	000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	8	$10 Copayment to $25 Copayment	000000000000010010000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	9	$20 Copayment to $200 Copayment	000000000000001000000000000000000000000000000000	2			1	20.00	200.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	1	$20 Copayment	000011100000100000000000000000000000000000000000	2			1	20.00	20.00	2	
H6328	001	0	1	04	01	H6328_001_0	9	10	20% Coinsurance	000000000000000000000000010000000000000011000000	1	20	20	2			2	
H6328	001	0	1	04	01	H6328_001_0	9	11	30% Coinsurance	000000000000000100000000000100000000000000100000	1	30	30	2			2	
H6328	001	0	1	04	01	H6328_001_0	9	12	30% Coinsurance to 40% Coinsurance	000000000000000000000001100000000000000000000000	1	30	40	2			2	
H6328	001	0	1	04	01	H6328_001_0	9	13	0% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	0	99	2			2	
H6328	002	0	1	04	01	H6328_002_0	8	9	$30 Copayment to $200 Copayment	000000000000001000000000000000000000000000000000	2			1	30.00	200.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	1	$20 Copayment	000001100000100000000000000000000000000000000000	2			1	20.00	20.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	10	20% Coinsurance	000000000000000000000000010000000000000011000000	1	20	20	2			2	
H6328	002	0	1	04	01	H6328_002_0	8	11	30% Coinsurance	000000000000000100000000000100000000000000100000	1	30	30	2			2	
H6328	002	0	1	04	01	H6328_002_0	8	12	30% Coinsurance to 40% Coinsurance	000000000000000000000001100000000000000000000000	1	30	40	2			2	
H6328	002	0	1	04	01	H6328_002_0	8	13	1% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	002	0	1	04	01	H6328_002_0	8	8	$10 Copayment to $25 Copayment	000000000000010010000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	2	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	3	$30 Copayment	010000000000000000001000000000001111111100000000	2			1	30.00	30.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	4	$40 Copayment	000100010110000000000000000000000000000000000101	2			1	40.00	40.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	5	$55 Copayment	000000001001000000010000001000000000000000000000	2			1	55.00	55.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	6	$100 Copayment	001000000000000000100100000000000000000000000000	2			1	100.00	100.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	7	$200 Copayment	000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H6328	002	0	1	04	01	H6328_002_0	8	14	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	003	0	1	04	01	H6328_003_0	8	9	$250 Copayment	000000000000000001000000000000000000000000000000	2			1	250.00	250.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	8	$150 Copayment	001000000000000000100000000000000000000000000000	2			1	150.00	150.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	7	$100 Copayment	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	6	$60 Copayment	000000001001000000010000000000000000000000000000	2			1	60.00	60.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	5	$50 Copayment	000000000000000000000000001000000000000000000000	2			1	50.00	50.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	4	$45 Copayment	010100010110000000001000000000000000000000000101	2			1	45.00	45.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	3	$30 Copayment	000010000000000000000000000000001111111100000000	2			1	30.00	30.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	2	$25 Copayment	000000100000100000000000000000000000000000000000	2			1	25.00	25.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	15	1% to 99% Coinsurance	100000000000000000000000000000000000000000011010	1	1	99	2			2	
H6328	003	0	1	04	01	H6328_003_0	8	14	30% Coinsurance to 40% Coinsurance	000000000000000000000001100000000000000000000000	1	30	40	2			2	
H6328	003	0	1	04	01	H6328_003_0	8	13	30% Coinsurance	000000000000000100000000000100000000000000100000	1	30	30	2			2	
H6328	003	0	1	04	01	H6328_003_0	8	12	20% Coinsurance	000000000000000000000000010000000000000011000000	1	20	20	2			2	
H6328	003	0	1	04	01	H6328_003_0	8	11	$40 Copayment to $250 Copayment	000000000000001000000000000000000000000000000000	2			1	40.00	250.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	1	$20 Copayment	000001000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H6328	003	0	1	04	01	H6328_003_0	8	10	$10 Copayment to $25 Copayment	000000000000010010000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	9	$20 Copayment to $200 Copayment	000000000000001000000000000000000000000000000000	2			1	20.00	200.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	8	$10 Copayment to $25 Copayment	000000000000010010000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	7	$150 Copayment	000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	6	$100 Copayment	001000000000000000100100000000000000000000000000	2			1	100.00	100.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	5	$50 Copayment	000000001001000000010000001000000000000000000000	2			1	50.00	50.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	4	$40 Copayment	000100000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	3	$35 Copayment	000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	2	$30 Copayment	010000010110000000001000000000001111111100000000	2			1	30.00	30.00	2	
H6328	005	0	1	04	01	H6328_005_0	5	14	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	005	0	1	04	01	H6328_005_0	5	13	1% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	005	0	1	04	01	H6328_005_0	5	12	30% Coinsurance to 40% Coinsurance	000000000000000000000001100000000000000000000000	1	30	40	2			2	
H6328	005	0	1	04	01	H6328_005_0	5	11	30% Coinsurance	000000000000000100000000000100000000000000100000	1	30	30	2			2	
H6328	005	0	1	04	01	H6328_005_0	5	10	20% Coinsurance	000000000000000000000000010000000000000011000000	1	20	20	2			2	
H6328	005	0	1	04	01	H6328_005_0	5	1	$20 Copayment	000011100000100000000000000000000000000000000000	2			1	20.00	20.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	10	20% Coinsurance	000000000000000000000000010000000000000011000000	1	20	20	2			2	
H6328	006	0	1	04	01	H6328_006_0	4	11	30% Coinsurance	000000000000000100000000000100000000000000100000	1	30	30	2			2	
H6328	006	0	1	04	01	H6328_006_0	4	12	30% Coinsurance to 40% Coinsurance	000000000000000000000001100000000000000000000000	1	30	40	2			2	
H6328	006	0	1	04	01	H6328_006_0	4	13	1% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	006	0	1	04	01	H6328_006_0	4	14	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	006	0	1	04	01	H6328_006_0	4	2	$25 Copayment	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	1	$20 Copayment	000001100000100000000000000000000000000000000000	2			1	20.00	20.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	4	$40 Copayment	000100010110000000000000000000000000000000000101	2			1	40.00	40.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	5	$55 Copayment	000000001001000000010000001000000000000000000000	2			1	55.00	55.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	6	$100 Copayment	001000000000000000100100000000000000000000000000	2			1	100.00	100.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	7	$200 Copayment	000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	8	$10 Copayment to $25 Copayment	000000000000010010000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	9	$30 Copayment to $200 Copayment	000000000000001000000000000000000000000000000000	2			1	30.00	200.00	2	
H6328	006	0	1	04	01	H6328_006_0	4	3	$30 Copayment	010000000000000000001000000000001111111100000000	2			1	30.00	30.00	2	
H6328	801	0	1	04	01	H6328_801_0	4	3	1% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	801	0	1	04	01	H6328_801_0	4	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H6328	801	0	1	04	01	H6328_801_0	4	1	20% Coinsurance	011111110110111111111101111100001111111111100101	1	20	20	2			2	
H6328	801	0	1	04	01	H6328_801_0	4	4	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	802	0	1	04	01	H6328_802_0	4	4	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	802	0	1	04	01	H6328_802_0	4	3	1 to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	802	0	1	04	01	H6328_802_0	4	1	20% Coinsurance	011111110110111111111101111100001111111111100101	1	20	20	2			2	
H6328	802	0	1	04	01	H6328_802_0	4	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H6328	803	0	1	04	01	H6328_803_0	4	1	20% Coinsurance	011111110110111111111101111100001111111111100101	1	20	20	2			2	
H6328	803	0	1	04	01	H6328_803_0	4	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H6328	803	0	1	04	01	H6328_803_0	4	3	1% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	803	0	1	04	01	H6328_803_0	4	4	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6328	804	0	1	04	01	H6328_804_0	4	1	20% Coinsurance	011111110110111111111101111100001111111111100101	1	20	20	2			2	
H6328	804	0	1	04	01	H6328_804_0	4	2	45% Coinsurance	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H6328	804	0	1	04	01	H6328_804_0	4	3	1% to 99% Coinsurance	100000000000000000000000000000000000000000010010	1	1	99	2			2	
H6328	804	0	1	04	01	H6328_804_0	4	4	Not Covered	000000000000000000000000000000000000000000001000	1	100	100	2			2	
H6411	002	0	1	04	01	H6411_002_0	5	6		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H6411	002	0	1	04	01	H6411_002_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6411	002	0	1	04	01	H6411_002_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6411	002	0	1	04	01	H6411_002_0	5	5		000000000000000000000000000001101000000000010000	1	50	50	2			2	
H6411	002	0	1	04	01	H6411_002_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H6411	002	0	1	04	01	H6411_002_0	5	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H6411	007	0	1	04	01	H6411_007_0	4	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H6411	007	0	1	04	01	H6411_007_0	4	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H6411	007	0	1	04	01	H6411_007_0	4	2		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6411	007	0	1	04	01	H6411_007_0	4	3		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6411	007	0	1	04	01	H6411_007_0	4	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H6411	007	0	1	04	01	H6411_007_0	4	6		000000000000000000000000000001101000000000011000	1	50	50	2			2	
H6411	008	0	1	04	01	H6411_008_0	4	4		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H6411	008	0	1	04	01	H6411_008_0	4	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H6411	008	0	1	04	01	H6411_008_0	4	6		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6411	008	0	1	04	01	H6411_008_0	4	3		000000000000000000000000000001101000000000011000	1	50	50	2			2	
H6411	008	0	1	04	01	H6411_008_0	4	2		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6411	008	0	1	04	01	H6411_008_0	4	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H6411	801	0	1	04	01	H6411_801_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6411	801	0	1	04	01	H6411_801_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6411	801	0	1	04	01	H6411_801_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6411	802	0	1	04	01	H6411_802_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6411	802	0	1	04	01	H6411_802_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6411	802	0	1	04	01	H6411_802_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6411	803	0	1	04	01	H6411_803_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6411	803	0	1	04	01	H6411_803_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6411	803	0	1	04	01	H6411_803_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6528	001	0	1	04	01	H6528_001_0	4	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	10	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
H6528	001	0	1	04	01	H6528_001_0	4	11	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
H6528	001	0	1	04	01	H6528_001_0	4	12	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
H6528	001	0	1	04	01	H6528_001_0	4	13	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
H6528	001	0	1	04	01	H6528_001_0	4	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	9	$175 Copay	000000000000000001100000000000000000000000000000	2			1	175.00	175.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	4	$0 - $35 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	35.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	5	$20-$35 Copay	000000001001000000010000000000000000000000000000	2			1	20.00	35.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	6	$30	000000000000000000000000000000000000000000000100	2			1	30.00	30.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	7	$35 Copay	011001110010100000001000000000000000000000000111	2			1	35.00	35.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	8	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H6528	001	0	1	04	01	H6528_001_0	4	3	$20 Copay	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H6609	001	0	1	04	01	H6609_001_0	6	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	001	0	1	04	01	H6609_001_0	6	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	001	0	1	04	01	H6609_001_0	6	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	001	0	1	04	01	H6609_001_0	6	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H6609	001	0	1	04	01	H6609_001_0	6	9		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	001	0	1	04	01	H6609_001_0	6	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	001	0	1	04	01	H6609_001_0	6	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	001	0	1	04	01	H6609_001_0	6	8		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	001	0	1	04	01	H6609_001_0	6	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	002	0	1	04	01	H6609_002_0	5	6		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	002	0	1	04	01	H6609_002_0	5	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	002	0	1	04	01	H6609_002_0	5	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	002	0	1	04	01	H6609_002_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	002	0	1	04	01	H6609_002_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	002	0	1	04	01	H6609_002_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H6609	002	0	1	04	01	H6609_002_0	5	7		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	003	0	1	04	01	H6609_003_0	6	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	003	0	1	04	01	H6609_003_0	6	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	003	0	1	04	01	H6609_003_0	6	9		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	003	0	1	04	01	H6609_003_0	6	8		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	003	0	1	04	01	H6609_003_0	6	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	003	0	1	04	01	H6609_003_0	6	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	003	0	1	04	01	H6609_003_0	6	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	003	0	1	04	01	H6609_003_0	6	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	003	0	1	04	01	H6609_003_0	6	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H6609	004	0	1	04	01	H6609_004_0	5	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	004	0	1	04	01	H6609_004_0	5	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	004	0	1	04	01	H6609_004_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	004	0	1	04	01	H6609_004_0	5	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	004	0	1	04	01	H6609_004_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H6609	004	0	1	04	01	H6609_004_0	5	6		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	004	0	1	04	01	H6609_004_0	5	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	005	0	1	04	01	H6609_005_0	6	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	005	0	1	04	01	H6609_005_0	6	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	005	0	1	04	01	H6609_005_0	6	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H6609	005	0	1	04	01	H6609_005_0	6	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	005	0	1	04	01	H6609_005_0	6	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	005	0	1	04	01	H6609_005_0	6	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	005	0	1	04	01	H6609_005_0	6	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	005	0	1	04	01	H6609_005_0	6	8		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	005	0	1	04	01	H6609_005_0	6	9		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	006	0	1	04	01	H6609_006_0	5	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H6609	006	0	1	04	01	H6609_006_0	5	2		000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H6609	006	0	1	04	01	H6609_006_0	5	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	006	0	1	04	01	H6609_006_0	5	3		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	006	0	1	04	01	H6609_006_0	5	4		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	006	0	1	04	01	H6609_006_0	5	5		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	006	0	1	04	01	H6609_006_0	5	6		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	007	0	1	04	01	H6609_007_0	6	9		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	007	0	1	04	01	H6609_007_0	6	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	007	0	1	04	01	H6609_007_0	6	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	007	0	1	04	01	H6609_007_0	6	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H6609	007	0	1	04	01	H6609_007_0	6	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	007	0	1	04	01	H6609_007_0	6	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	007	0	1	04	01	H6609_007_0	6	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	007	0	1	04	01	H6609_007_0	6	8		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	007	0	1	04	01	H6609_007_0	6	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	008	0	1	04	01	H6609_008_0	6	8		000000000000000000000000010000000000000000000000	1	20	30	2			2	
H6609	008	0	1	04	01	H6609_008_0	6	9		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6609	008	0	1	04	01	H6609_008_0	6	6		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6609	008	0	1	04	01	H6609_008_0	6	5		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H6609	008	0	1	04	01	H6609_008_0	6	7		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H6609	008	0	1	04	01	H6609_008_0	6	2		000000100000111110011000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	008	0	1	04	01	H6609_008_0	6	3		011100000000000001100001100000000000000000000000	1	30	30	2			2	
H6609	008	0	1	04	01	H6609_008_0	6	4		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	008	0	1	04	01	H6609_008_0	6	1		000011011111000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	009	0	1	04	01	H6609_009_0	7	9		000000000000000000000001100000000000000000000000	1	40	40	2			2	
H6609	009	0	1	04	01	H6609_009_0	7	8		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H6609	009	0	1	04	01	H6609_009_0	7	7		000000000000000000000000000100000100000000010010	2			1	0.00	0.00	2	
H6609	009	0	1	04	01	H6609_009_0	7	6		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H6609	009	0	1	04	01	H6609_009_0	7	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	009	0	1	04	01	H6609_009_0	7	4		000000000000000000000000000000000000000000100000	1	20	30	2			2	
H6609	009	0	1	04	01	H6609_009_0	7	3		000000000000000000000000010000000000000000000000	1	20	40	2			2	
H6609	009	0	1	04	01	H6609_009_0	7	1		011011111111111111111000000000000011111111001101	1	30	30	2			2	
H6609	009	0	1	04	01	H6609_009_0	7	2		000100000000000000000000000000000000000000000000	1	25	25	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	8		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	7		000000000000000000000000000100000100000000010010	2			1	0.00	0.00	2	
H6609	010	0	1	04	01	H6609_010_0	5	6		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	010	0	1	04	01	H6609_010_0	5	9		000000000000000000000001100000000000000000000000	1	40	40	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	2		000100000000000000000000000000000000000000000000	1	25	25	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	3		000000000000000000000000010000000000000000000000	1	20	40	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	4		000000000000000000000000000000000000000000100000	1	20	30	2			2	
H6609	010	0	1	04	01	H6609_010_0	5	1		011011111111111111111000000000000011111111001101	1	30	30	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	8		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	9		000000000000000000000001100000000000000000000000	1	40	40	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	1		011011111111111111111000000000000011111111001101	1	30	30	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	2		000100000000000000000000000000000000000000000000	1	25	25	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	3		000000000000000000000000010000000000000000000000	1	20	40	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	4		000000000000000000000000000000000000000000100000	1	20	30	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H6609	011	0	1	04	01	H6609_011_0	5	6		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H6609	011	0	1	04	01	H6609_011_0	5	7		000000000000000000000000000100000100000000010010	2			1	0.00	0.00	2	
H6609	012	0	1	04	01	H6609_012_0	5	8		000000000000000000000000000001101000000000000000	1	50	50	2			2	
H6609	012	0	1	04	01	H6609_012_0	5	9		000000000000000000000001100000000000000000000000	1	35	35	2			2	
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H6609	016	0	1	04	01	H6609_016_0	5	5		000000000000001000000000000000000000000000000000	2			1	25.00	125.00	2	
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H6609	801	0	1	04	01	H6609_801_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6609	801	0	1	04	01	H6609_801_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6609	801	0	1	04	01	H6609_801_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6609	802	0	1	04	01	H6609_802_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6609	802	0	1	04	01	H6609_802_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6609	802	0	1	04	01	H6609_802_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6609	803	0	1	04	01	H6609_803_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6609	803	0	1	04	01	H6609_803_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6609	803	0	1	04	01	H6609_803_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6900	001	0	1	04	01	H6900_001_0	9	6		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H6900	001	0	1	04	01	H6900_001_0	9	5		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H6900	001	0	1	04	01	H6900_001_0	9	4		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6900	001	0	1	04	01	H6900_001_0	9	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H6900	001	0	1	04	01	H6900_001_0	9	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H6900	001	0	1	04	01	H6900_001_0	9	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H6900	001	0	1	04	01	H6900_001_0	9	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
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H6900	002	0	1	04	01	H6900_002_0	7	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H6900	002	0	1	04	01	H6900_002_0	7	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H6900	002	0	1	04	01	H6900_002_0	7	4		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6900	002	0	1	04	01	H6900_002_0	7	5		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H6900	002	0	1	04	01	H6900_002_0	7	6		000000000000000000000000000000000000000000011000	1	50	55	2			2	
H6900	002	0	1	04	01	H6900_002_0	7	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6900	004	0	1	04	01	H6900_004_0	9	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H6900	004	0	1	04	01	H6900_004_0	9	6		000000000000000000000000000000000000000000010000	1	50	55	2			2	
H6900	004	0	1	04	01	H6900_004_0	9	5		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H6900	004	0	1	04	01	H6900_004_0	9	4		000000000000000000000000000000000000000000100000	1	20	20	2			2	
H6900	004	0	1	04	01	H6900_004_0	9	3		000000000000000000000000001000000000000000000000	1	0	20	2			2	
H6900	004	0	1	04	01	H6900_004_0	9	1		011111111111111111111001110000000011111111001111	1	30	30	2			2	
H6900	004	0	1	04	01	H6900_004_0	9	2		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H6900	801	0	1	04	01	H6900_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6900	801	0	1	04	01	H6900_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6900	801	0	1	04	01	H6900_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6900	802	0	1	04	01	H6900_802_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6900	802	0	1	04	01	H6900_802_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6900	802	0	1	04	01	H6900_802_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H6900	803	0	1	04	01	H6900_803_0	3	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H6900	803	0	1	04	01	H6900_803_0	3	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H6900	803	0	1	04	01	H6900_803_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	7		000000000000000000000000000000101000000000000000	1	50	50	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	6		000000000000000000000000000000000000000000100000	1	20	30	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	5		000000000000000000000000010000000000000000000000	1	20	40	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	4		000000000000000000000001100000000000000000000000	1	40	40	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	3		000000000000000000000000001000000000000000000000	2			1	0.00	75.00	2	
H7002	002	0	1	04	01	H7002_002_0	4	2		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7002	002	0	1	04	01	H7002_002_0	4	1		011111111111111111111000000000000011111111001101	1	30	30	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	8		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H7002	805	0	1	04	01	H7002_805_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H7002	805	0	1	04	01	H7002_805_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7002	805	0	1	04	01	H7002_805_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H7002	806	0	1	04	01	H7002_806_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7002	806	0	1	04	01	H7002_806_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H7002	806	0	1	04	01	H7002_806_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H7002	807	0	1	04	01	H7002_807_0	5	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H7002	807	0	1	04	01	H7002_807_0	5	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H7002	807	0	1	04	01	H7002_807_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7006	001	0	1	04	01	H7006_001_0	5	1	Office Visits	000010011111000000010000000000000010000000001101	2			1	30.00	30.00	2	
H7006	001	0	1	04	01	H7006_001_0	5	6	Outpatient  Surgery	001000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H7006	001	0	1	04	01	H7006_001_0	5	5	Lab  Imaging	000000000000011110000000000000000000000000000000	1	20	20	2			2	
H7006	001	0	1	04	01	H7006_001_0	5	4	Drugs  Supplies	000000000000000000000001100000000000000000100000	1	20	20	2			2	
H7006	001	0	1	04	01	H7006_001_0	5	3	Rehab	010101100000100000000000000000000000000000000000	2			1	30.00	30.00	2	
H7006	001	0	1	04	01	H7006_001_0	5	8	Supplemental	000000000000000000000000000000000000000000010010	2			2			2	
H7006	001	0	1	04	01	H7006_001_0	5	2	Preventative	000000000000000000001000011100001101111111000000	2			2			2	
H7006	001	0	1	04	01	H7006_001_0	5	7	Transportation	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H7006	002	0	1	04	01	H7006_002_0	5	2	Preventative	000000000000000000001000011100001101111111000000	2			2			2	
H7006	002	0	1	04	01	H7006_002_0	5	3	Rehab	010101100000100000000000000000000000000000000000	2			1	30.00	30.00	2	
H7006	002	0	1	04	01	H7006_002_0	5	8	Supplemental	000000000000000000000000000000000000000000010010	2			2			2	
H7006	002	0	1	04	01	H7006_002_0	5	7	Transportation	000000000000000000000100000000000000000000000000	2			1	50.00	50.00	2	
H7006	002	0	1	04	01	H7006_002_0	5	6	Outpatient  Surgery	001000000000000001100000000000000000000000000000	2			1	200.00	200.00	2	
H7006	002	0	1	04	01	H7006_002_0	5	1	Office Visits	000010011111000000010000000000000010000000001101	2			1	30.00	30.00	2	
H7006	002	0	1	04	01	H7006_002_0	5	4	Drugs  Supplies	000000000000000000000001100000000000000000100000	1	20	20	2			2	
H7006	002	0	1	04	01	H7006_002_0	5	5	Lab  Imaging	000000000000011110000000000000000000000000000000	1	20	20	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	2		000000000000000000000000000100000100000000000110	2			1	0.00	0.00	2	
H7188	003	0	1	04	01	H7188_003_0	8	3		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H7188	003	0	1	04	01	H7188_003_0	8	4		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H7188	003	0	1	04	01	H7188_003_0	8	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	6		000000000000000000000000000000101000000000011000	1	50	50	2			2	
H7188	801	0	1	04	01	H7188_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H7188	801	0	1	04	01	H7188_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H7188	801	0	1	04	01	H7188_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7188	802	0	1	04	01	H7188_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H7188	802	0	1	04	01	H7188_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H7188	802	0	1	04	01	H7188_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7188	803	0	1	04	01	H7188_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H7188	803	0	1	04	01	H7188_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H7188	803	0	1	04	01	H7188_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H7301	002	0	1	04	01	H7301_002_0	8	1	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7301	002	0	1	04	01	H7301_002_0	8	2	OON Covered Benefits	011111111111111111111001111100000111111111101101	1	30	30	2			2	
H7301	002	0	1	04	01	H7301_002_0	8	3	No Applicable OON Coverage or N/C	100000000000000000000010000011111000000000010010	2			2			2	
H7301	801	0	1	04	01	H7301_801_0	3	3	Goup 3	100000000000000000000010000011110000000000010000	2			2			2	
H7301	801	0	1	04	01	H7301_801_0	3	1	Group 1	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H7301	801	0	1	04	01	H7301_801_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H7301	802	0	1	04	01	H7301_802_0	3	1	Group 1	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H7301	802	0	1	04	01	H7301_802_0	3	3	Goup 3	100000000000000000000010000011110000000000010000	2			2			2	
H7301	802	0	1	04	01	H7301_802_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H7301	803	0	1	04	01	H7301_803_0	3	3	Goup 3	100000000000000000000010000011110000000000010000	2			2			2	
H7301	803	0	1	04	01	H7301_803_0	3	1	Group 1	011111110110111111111101111100001111111111101111	1	20	20	2			2	
H7301	803	0	1	04	01	H7301_803_0	3	2	Group 2	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H7306	001	0	1	04	01	H7306_001_0	4	1	Group 1	011111111111111111111101111100001111111111101001	1	30	30	2			2	
H7306	001	0	1	04	01	H7306_001_0	4	2	Group 2	000000000000000000000000000000000000000000000100	2			1	30.00	30.00	2	
H7306	001	0	1	04	01	H7306_001_0	4	3	Group 3	000000000000000000000000000000000000000000000010	2			2			2	
H7306	801	0	1	04	01	H7306_801_0	2	2	Group 2	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H7306	801	0	1	04	01	H7306_801_0	2	1	Group 1	010011110110111111111101111100001111111111101111	1	20	20	2			2	
H7306	801	0	1	04	01	H7306_801_0	2	3	Group 3	000100000000000000000000000000000000000000000000	2			2			2	
H7306	803	0	1	04	01	H7306_803_0	1	1	Group 1	010011110110111111111101111100001111111111101111	1	20	20	2			2	
H7306	803	0	1	04	01	H7306_803_0	1	2	Group 2	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H7306	803	0	1	04	01	H7306_803_0	1	3	Group 3	000100000000000000000000000000000000000000000000	2			2			2	
H7306	804	0	1	04	01	H7306_804_0	1	1	Group 1	010011110110111111111101111100001111111111101111	1	20	20	2			2	
H7306	804	0	1	04	01	H7306_804_0	1	2	Group 2	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H7306	804	0	1	04	01	H7306_804_0	1	3	Group 3	000100000000000000000000000000000000000000000000	2			2			2	
H7787	001	0	1	04	01	H7787_001_0	8	6	no charge	000000000000000000000000000000001000000000000000	2			2			2	
H7787	001	0	1	04	01	H7787_001_0	8	5	$25 copay	001000000000000000000000000000000000000000000000	2			2			2	
H7787	001	0	1	04	01	H7787_001_0	8	4	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7787	001	0	1	04	01	H7787_001_0	8	3	30% coinsurance after deductible	000100001001011111111001111100000101111111101110	1	30	30	2			2	
H7787	001	0	1	04	01	H7787_001_0	8	2	40.00 copayment	010010000000000000000000000000000010000000000000	2			1	40.00	40.00	2	
H7787	001	0	1	04	01	H7787_001_0	8	1	60.00 copay	000001110110100000000000000000000000000000000001	2			1	60.00	60.00	2	
H7787	002	0	1	04	01	H7787_002_0	4	6	no charge	000000000000000000000000000000001000000000000000	2			2			2	
H7787	002	0	1	04	01	H7787_002_0	4	5	$25 copay	001000000000000000000000000000000000000000000000	2			2			2	
H7787	002	0	1	04	01	H7787_002_0	4	4	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7787	002	0	1	04	01	H7787_002_0	4	3	30% coinsurance after deductible	000100001001011111111001111100000101111111101110	1	30	30	2			2	
H7787	002	0	1	04	01	H7787_002_0	4	2	40.00 copayment	010010000000000000000000000000000010000000000000	2			1	40.00	40.00	2	
H7787	002	0	1	04	01	H7787_002_0	4	1	60.00 copay	000001110110100000000000000000000000000000000001	2			1	60.00	60.00	2	
H7787	002	0	1	04	01	H7787_002_0	4	7	50% coinsurance until max benefit	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H7787	003	0	1	04	01	H7787_003_0	4	3	30% coinsurance after deductible	000100001001011111111001111100000101111111100110	1	30	30	2			2	
H7787	003	0	1	04	01	H7787_003_0	4	7	50% coinsurance until max met	000000000000000000000000000000000000000000011000	1	50	50	2			2	
H7787	003	0	1	04	01	H7787_003_0	4	6	no charge	000000000000000000000000000000001000000000000000	2			2			2	
H7787	003	0	1	04	01	H7787_003_0	4	5	$25 copay	001000000000000000000000000000000000000000000000	2			2			2	
H7787	003	0	1	04	01	H7787_003_0	4	4	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7787	003	0	1	04	01	H7787_003_0	4	2	40.00 copayment	010010000000000000000000000000000010000000000000	2			1	40.00	40.00	2	
H7787	003	0	1	04	01	H7787_003_0	4	1	60.00 copay	000001110110100000000000000000000000000000000001	2			1	60.00	60.00	2	
H7787	004	0	1	04	01	H7787_004_0	4	4	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7787	004	0	1	04	01	H7787_004_0	4	3	30% coinsurance after deductible	000100001001011111111001111100000101111111101110	1	30	30	2			2	
H7787	004	0	1	04	01	H7787_004_0	4	5	$25 copay	001000000000000000000000000000000000000000000000	2			2			2	
H7787	004	0	1	04	01	H7787_004_0	4	1	60.00 copay	000001110110100000000000000000000000000000000001	2			1	60.00	60.00	2	
H7787	004	0	1	04	01	H7787_004_0	4	2	40.00 copayment	010010000000000000000000000000000010000000000000	2			1	40.00	40.00	2	
H7787	004	0	1	04	01	H7787_004_0	4	6	no charge	000000000000000000000000000000001000000000000000	2			2			2	
H7787	005	0	1	04	01	H7787_005_0	5	7	50% coinsurance until max met	000000000000000000000000000000000000000000010000	1	50	50	2			2	
H7787	005	0	1	04	01	H7787_005_0	5	6	no charge	000000000000000000000000000000001000000000000000	2			2			2	
H7787	005	0	1	04	01	H7787_005_0	5	5	$25 copay	001000000000000000000000000000000000000000000000	2			2			2	
H7787	005	0	1	04	01	H7787_005_0	5	4	Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7787	005	0	1	04	01	H7787_005_0	5	3	30% coinsurance after deductible	000100001001011111111001111100000101111111101110	1	30	30	2			2	
H7787	005	0	1	04	01	H7787_005_0	5	2	40.00 copayment	010010000000000000000000000000000010000000000000	2			1	40.00	40.00	2	
H7787	005	0	1	04	01	H7787_005_0	5	1	60.00 copay	000001110110100000000000000000000000000000000001	2			1	60.00	60.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	1		010010100010100000001000000000000000000000000101	2			1	35.00	35.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	10		000000000000010010000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	2		000100000000000000000000010100001111111111001010	2			1	0.00	0.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	3		000000000000001100000000000000000000000000000000	1	30	30	2			2	
H7917	004	0	1	04	01	H7917_004_0	4	4		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	5		000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	6		000000000000000000000000000000000000000000100000	1	10	30	2			2	
H7917	004	0	1	04	01	H7917_004_0	4	7		000000000000000000000000001000000000000000000000	2			1	20.00	20.00	2	
H7917	004	0	1	04	01	H7917_004_0	4	8		000000000000000000000001100000000000000000000000	1	30	30	2			2	
H7917	004	0	1	04	01	H7917_004_0	4	9		001001011101000000010000000000000000000000000000	2			1	45.00	45.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	8		000000000000000000000001100000000000000000000000	1	30	30	2			2	
H7917	005	0	1	04	01	H7917_005_0	4	9		001001011101000000010000000000000000000000000000	2			1	45.00	45.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	7		000000000000000000000000001000000000000000000000	2			1	20.00	20.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	6		000000000000000000000000000000000000000000100000	1	10	30	2			2	
H7917	005	0	1	04	01	H7917_005_0	4	5		000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	4		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	3		000000000000001100000000000000000000000000000000	1	30	30	2			2	
H7917	005	0	1	04	01	H7917_005_0	4	2		000100000000000000000000010100001111111111001010	2			1	0.00	0.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	10		000000000000010010000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	005	0	1	04	01	H7917_005_0	4	1		010010100010100000001000000000000000000000000101	2			1	35.00	35.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	1		010010100010100000001000000000000000000000000101	2			1	35.00	35.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	8		000000000000000000000001100000000000000000000000	1	30	30	2			2	
H7917	006	0	1	04	01	H7917_006_0	4	7		000000000000000000000000001000000000000000000000	2			1	20.00	20.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	6		000000000000000000000000000000000000000000100000	1	10	30	2			2	
H7917	006	0	1	04	01	H7917_006_0	4	9		001001011101000000010000000000000000000000000000	2			1	45.00	45.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	4		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	3		000000000000001100000000000000000000000000000000	1	30	30	2			2	
H7917	006	0	1	04	01	H7917_006_0	4	2		000100000000000000000000010100001111111111001010	2			1	0.00	0.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	10		000000000000010010000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	006	0	1	04	01	H7917_006_0	4	5		000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	6		000000000000000000000000000000000000000000100000	1	10	30	2			2	
H7917	007	0	1	04	01	H7917_007_0	4	7		000000000000000000000000001000000000000000000000	2			1	20.00	20.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	8		000000000000000000000001100000000000000000000000	1	30	30	2			2	
H7917	007	0	1	04	01	H7917_007_0	4	9		001001011101000000010000000000000000000000000000	2			1	45.00	45.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	1		010010100010100000001000000000000000000000000101	2			1	35.00	35.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	10		000000000000010010000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	2		000100000000000000000000010100001111111111001010	2			1	0.00	0.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	3		000000000000001100000000000000000000000000000000	1	30	30	2			2	
H7917	007	0	1	04	01	H7917_007_0	4	4		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	007	0	1	04	01	H7917_007_0	4	5		000000000000000000000100000000000000000000000000	2			1	200.00	200.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	1		011010101011100000011000000000000000000000000000	2			1	25.00	25.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	2		000100000000000000000000011100001111111111011010	2			1	0.00	0.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	9		000001010100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	8		000000000000000000000001100000000000000000000000	1	20	20	2			2	
H7917	008	0	1	04	01	H7917_008_0	3	7		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	6		000000000000000000000000000000000000000000100000	1	10	20	2			2	
H7917	008	0	1	04	01	H7917_008_0	3	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	4		000000000000010010000000000000000000000000000101	2			1	10.00	10.00	2	
H7917	008	0	1	04	01	H7917_008_0	3	3		000000000000001100000000000000000000000000000000	1	20	20	2			2	
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H7917	009	0	1	04	01	H7917_009_0	3	7		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	009	0	1	04	01	H7917_009_0	3	6		000000000000000000000000000000000000000000100000	1	10	20	2			2	
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H7917	009	0	1	04	01	H7917_009_0	3	4		000000000000010010000000000000000000000000000101	2			1	10.00	10.00	2	
H7917	009	0	1	04	01	H7917_009_0	3	3		000000000000001100000000000000000000000000000000	1	20	20	2			2	
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H7917	009	0	1	04	01	H7917_009_0	3	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7917	010	0	1	04	01	H7917_010_0	3	9		000001010100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H7917	010	0	1	04	01	H7917_010_0	3	8		000000000000000000000001100000000000000000000000	1	20	20	2			2	
H7917	010	0	1	04	01	H7917_010_0	3	7		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	010	0	1	04	01	H7917_010_0	3	6		000000000000000000000000000000000000000000100000	1	10	20	2			2	
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H7917	010	0	1	04	01	H7917_010_0	3	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7917	011	0	1	04	01	H7917_011_0	3	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
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H7917	011	0	1	04	01	H7917_011_0	3	7		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	011	0	1	04	01	H7917_011_0	3	6		000000000000000000000000000000000000000000100000	1	10	20	2			2	
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H7917	015	0	1	04	01	H7917_015_0	3	2		000100000000000000000000010100001111111111011010	2			1	0.00	0.00	2	
H7917	015	0	1	04	01	H7917_015_0	3	3		000000000000001100000000000000000000000000000000	1	25	25	2			2	
H7917	015	0	1	04	01	H7917_015_0	3	9		000001010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H7917	015	0	1	04	01	H7917_015_0	3	5		000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H7917	015	0	1	04	01	H7917_015_0	3	6		000000000000000000000000000000000000000000100000	1	10	30	2			2	
H7917	015	0	1	04	01	H7917_015_0	3	7		000000000000000000000000000000000000000000000101	2			1	20.00	20.00	2	
H7917	015	0	1	04	01	H7917_015_0	3	8		000000000000000000000001100000000000000000000000	1	30	30	2			2	
H7917	015	0	1	04	01	H7917_015_0	3	4		000000000000000001100000000000000000000000000000	2			1	400.00	400.00	2	
H7917	801	0	1	04	01	H7917_801_0	3	2	All Other	010111110110111111111101111100001111111111101111	1	0	20	2			2	
H7917	801	0	1	04	01	H7917_801_0	3	3	Part. Hosp.	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H7917	801	0	1	04	01	H7917_801_0	3	1	MH-Psych	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H7917	802	0	1	04	01	H7917_802_0	2	3	Part. Hosp.	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H7917	802	0	1	04	01	H7917_802_0	2	2	All Other	010111110110111111111101111100001111111111101111	1	0	20	2			2	
H7917	802	0	1	04	01	H7917_802_0	2	1	MH-Psych	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H7917	803	0	1	04	01	H7917_803_0	2	1	MH-Psych	000000001001000000000000000000000000000000000000	1	45	45	2			2	
H7917	803	0	1	04	01	H7917_803_0	2	3	Part. Hosp.	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H7917	803	0	1	04	01	H7917_803_0	2	2	All Other	010111110110111111111101111100001111111111101111	1	0	20	2			2	
H8105	001	0	1	04	01	H8105_001_0	5	1	Group 1	011000001001000000011001110000000000000000000000	1	30	30	2			2	
H8105	001	0	1	04	01	H8105_001_0	5	3	Group 3	100000000000000000000000000000000000000000000000	2			2			2	
H8105	001	0	1	04	01	H8105_001_0	5	2	Group 2	000111110110111111100100001100001111111111101111	1	20	20	2			2	
H8393	001	0	1	04	01	H8393_001_0	7	1	OON	011111111111111111111000011100001111111111101111	1	20	20	2			2	
H8393	001	0	1	04	01	H8393_001_0	7	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8393	001	0	1	04	01	H8393_001_0	7	3	DME/Pros	000000000000000000000001100000000000000000000000	1	20	20	2			2	
H8393	801	0	1	04	01	H8393_801_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
H8393	802	0	1	04	01	H8393_802_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
H8393	803	0	1	04	01	H8393_803_0	4	1		111111111111111111111111111111111111111111111111	2			2			2	
H8558	001	0	1	04	01	H8558_001_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8558	001	0	1	04	01	H8558_001_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H8558	001	0	1	04	01	H8558_001_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H8558	001	0	1	04	01	H8558_001_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	001	0	1	04	01	H8558_001_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H8558	001	0	1	04	01	H8558_001_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H8558	001	0	1	04	01	H8558_001_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H8558	001	0	1	04	01	H8558_001_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H8558	001	0	1	04	01	H8558_001_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H8558	001	0	1	04	01	H8558_001_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H8558	001	0	1	04	01	H8558_001_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H8558	001	0	1	04	01	H8558_001_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H8558	002	0	1	04	01	H8558_002_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8558	002	0	1	04	01	H8558_002_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H8558	002	0	1	04	01	H8558_002_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H8558	002	0	1	04	01	H8558_002_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	002	0	1	04	01	H8558_002_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H8558	002	0	1	04	01	H8558_002_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H8558	002	0	1	04	01	H8558_002_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H8558	002	0	1	04	01	H8558_002_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H8558	002	0	1	04	01	H8558_002_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H8558	002	0	1	04	01	H8558_002_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H8558	002	0	1	04	01	H8558_002_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H8558	002	0	1	04	01	H8558_002_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H8558	003	0	1	04	01	H8558_003_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H8558	003	0	1	04	01	H8558_003_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H8558	003	0	1	04	01	H8558_003_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H8558	003	0	1	04	01	H8558_003_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8558	003	0	1	04	01	H8558_003_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H8558	003	0	1	04	01	H8558_003_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H8558	003	0	1	04	01	H8558_003_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	003	0	1	04	01	H8558_003_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H8558	003	0	1	04	01	H8558_003_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H8558	003	0	1	04	01	H8558_003_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H8558	003	0	1	04	01	H8558_003_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H8558	003	0	1	04	01	H8558_003_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H8558	004	0	1	04	01	H8558_004_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H8558	004	0	1	04	01	H8558_004_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8558	004	0	1	04	01	H8558_004_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H8558	004	0	1	04	01	H8558_004_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H8558	004	0	1	04	01	H8558_004_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	004	0	1	04	01	H8558_004_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H8558	004	0	1	04	01	H8558_004_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H8558	004	0	1	04	01	H8558_004_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H8558	004	0	1	04	01	H8558_004_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H8558	004	0	1	04	01	H8558_004_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H8558	004	0	1	04	01	H8558_004_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H8558	004	0	1	04	01	H8558_004_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H8558	005	0	1	04	01	H8558_005_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8558	005	0	1	04	01	H8558_005_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H8558	005	0	1	04	01	H8558_005_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H8558	005	0	1	04	01	H8558_005_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H8558	005	0	1	04	01	H8558_005_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H8558	005	0	1	04	01	H8558_005_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H8558	006	0	1	04	01	H8558_006_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H8558	006	0	1	04	01	H8558_006_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H8558	006	0	1	04	01	H8558_006_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H8558	006	0	1	04	01	H8558_006_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H8558	006	0	1	04	01	H8558_006_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H8558	006	0	1	04	01	H8558_006_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H8558	006	0	1	04	01	H8558_006_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H8558	006	0	1	04	01	H8558_006_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	006	0	1	04	01	H8558_006_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H8558	006	0	1	04	01	H8558_006_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H8558	006	0	1	04	01	H8558_006_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8558	006	0	1	04	01	H8558_006_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H8604	001	0	1	04	01	H8604_001_0	5	5	$25 PCP/Routine Physical	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H8604	001	0	1	04	01	H8604_001_0	5	6	$40 SCP	000001111111100000010000000000000000000000001101	2			1	40.00	40.00	2	
H8604	001	0	1	04	01	H8604_001_0	5	2	DME	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H8604	001	0	1	04	01	H8604_001_0	5	1	20% Coinsurance	011100000000011111101000010100001101111111100010	1	20	20	2			2	
H8604	001	0	1	04	01	H8604_001_0	5	7	No cost sharing	000000000000000000000000001000000000000000000000	2			2			2	
H8604	001	0	1	04	01	H8604_001_0	5	8	$125 Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H8604	002	0	1	04	01	H8604_002_0	4	2	DME	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H8604	002	0	1	04	01	H8604_002_0	4	1	20% Coinsurance	011100000000011111101000010100001101111111100010	1	20	20	2			2	
H8604	002	0	1	04	01	H8604_002_0	4	5	$25 PCP/Routine Physical	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H8604	002	0	1	04	01	H8604_002_0	4	8	$125 Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H8604	002	0	1	04	01	H8604_002_0	4	7	No cost sharing	000000000000000000000000001000000000000000000000	2			2			2	
H8604	002	0	1	04	01	H8604_002_0	4	6	$45 SCP	000001111111100000010000000000000000000000001101	2			1	45.00	45.00	2	
H8604	003	0	1	04	01	H8604_003_0	5	7	No cost sharing	000000000000000000000000001000000000000000000000	2			2			2	
H8604	003	0	1	04	01	H8604_003_0	5	6	$40 SCP	000001111111100000010000000000000000000000001101	2			1	40.00	40.00	2	
H8604	003	0	1	04	01	H8604_003_0	5	1	20% Coinsurance	011100000000011111101000010100001101111111100010	1	20	20	2			2	
H8604	003	0	1	04	01	H8604_003_0	5	2	DME	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H8604	003	0	1	04	01	H8604_003_0	5	5	$25 PCP/Routine Physical	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H8604	003	0	1	04	01	H8604_003_0	5	8	$125 Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H8604	004	0	1	04	01	H8604_004_0	4	1	20% Coinsurance	011100000000011111101000010100001101111111100010	1	20	20	2			2	
H8604	004	0	1	04	01	H8604_004_0	4	2	DME	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H8604	004	0	1	04	01	H8604_004_0	4	5	$25 PCP/Routine Physical	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H8604	004	0	1	04	01	H8604_004_0	4	7	No cost sharing	000000000000000000000000001000000000000000000000	2			2			2	
H8604	004	0	1	04	01	H8604_004_0	4	6	$45 SCP	000001111111100000010000000000000000000000001101	2			1	45.00	45.00	2	
H8604	004	0	1	04	01	H8604_004_0	4	8	$125 Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H8604	801	0	1	04	01	H8604_801_0	4	7	No cost sharing	000000000000000000000000001000000000000000000000	2			2			2	
H8604	801	0	1	04	01	H8604_801_0	4	6	$40 SCP	000001111111100000010000000000000000000000001101	2			1	40.00	40.00	2	
H8604	801	0	1	04	01	H8604_801_0	4	5	$25 PCP/Routine Physical	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H8604	801	0	1	04	01	H8604_801_0	4	2	DME	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H8604	801	0	1	04	01	H8604_801_0	4	1	20% Coinsurance	011100000000011111101000010100001101111111100010	1	20	20	2			2	
H8604	801	0	1	04	01	H8604_801_0	4	8	$100 Ambulance	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H8604	802	0	1	04	01	H8604_802_0	6	7	No cost sharing	000000000000000000000000001000000000000000000000	2			2			2	
H8604	802	0	1	04	01	H8604_802_0	6	6	$45 SCP	000001111111100000010000000000000000000000001101	2			1	45.00	45.00	2	
H8604	802	0	1	04	01	H8604_802_0	6	5	$25 PCP/Routine Physical	000010000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H8604	802	0	1	04	01	H8604_802_0	6	2	DME	000000000000000000000001100000000000000000000000	1	30	30	2			2	
H8604	802	0	1	04	01	H8604_802_0	6	1	20% Coinsurance	011100000000011111101000010100001101111111100010	1	20	20	2			2	
H8604	802	0	1	04	01	H8604_802_0	6	8	$125 Ambulance	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H8644	003	0	1	04	01	H8644_003_0	8	1		011111111111111111111001100000000011111111001101	1	30	30	2			2	
H8644	003	0	1	04	01	H8644_003_0	8	2		000000000000000000000000000100000100000000000010	2			1	0.00	0.00	2	
H8644	003	0	1	04	01	H8644_003_0	8	3		000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H8644	003	0	1	04	01	H8644_003_0	8	4		000000000000000000000000001000000000000000000000	1	20	20	1	0.00	0.00	2	
H8644	003	0	1	04	01	H8644_003_0	8	5		000000000000000000000000010000000000000000100000	1	20	30	2			2	
H8644	003	0	1	04	01	H8644_003_0	8	6		000000000000000000000000000000101000000000011000	1	50	50	2			2	
H8644	801	0	1	04	01	H8644_801_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H8644	801	0	1	04	01	H8644_801_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H8644	801	0	1	04	01	H8644_801_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H8644	802	0	1	04	01	H8644_802_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H8644	802	0	1	04	01	H8644_802_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H8644	802	0	1	04	01	H8644_802_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H8644	803	0	1	04	01	H8644_803_0	4	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
H8644	803	0	1	04	01	H8644_803_0	4	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
H8644	803	0	1	04	01	H8644_803_0	4	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H8684	001	0	1	04	01	H8684_001_0	5	4	Tier 4	000000000000000000000000001000000000000000000000	2			1	25.00	25.00	2	
H8684	001	0	1	04	01	H8684_001_0	5	5	Tier 5	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H8684	001	0	1	04	01	H8684_001_0	5	3	Tier 3	100000000000000000000010000011100000000000010000	2			2			2	
H8684	001	0	1	04	01	H8684_001_0	5	2	Tier 2	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H8684	001	0	1	04	01	H8684_001_0	5	1	Tier 1	011111111111111111111001110100001111111111101101	1	20	20	2			2	
H8684	801	0	1	04	01	H8684_801_0	2	2	Tier 2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
H8684	801	0	1	04	01	H8684_801_0	2	3	Tier 3	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H8684	801	0	1	04	01	H8684_801_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
H8684	802	0	1	04	01	H8684_802_0	2	1	Tier 1	011011110110111111101101111100001111111111101111	1	20	20	2			2	
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H8707	801	0	1	04	01	H8707_801_0	3	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
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H8980	003	0	1	04	01	H8980_003_0	8	1	30%	010011110110111111101001111100000011111111101111	1	30	30	2			2	
H8980	003	0	1	04	01	H8980_003_0	8	2	45%	001000001001000000010000000000001000000000000000	1	45	45	2			2	
H8980	801	0	1	04	01	H8980_801_0	5	2	23 %	011011111111111111111101111100001111111111101111	1	23	23	2			2	
H8980	801	0	1	04	01	H8980_801_0	5	1	0 %	000100000000000000000000000000000000000000000000	2			2			2	
H8980	802	0	1	04	01	H8980_802_0	5	1	0 %	000100000000000000000000000000000000000000000000	2			2			2	
H8980	802	0	1	04	01	H8980_802_0	5	2	23 %	011011111111111111111101111100001111111111101111	1	23	23	2			2	
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H9615	802	0	1	04	01	H9615_802_0	4	2	50% Coinsurance	001000001000000000000000000010000000000000000000	1	50	50	2			2	
H9615	802	0	1	04	01	H9615_802_0	4	1	20% Coinsurance	010100100000011101100001110000000000000000100000	1	20	20	2			2	
H9615	804	0	1	04	01	H9615_804_0	4	2	50% Coinsurance	001000001000000000000000000010000000000000000000	1	50	50	2			2	
H9615	804	0	1	04	01	H9615_804_0	4	1	20% Coinsurance	010100100000011101100001110000000000000000100000	1	20	20	2			2	
H9615	804	0	1	04	01	H9615_804_0	4	3	$25 Copayment	000011010111100010011000000000000010000000001101	2			1	25.00	25.00	2	
H9615	804	0	1	04	01	H9615_804_0	4	7	$600 Allowance	100000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H9615	804	0	1	04	01	H9615_804_0	4	6	$100 Limit	000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H9615	804	0	1	04	01	H9615_804_0	4	5	$0 Copayment	000000000000000000000000001100001101111111000000	2			1	0.00	0.00	2	
H9615	804	0	1	04	01	H9615_804_0	4	4	$35 Copayment	000000000000000000000100000000000000000000000000	2			1	35.00	35.00	2	
H9670	001	0	1	04	01	H9670_001_0	6	5	Non-covered grouping	000000000000000000000010000011110000000000010000	1	100	100	2			2	
H9670	001	0	1	04	01	H9670_001_0	6	4	OON - 50% coinsurance group	100000000000000000000001110000001000000011000000	1	50	50	2			2	
H9670	001	0	1	04	01	H9670_001_0	6	3	OON - 20% coinsurance group	011100100000111111101100001100000001111100100010	1	20	20	2			2	
H9670	001	0	1	04	01	H9670_001_0	6	2	OON - $0 copay grouping	000000000000000000000000000000000100000000000000	2			2			2	
H9670	001	0	1	04	01	H9670_001_0	6	1	OON - $45 copay grouping	000011011111000000010000000000000010000000001101	2			1	45.00	45.00	2	
H9670	002	0	1	04	01	H9670_002_0	6	5	Non-covered grouping	000000000000000000000010000011110000000000010000	1	100	100	2			2	
H9670	002	0	1	04	01	H9670_002_0	6	4	OON - 50% coinsurance group	100000000000000000000001110000001000000011000000	1	50	50	2			2	
H9670	002	0	1	04	01	H9670_002_0	6	3	OON - 20% coinsurance group	011100100000111111101100001100000001111100100010	1	20	20	2			2	
H9670	002	0	1	04	01	H9670_002_0	6	2	OON - $0 copay grouping	000000000000000000000000000000000100000000000000	2			2			2	
H9670	002	0	1	04	01	H9670_002_0	6	1	OON - $45 copay grouping	000011011111000000010000000000000010000000001101	2			1	45.00	45.00	2	
H9670	003	0	1	04	01	H9670_003_0	3	3	OON - $0 copay grouping	000000000000000000000000000000000100000000000000	2			2			2	
H9670	003	0	1	04	01	H9670_003_0	3	2	OON 50 % grouping	100000000000000000000001110000001000000011000000	1	50	50	2			2	
H9670	003	0	1	04	01	H9670_003_0	3	1	OON 20 % grouping	011111111111111111111100001100000011111100101111	1	20	20	2			2	
H9670	003	0	1	04	01	H9670_003_0	3	4	OON - Non covered grouping	000000000000000000000010000011110000000000010000	1	100	100	2			2	
H9670	004	0	1	04	01	H9670_004_0	4	3	OON - $0 copay grouping	000000000000000000000000000000000100000000000000	2			2			2	
H9670	004	0	1	04	01	H9670_004_0	4	4	OON - Non covered grouping	000000000000000000000010000011110000000000010000	1	100	100	2			2	
H9670	004	0	1	04	01	H9670_004_0	4	1	OON 20 % grouping	011111111111111111111100001100000011111100101111	1	20	20	2			2	
H9670	004	0	1	04	01	H9670_004_0	4	2	OON 50 % grouping	100000000000000000000001110000001000000011000000	1	50	50	2			2	
H9670	801	0	1	04	01	H9670_801_0	3	4	100% member paid (non-covered)	000000000000000000000010000011110000000000000000	1	100	100	2			2	
H9670	801	0	1	04	01	H9670_801_0	3	2	20% coinsurance group	011111111111111111111100011100000011111111101101	1	20	20	2			2	
H9670	801	0	1	04	01	H9670_801_0	3	3	50% coinsurance group	100000000000000000000001100000001000000000010010	1	50	50	2			2	
H9670	801	0	1	04	01	H9670_801_0	3	1	100% Covered Group	000000000000000000000000000000000100000000000000	2			2			2	
H9670	802	0	1	04	01	H9670_802_0	3	1	100% Covered Group	000000000000000000000000000000000100000000000000	2			2			2	
H9670	802	0	1	04	01	H9670_802_0	3	2	20% coinsurance group	011111111111111111111100011100000011111111101101	1	20	20	2			2	
H9670	802	0	1	04	01	H9670_802_0	3	3	50% coinsurance group	100000000000000000000001100000001000000000010010	1	50	50	2			2	
H9670	802	0	1	04	01	H9670_802_0	3	4	100% member paid (non-covered)	000000000000000000000010000011110000000000000000	1	100	100	2			2	
H9670	803	0	1	04	01	H9670_803_0	3	1	100% Covered Group	000000000000000000000000000000000100000000000000	2			2			2	
H9670	803	0	1	04	01	H9670_803_0	3	4	100% member paid (non-covered)	000000000000000000000010000011110000000000000000	1	100	100	2			2	
H9670	803	0	1	04	01	H9670_803_0	3	3	50% coinsurance group	100000000000000000000001100000001000000000010010	1	50	50	2			2	
H9670	803	0	1	04	01	H9670_803_0	3	2	20% coinsurance group	011111111111111111111100011100000011111111101101	1	20	20	2			2	
H9779	001	0	1	04	01	H9779_001_0	11	1	20% coinsurance	011111111111111111111101111100001111111111101111	1	20	20	2			2	
H9847	001	0	1	04	01	H9847_001_0	14	1	Group 1	001111111111111111111000011100001111111111101101	1	20	20	2			2	
H9847	001	0	1	04	01	H9847_001_0	14	2	Group 2	010000000000000000000001100000000000000000000000	1	40	40	2			2	
H9847	001	0	1	04	01	H9847_001_0	14	3	Group 3	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
H9847	001	0	1	04	01	H9847_001_0	14	4	Group 4	000000000000000000000000000000000000000000000010	1	20	20	2			2	
H9847	003	0	1	04	01	H9847_003_0	11	3	Group 3	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
H9847	003	0	1	04	01	H9847_003_0	11	2	Group 2	010000000000000000000001100000000000000000000000	1	40	40	2			2	
H9847	003	0	1	04	01	H9847_003_0	11	4	Group 4	000000000000000000000000000000010000000000010010	2			2			2	
H9847	003	0	1	04	01	H9847_003_0	11	1	Group 1	001111111111111111111000011101001111111111101101	1	20	20	2			2	
H9847	801	0	1	04	01	H9847_801_0	2	3	Group 3	000100000000000000000000000000000000000000000000	2			2			2	
H9847	801	0	1	04	01	H9847_801_0	2	1	Group 1	010011110110111111111101111100001111111111101111	1	20	20	2			2	
H9847	801	0	1	04	01	H9847_801_0	2	2	Group 2	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H9847	802	0	1	04	01	H9847_802_0	2	1	Group 1	010011110110111111111101111100001111111111101111	1	20	20	2			2	
H9847	802	0	1	04	01	H9847_802_0	2	2	Group 2	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H9847	802	0	1	04	01	H9847_802_0	2	3	Group 3	000100000000000000000000000000000000000000000000	2			2			2	
H9847	803	0	1	04	01	H9847_803_0	2	1	Group 1	010011110110111111111101111100001111111111101111	1	20	20	2			2	
H9847	803	0	1	04	01	H9847_803_0	2	2	Group 2	001000001001000000000000000000000000000000000000	1	45	45	2			2	
H9847	803	0	1	04	01	H9847_803_0	2	3	Group 3	000100000000000000000000000000000000000000000000	2			2			2	
H9988	001	0	1	04	01	H9988_001_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H9988	001	0	1	04	01	H9988_001_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H9988	001	0	1	04	01	H9988_001_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H9988	001	0	1	04	01	H9988_001_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H9988	001	0	1	04	01	H9988_001_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H9988	001	0	1	04	01	H9988_001_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	001	0	1	04	01	H9988_001_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H9988	001	0	1	04	01	H9988_001_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H9988	001	0	1	04	01	H9988_001_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H9988	001	0	1	04	01	H9988_001_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H9988	001	0	1	04	01	H9988_001_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H9988	001	0	1	04	01	H9988_001_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H9988	002	0	1	04	01	H9988_002_0	6	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H9988	002	0	1	04	01	H9988_002_0	6	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H9988	002	0	1	04	01	H9988_002_0	6	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H9988	002	0	1	04	01	H9988_002_0	6	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H9988	002	0	1	04	01	H9988_002_0	6	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H9988	002	0	1	04	01	H9988_002_0	6	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H9988	003	0	1	04	01	H9988_003_0	4	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H9988	003	0	1	04	01	H9988_003_0	4	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H9988	003	0	1	04	01	H9988_003_0	4	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H9988	003	0	1	04	01	H9988_003_0	4	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H9988	003	0	1	04	01	H9988_003_0	4	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H9988	003	0	1	04	01	H9988_003_0	4	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	003	0	1	04	01	H9988_003_0	4	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H9988	003	0	1	04	01	H9988_003_0	4	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H9988	003	0	1	04	01	H9988_003_0	4	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H9988	003	0	1	04	01	H9988_003_0	4	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H9988	003	0	1	04	01	H9988_003_0	4	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H9988	003	0	1	04	01	H9988_003_0	4	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H9988	004	0	1	04	01	H9988_004_0	7	11	Preventive Services	000000000000000000000000000000000101111111000000	2			1	25.00	45.00	2	
H9988	004	0	1	04	01	H9988_004_0	7	12	Blood	000000000000000000000000000100000000000000000000	1	15	15	2			2	
H9988	004	0	1	04	01	H9988_004_0	7	2	Primary Care Physician	000011000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H9988	004	0	1	04	01	H9988_004_0	7	3	Physician Specialist	000000010110000000000000000000000000000000000000	2			1	45.00	45.00	2	
H9988	004	0	1	04	01	H9988_004_0	7	4	DME	000000000000000000000001110000000000000000000000	1	25	25	2			2	
H9988	004	0	1	04	01	H9988_004_0	7	1	Outpatient Services	010000100000101111101000001000000000000000100000	1	20	20	2			2	
H9988	004	0	1	04	01	H9988_004_0	7	6	Mental Health/Psychiatric Services	000000001001000000000000000000000000000000000000	1	50	50	2			2	
H9988	004	0	1	04	01	H9988_004_0	7	7	Outpatient Substance Abuse	000000000000000000010000000000000000000000000000	1	50	50	2			2	
H9988	004	0	1	04	01	H9988_004_0	7	8	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
H9988	004	0	1	04	01	H9988_004_0	7	9	Non-Covered	100000000000000000000010000011110000000000000000	2			2			2	
H9988	004	0	1	04	01	H9988_004_0	7	10	No Cost Sharing	000100000000010000000000000000001010000000011111	2			2			2	
H9988	004	0	1	04	01	H9988_004_0	7	5	Partial Hospitalization	001000000000000000000000000000000000000000000000	1	50	50	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	1	Group 1	000010000010000000000000000000000010000000000000	2			1	30.00	30.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	11	Group 11	100000000000000000000000000000000000000000010000	1	50	50	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	12	Group 12	000000000000000000000000000000000000000000000010	1	0	30	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	2	Group 2	010001110100100000001000000000000000000000001101	2			1	45.00	45.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	3	Group 3	000100000000001101100001110000000001111111100000	1	30	30	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	11	Group 11	100000000000000000000000000010000000000000010000	1	50	50	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	12	Group 12	000001000000000000000000000000000000000000000000	1	50	50	1	45.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	13	Group 13	000000000000000000000000000000000000000000000010	1	0	30	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	2	Group 2	010000110100100000001000000000000000000000001101	2			1	45.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	3	Group 3	000100000000001101100001110000000001111111100000	1	30	30	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R3175	002	0	1	31	11	R3175_002_0	4	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R3175	002	0	1	31	11	R3175_002_0	4	1	Group 1	000010000010000000000000000000000010000000000000	2			1	30.00	30.00	2	
R3175	003	0	1	31	11	R3175_003_0	4	5	Group 5	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	4	Group 4	000000000000000000000000000000000000000000000010	1	0	50	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	3	Group 3	000000000000000000000000000000001000000000000000	1	0	30	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	6	Group 6	000000000000000000000010000000000000000000010000	1	50	50	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	9	Group 9	100000000000000000000010000000000000000000000000	1	50	50	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	8	Group 8	000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R3175	004	0	1	31	11	R3175_004_0	4	1	Group 1	010111110110101101101001110100001011111111101101	1	30	30	2			2	
R3175	004	0	1	31	11	R3175_004_0	4	10	Group 10	000000000000000000000000000000000000000000000010	1	0	30	2			2	
R3175	801	0	1	31	11	R3175_801_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R3175	801	0	1	31	11	R3175_801_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R3175	801	0	1	31	11	R3175_801_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R3175	801	0	1	31	11	R3175_801_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R3175	802	0	1	31	11	R3175_802_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R3175	802	0	1	31	11	R3175_802_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R3175	802	0	1	31	11	R3175_802_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R3175	802	0	1	31	11	R3175_802_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R3175	803	0	1	31	11	R3175_803_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R3175	803	0	1	31	11	R3175_803_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R3175	803	0	1	31	11	R3175_803_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R3175	803	0	1	31	11	R3175_803_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R3332	001	0	1	31	11	R3332_001_0	6	2	Ambulance	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3332	001	0	1	31	11	R3332_001_0	6	3	Renal Dialysis	000000000000000000000000001000000000000000000000	2			1	45.00	45.00	2	
R3332	001	0	1	31	11	R3332_001_0	6	4	No Copayment	000000000000000000000000000000001000000000000000	2			2			2	
R3332	001	0	1	31	11	R3332_001_0	6	1	30% Coinsurance	011111111111111111111001110100000111111111101111	1	30	30	2			2	
R3444	008	0	1	31	11	R3444_008_0	8	1	$0 Copay	000100000100000000000010000001001111000000001010	2			1	0.00	0.00	2	
R3444	008	0	1	31	11	R3444_008_0	8	2	$10 Copay	000000000000000000000000000000000000000000000100	2			1	10.00	10.00	2	
R3444	008	0	1	31	11	R3444_008_0	8	3	$15 Copay	000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R3444	008	0	1	31	11	R3444_008_0	8	4	20% Coinsurance	010011110110111111101101111100000101111111101111	1	20	20	2			2	
R3444	008	0	1	31	11	R3444_008_0	8	5	45% Coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
R3444	009	0	1	31	11	R3444_009_0	10	13	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R3444	009	0	1	31	11	R3444_009_0	10	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	3	$25 Copay	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	4	$30 Copay	000000000000000000000000000000000000000000000100	2			1	30.00	30.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	5	$0 - $40 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	40.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	6	$25-$40 Copay	000000001001000000010000000000000000000000000000	2			1	25.00	40.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	7	$40 Copay	011001110010100000001000000000000000000000000111	2			1	40.00	40.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	8	$100 Copay	000000000000000001100000000000000000000000000000	2			1	100.00	100.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	9	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R3444	009	0	1	31	11	R3444_009_0	10	10	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R3444	009	0	1	31	11	R3444_009_0	10	11	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R3444	009	0	1	31	11	R3444_009_0	10	12	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R3444	010	0	1	31	11	R3444_010_0	8	10	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R3444	010	0	1	31	11	R3444_010_0	8	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	11	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R3444	010	0	1	31	11	R3444_010_0	8	12	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R3444	010	0	1	31	11	R3444_010_0	8	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	9	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R3444	010	0	1	31	11	R3444_010_0	8	4	$0 - $30 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	30.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	5	$15 - $30 Copay	000000001001000000010000000000000000000000000000	2			1	15.00	30.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	6	$30 Copay	011001110010100000001000000000000000000000000111	2			1	30.00	30.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	7	$100 Copay	000000000000000001100000000000000000000000000000	2			1	100.00	100.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	8	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3444	010	0	1	31	11	R3444_010_0	8	3	$15 Copay	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R3444	011	0	1	31	11	R3444_011_0	9	2	$10 Copay	000000000000000000000000000000000000000000000100	2			1	10.00	10.00	2	
R3444	011	0	1	31	11	R3444_011_0	9	1	$0 Copay	000100000000000000000010000001001111000000001010	2			1	0.00	0.00	2	
R3444	011	0	1	31	11	R3444_011_0	9	3	$15 Copay	000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R3444	011	0	1	31	11	R3444_011_0	9	5	45% Coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
R3444	011	0	1	31	11	R3444_011_0	9	4	20% Coinsurance	010011110110111111101101111100000101111111101111	1	20	20	2			2	
R3444	012	0	1	31	11	R3444_012_0	6	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	10	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R3444	012	0	1	31	11	R3444_012_0	6	11	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R3444	012	0	1	31	11	R3444_012_0	6	12	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R3444	012	0	1	31	11	R3444_012_0	6	13	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R3444	012	0	1	31	11	R3444_012_0	6	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	9	$175 Copayment	000000000000000001100000000000000000000000000000	2			1	175.00	175.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	4	$30 Copay	000000000000000000000000000000000000000000000100	2			1	30.00	30.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	5	$0 - $40 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	40.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	6	$25 - $40 Copay	000000001001000000010000000000000000000000000000	2			1	25.00	40.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	8	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	7	$40 Copay	011001110010100000001000000000000000000000000111	2			1	40.00	40.00	2	
R3444	012	0	1	31	11	R3444_012_0	6	3	$25 Copay	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	9	Group 9	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	7	Group 7	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	8	Group 8	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	5	Group 5	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	4	Group 4	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	3	Group 3	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	2	Group 2	000100000000001101100001110000000001111111100010	1	30	30	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	10	Group 10	100000000000000000000000000000000000000000000000	1	50	50	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	1	Group 1	010011110110100000001000000000000010000000011101	2			1	40.00	40.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	3	Group 3	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	5	Group 5	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	7	Group 7	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	8	Group 8	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5287	002	0	1	31	11	R5287_002_0	5	9	Group 9	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	1	Group 1	010011110110100000001000000000000010000000011101	2			1	40.00	40.00	2	
R5287	002	0	1	31	11	R5287_002_0	5	10	Group 10	100000000000000000000000000000000000000000000000	1	50	50	2			2	
R5287	002	0	1	31	11	R5287_002_0	5	2	Group 2	000100000000001101100001110000000001111111100010	1	30	30	2			2	
R5287	002	0	1	31	11	R5287_002_0	5	4	Group 4	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R5287	003	0	1	31	11	R5287_003_0	5	1	Group 1	011111111111111111111101110100000010000000101001	1	22	22	2			2	
R5287	003	0	1	31	11	R5287_003_0	5	7	Group 7	000000000000000000000000000000000000000000000100	1	22	30	2			2	
R5287	003	0	1	31	11	R5287_003_0	5	6	Group 6	000000000000000000000000000000000000000000010000	2			1	40.00	40.00	2	
R5287	003	0	1	31	11	R5287_003_0	5	5	Group 5	000000000000000000000010000000000000000000000000	1	50	50	2			2	
R5287	003	0	1	31	11	R5287_003_0	5	4	Group 4	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5287	003	0	1	31	11	R5287_003_0	5	3	Group 3	000000000000000000000000000000000000000000000010	1	0	50	2			2	
R5287	003	0	1	31	11	R5287_003_0	5	2	Group 2	000000000000000000000000000000001101111111000000	1	0	0	1	0.00	0.00	2	
R5287	801	0	1	31	11	R5287_801_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R5287	801	0	1	31	11	R5287_801_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R5287	801	0	1	31	11	R5287_801_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R5287	801	0	1	31	11	R5287_801_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R5287	802	0	1	31	11	R5287_802_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R5287	802	0	1	31	11	R5287_802_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R5287	802	0	1	31	11	R5287_802_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R5287	802	0	1	31	11	R5287_802_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R5287	805	0	1	31	11	R5287_805_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R5287	805	0	1	31	11	R5287_805_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R5287	805	0	1	31	11	R5287_805_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R5287	805	0	1	31	11	R5287_805_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R5342	001	0	1	31	11	R5342_001_0	5	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5342	001	0	1	31	11	R5342_001_0	5	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
R5342	001	0	1	31	11	R5342_001_0	5	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	1	Group 1	000010000010000000000000000000000010000000000000	2			1	25.00	25.00	2	
R5342	001	0	1	31	11	R5342_001_0	5	3	Group 3	000100000000001101100001110000000001111111100010	1	30	30	2			2	
R5342	002	0	1	31	11	R5342_002_0	5	9	Group 9	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5342	002	0	1	31	11	R5342_002_0	5	8	Group 8	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	7	Group 7	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	5	Group 5	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	4	Group 4	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	3	Group 3	000100000000001101100001110000000001111111100010	1	30	30	2			2	
R5342	002	0	1	31	11	R5342_002_0	5	2	Group 2	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
R5342	002	0	1	31	11	R5342_002_0	5	10	Group 10	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R5342	002	0	1	31	11	R5342_002_0	5	1	Group 1	000010000010000000000000000000000010000000000000	2			1	25.00	25.00	2	
R5342	003	0	1	31	11	R5342_003_0	4	2	Group 2	000010000000000000000000000000000000000000000000	1	20	30	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	1	Group 1	011101111111111111111101110100000111111111101101	1	30	30	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	3	Group 3	000000000000000000000000000000001000000000000000	1	0	30	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	6	Group 6	000000000000000000000010000000000000000000010000	1	50	50	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	5	Group 5	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	4	Group 4	000000000000000000000000000000000000000000000010	1	0	50	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	1	Group 1	010111110110101101101001110100000011111111101111	1	30	30	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	2	Group 2	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	3	Group 3	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	9	Group 9	100000000000000000000000000000000000000000000000	1	50	50	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	4	Group 4	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	7	Group 7	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R5342	004	0	1	31	11	R5342_004_0	5	8	Group 8	000000000000000000000000000000001100000000000000	2			1	0.00	0.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	5	Group 5	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R5342	004	0	1	31	11	R5342_004_0	5	6	Group 6	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R5342	801	0	1	31	11	R5342_801_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R5342	801	0	1	31	11	R5342_801_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R5342	801	0	1	31	11	R5342_801_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R5342	801	0	1	31	11	R5342_801_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R5342	802	0	1	31	11	R5342_802_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R5342	802	0	1	31	11	R5342_802_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R5342	802	0	1	31	11	R5342_802_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R5342	803	0	1	31	11	R5342_803_0	5	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R5342	803	0	1	31	11	R5342_803_0	5	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R5342	803	0	1	31	11	R5342_803_0	5	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R5342	803	0	1	31	11	R5342_803_0	5	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R5566	005	0	1	31	11	R5566_005_0	4	1	Group 1	011111111111111111111111110100001011111111101111	1	40	40	2			2	
R5566	005	0	1	31	11	R5566_005_0	4	2	Group 2	000000000000000000000000000000000100000000000000	1	0	0	2			2	
R5566	005	0	1	31	11	R5566_005_0	4	3	Group 3	000000000000000000000000001000000000000000000000	1	0	40	2			2	
R5566	804	0	1	31	11	R5566_804_0	3	1	Group 1	000000000000000000000000001000000100000000000000	1	20	50	2			2	
R5566	804	0	1	31	11	R5566_804_0	3	2	Group 2	011111111111111111111111110100001011111111101111	1	50	50	2			2	
R5566	805	0	1	31	11	R5566_805_0	3	1	Group 1	000000000000000000000000001000000100000000000000	1	20	50	2			2	
R5566	805	0	1	31	11	R5566_805_0	3	2	Group 2	011111111111111111111111110100001011111111101111	1	50	50	2			2	
R5674	001	0	1	31	11	R5674_001_0	13	9	20%-30% Group	000000000000000000000000000000000000010000000000	1	20	30	2			2	
R5674	001	0	1	31	11	R5674_001_0	13	8	$0 Group	011000000000000000000000000100000000000000000000	2			2			2	
R5674	001	0	1	31	11	R5674_001_0	13	7	Ambulance Group	000000000000000000000100000000000000000000000000	1	40	40	1	100.00	100.00	2	
R5674	001	0	1	31	11	R5674_001_0	13	6	$0-$40 (HEW)  Group	000000000000000000000000000000001000000000000000	2			1	0.00	40.00	2	
R5674	001	0	1	31	11	R5674_001_0	13	1	30% Group	000000000000011110000001110000000000001101000000	1	30	30	2			2	
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R5826	843	0	1	31	11	R5826_843_0	5	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
R5826	844	0	1	31	11	R5826_844_0	6	2	#2	000000001001000000010000000000000000000000000000	1	45	45	2			2	
R5826	844	0	1	31	11	R5826_844_0	6	1	#1	011011110110101111101101111100001010111111101111	1	20	20	2			2	
R5826	844	0	1	31	11	R5826_844_0	6	3	#3	000100000000010000000000000000000101000000000000	1	0	20	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	8	OON Ambulance Services	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	7	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	45.00	45.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	45.00	275.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	1	20% Coinsurance OON	000000000000000100000000001000000000000011110000	1	20	20	2			2	
R5941	001	0	1	31	11	R5941_001_0	10	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	30.00	45.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	12	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	11	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	45.00	90.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	10	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	9	OON No Copayment	000100000000000000001000000100001111111100000000	2			1	0.00	0.00	2	
R5941	001	0	1	31	11	R5941_001_0	10	2	30% OON Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
R5941	003	0	1	31	11	R5941_003_0	11	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	6	Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	5	PCP	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	275.00	275.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	3	Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
R5941	003	0	1	31	11	R5941_003_0	11	2	30% Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
R5941	003	0	1	31	11	R5941_003_0	11	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	40.00	275.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	30.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	11	1	20% Coinsurance	000000000000000100000000001000000000000011110000	1	20	20	2			2	
R5941	003	0	1	31	11	R5941_003_0	11	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	1	20% Coinsurance OON	000000000000000100000000001000000000000011110000	1	20	20	2			2	
R5941	007	0	1	31	11	R5941_007_0	10	10	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	11	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	45.00	90.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	12	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	30.00	45.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	14	OON Ambulatory Surgical Center Services	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	9	OON No Copayment	000100000000000000001000000100001111111100000000	2			1	0.00	0.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
R5941	007	0	1	31	11	R5941_007_0	10	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	45.00	300.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	45.00	45.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	7	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	8	OON Ambulance Services	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
R5941	007	0	1	31	11	R5941_007_0	10	2	30% OON Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
R5941	008	0	1	31	11	R5941_008_0	9	13	OON Other Health Care Professional	000000000010000000000000000000000000000000000000	2			1	30.00	45.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	14	OON Ambulatory Surgical Services	000000000000000000100000000000000000000000000000	2			1	300.00	300.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	2	30% OON Coinsurance	000000000000001010000001110000000000000000000000	1	30	30	2			2	
R5941	008	0	1	31	11	R5941_008_0	9	3	OON Labs	000000000000010000000000000000000000000000000000	1	0	30	2			2	
R5941	008	0	1	31	11	R5941_008_0	9	4	OON Outpatient Hospital Services	000000000000000001000000000000000000000000000000	2			1	45.00	300.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	5	OON PCP	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	6	OON Specialist	010001010100000000000000000000000000000000000101	2			1	45.00	45.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	7	OON Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	8	OON Ambulance Services	000000000000000000000100000000000000000000000000	2			1	125.00	125.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	9	OON No Copayment	000100000000000000001000000100001111111100000000	2			1	0.00	0.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	1	20% Coinsurance OON	000000000000000100000000001000000000000011110000	1	20	20	2			2	
R5941	008	0	1	31	11	R5941_008_0	9	10	OON Eyewear	000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	11	OON Physical Therapy	000000100000100000000000000000000000000000000000	2			1	45.00	90.00	2	
R5941	008	0	1	31	11	R5941_008_0	9	12	OON Comprehensive Dental	000000000000000000000000000000000000000000001000	2			1	0.00	0.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	1	20% Coinsurance	000000000000000100000000001000000000000011100000	1	20	20	2			2	
R5941	009	0	1	31	11	R5941_009_0	8	10	No copayment	000100000000000000001000000100001111111100001000	2			1	0.00	0.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	11	Other Healthcare	000000000010000000000000000000000000000000000000	2			1	25.00	40.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	12	Eye Wear	000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	13	Outpatient Hospital	000000000000000001000000000000000000000000000000	2			1	40.00	375.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	2	35% Coinsurance	000000000000001010000001110000000000000000000000	1	35	35	2			2	
R5941	009	0	1	31	11	R5941_009_0	8	9	Ambulance Services	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	4	Outpatient Surgery	000000000000000000100000000000000000000000000000	2			1	375.00	375.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	5	PCP	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	6	Specialist	010001010100000000000000000000000000000000000101	2			1	40.00	40.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	7	PT, OT, ST	000000100000100000000000000000000000000000000000	2			1	40.00	80.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	8	Mental Health/Substance Abuse	001000001001000000010000000000000000000000000000	2			1	50.00	50.00	2	
R5941	009	0	1	31	11	R5941_009_0	8	3	Labs	000000000000010000000000000000000000000000000000	1	0	35	2			2	
R5941	801	0	1	31	11	R5941_801_0	8	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R5941	801	0	1	31	11	R5941_801_0	8	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R5941	802	0	1	31	11	R5941_802_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R5941	802	0	1	31	11	R5941_802_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R5941	805	0	1	31	11	R5941_805_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R5941	805	0	1	31	11	R5941_805_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R5941	806	0	1	31	11	R5941_806_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R5941	806	0	1	31	11	R5941_806_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R5941	807	0	1	31	11	R5941_807_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R5941	807	0	1	31	11	R5941_807_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R5941	808	0	1	31	11	R5941_808_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R5941	808	0	1	31	11	R5941_808_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R6801	008	0	1	31	11	R6801_008_0	7	5	45% Coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
R6801	008	0	1	31	11	R6801_008_0	7	1	$0 Copay	000100000100000000000010000001001111000000001010	2			1	0.00	0.00	2	
R6801	008	0	1	31	11	R6801_008_0	7	2	$10 Copay	000000000000000000000000000000000000000000000100	2			1	10.00	10.00	2	
R6801	008	0	1	31	11	R6801_008_0	7	3	$15 Copay	000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R6801	008	0	1	31	11	R6801_008_0	7	4	20% Coinsurance	010011110110111111101101111100000101111111101111	1	20	20	2			2	
R6801	009	0	1	31	11	R6801_009_0	10	3	$15 Copay	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	4	$0-$35 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	35.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	5	$15 - $35 Copay	000000001001000000010000000000000000000000000000	2			1	15.00	35.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	6	$35 Copay	011001110010100000001000000000000000000000000111	2			1	35.00	35.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	7	$150  Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	8	$175 Copay	000000000000000001100000000000000000000000000000	2			1	175.00	175.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	2	$10 Copay	000000000000000000000000000000000000000000010100	2			1	10.00	10.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	9	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R6801	009	0	1	31	11	R6801_009_0	10	11	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R6801	009	0	1	31	11	R6801_009_0	10	10	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R6801	009	0	1	31	11	R6801_009_0	10	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R6801	009	0	1	31	11	R6801_009_0	10	12	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R6801	010	0	1	31	11	R6801_010_0	7	2	$10 Copay	000010000000000000000000000000000000000000010110	2			1	10.00	10.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	12	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R6801	010	0	1	31	11	R6801_010_0	7	11	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R6801	010	0	1	31	11	R6801_010_0	7	10	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R6801	010	0	1	31	11	R6801_010_0	7	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	3	$25 Copay	011000110010100000001000000000000000000000000001	2			1	25.00	25.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	9	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R6801	010	0	1	31	11	R6801_010_0	7	8	$175 Copay	000000000000000001100000000000000000000000000000	2			1	175.00	175.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	7	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	6	$30 Copay	000001000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	5	$10 - $30 Copay	000000001001000000010000000000000000000000000000	2			1	10.00	30.00	2	
R6801	010	0	1	31	11	R6801_010_0	7	4	$0 - $30 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	30.00	2	
R6801	011	0	1	31	11	R6801_011_0	8	5	45% Coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
R6801	011	0	1	31	11	R6801_011_0	8	4	20% Coinsurance	010011110110111111101101111100000101111111101111	1	20	20	2			2	
R6801	011	0	1	31	11	R6801_011_0	8	3	$15 Copay	000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R6801	011	0	1	31	11	R6801_011_0	8	2	$10 Copay	000000000000000000000000000000000000000000000100	2			1	10.00	10.00	2	
R6801	011	0	1	31	11	R6801_011_0	8	1	$0 Copay	000100000000000000000010000000001111000000001010	2			1	0.00	0.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	7	$150 Copay	000000000000000001100100000000000000000000000000	2			1	150.00	150.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	6	$40 Copay	011001110010100000001000000000000000000000000001	2			1	40.00	40.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	5	$25 - $40 Copay	000000001001000000010000000000000000000000000000	2			1	25.00	40.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	4	$0 - $40 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	40.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	3	$25 Copay	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	8	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R6801	012	0	1	31	11	R6801_012_0	6	2	$10 Copay	000000000000000000000000000000000000000000010110	2			1	10.00	10.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	9	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R6801	012	0	1	31	11	R6801_012_0	6	10	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R6801	012	0	1	31	11	R6801_012_0	6	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R6801	012	0	1	31	11	R6801_012_0	6	11	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	10	Group 10	000010000010000000000000000000000010000000000000	2			1	30.00	30.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	1	Group 1	010001110100100000001000000000000000000000001101	2			1	40.00	40.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	11	Group 11	100000000000000000000000000000000000000000000000	1	50	50	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	9	Group 9	000000000000000000000000000100001100000000000000	2			1	0.00	0.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	8	Group 8	000000000000000000000000001000000000000000000000	1	20	20	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	2	Group 2	000100000000001101100001110000000001111111100010	1	30	30	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	6	Group 6	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	5	Group 5	001000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	4	Group 4	000000000000000010000000000000000000000000000000	2			1	21.00	21.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	3	Group 3	000000000000010000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	7	Group 7	000000001001000000010000000000000000000000000000	2			1	35.00	45.00	2	
R7444	801	0	1	31	11	R7444_801_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R7444	801	0	1	31	11	R7444_801_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R7444	801	0	1	31	11	R7444_801_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R7444	801	0	1	31	11	R7444_801_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R7444	802	0	1	31	11	R7444_802_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R7444	802	0	1	31	11	R7444_802_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7444	802	0	1	31	11	R7444_802_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R7444	803	0	1	31	11	R7444_803_0	4	3	Group 3	000000000000010000000000000000000101000000000000	1	0	20	2			2	
R7444	803	0	1	31	11	R7444_803_0	4	2	Group 2	000100000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7444	803	0	1	31	11	R7444_803_0	4	1	Group 1	010011110110101111111101111100001010111111101111	1	20	20	2			2	
R7444	803	0	1	31	11	R7444_803_0	4	4	Group 4	001000001001000000000000000000000000000000000000	1	45	45	2			2	
R9896	008	0	1	31	11	R9896_008_0	8	5	45% Coinsurance	001000001001000000010000000000000000000000000000	1	45	45	2			2	
R9896	008	0	1	31	11	R9896_008_0	8	4	20% Coinsurance	010011110110111111101101111100000101111111101111	1	20	20	2			2	
R9896	008	0	1	31	11	R9896_008_0	8	3	$15 Copay	000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R9896	008	0	1	31	11	R9896_008_0	8	2	$10 Copay	000000000000000000000000000000000000000000000100	2			1	10.00	10.00	2	
R9896	008	0	1	31	11	R9896_008_0	8	1	$0 Copay	000100000100000000000010000001001111000000001010	2			1	0.00	0.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	3	$20 Copay	000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	4	$25 Copay	000000000000000000000000000000000000000000000100	2			1	25.00	25.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	5	$0 - $35 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	35.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	6	$20 -$35 Copay	000000001001000000010000000000000000000000000000	2			1	20.00	35.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	13	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R9896	009	0	1	31	11	R9896_009_0	7	12	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R9896	009	0	1	31	11	R9896_009_0	7	11	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R9896	009	0	1	31	11	R9896_009_0	7	10	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R9896	009	0	1	31	11	R9896_009_0	7	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	7	$35 Copay	011001110010100000001000000000000000000000000111	2			1	35.00	35.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	9	$185 Copay	000000000000000001100000000000000000000000000000	2			1	185.00	185.00	2	
R9896	009	0	1	31	11	R9896_009_0	7	8	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	10	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R9896	010	0	1	31	11	R9896_010_0	8	11	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R9896	010	0	1	31	11	R9896_010_0	8	12	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R9896	010	0	1	31	11	R9896_010_0	8	13	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R9896	010	0	1	31	11	R9896_010_0	8	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	9	$185 Copay	000000000000000001100000000000000000000000000000	2			1	185.00	185.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	4	$25 Copay	000000000000000000000000000000000000000000000100	2			1	25.00	25.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	5	$0 - $30 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	30.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	6	$15 - $30 Copay	000000001001000000010000000000000000000000000000	2			1	15.00	30.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	8	$150 Copay	000000000000000000000100000000000000000000000000	2			1	150.00	150.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	7	$30 Copay	011001110010100000001000000000000000000000000111	2			1	30.00	30.00	2	
R9896	010	0	1	31	11	R9896_010_0	8	3	$15 Copay	000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	10	30% Coinsurance	000100000000000000000000000000000000000000000000	1	30	30	2			2	
R9896	012	0	1	31	11	R9896_012_0	7	11	35% Coinsurance	000000000000000000000000100000000000000000000000	1	35	35	2			2	
R9896	012	0	1	31	11	R9896_012_0	7	12	40% Coinsurance	000000000000000000000001000000000000000000000000	1	40	40	2			2	
R9896	012	0	1	31	11	R9896_012_0	7	2	$10 Copay	000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	3	$25 Copay	000010000000000000000000000000000000000000000100	2			1	25.00	25.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	4	$0 - $40 Copay	000000000100000000000000000000000000000000000000	2			1	0.00	40.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	5	$25 - $40 Copay	000000001001000000010000000000000000000000000000	2			1	25.00	40.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	6	$40 Copay	011001110010100000001000000000000000000000000111	2			1	40.00	40.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	7	$100 Copay	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	8	$150 Copayment	000000000000000001100000000000000000000000000000	2			1	150.00	150.00	2	
R9896	012	0	1	31	11	R9896_012_0	7	9	20% Coinsurance	000000000000011110000000001000000000000000100000	1	20	20	2			2	
R9896	012	0	1	31	11	R9896_012_0	7	1	$0 Copay	000000000000000000000010010100001111111111001010	2			1	0.00	0.00	2	
R9943	001	0	1	31	11	R9943_001_0	9	5	$175 OON Copayment Group	000000000000000000000100000000000000000000000000	2			1	175.00	175.00	2	
R9943	001	0	1	31	11	R9943_001_0	9	4	$200 OON Copayment Group	000000000000001000000000000000000000000000000000	2			1	200.00	200.00	2	
R9943	001	0	1	31	11	R9943_001_0	9	3	$40 OON Copayment Group	000000010000000000000000000000000000000000000000	2			1	40.00	40.00	2	
R9943	001	0	1	31	11	R9943_001_0	9	2	$30 OON Copayment Group	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R9943	001	0	1	31	11	R9943_001_0	9	8	25% OON Coinsurance Group	000000000000000000000000000000000000000000100000	1	25	25	2			2	
R9943	001	0	1	31	11	R9943_001_0	9	7	$0 OON Copayment Group	100000000000000000000000000000001100000000001010	2			1	0.00	0.00	2	
R9943	001	0	1	31	11	R9943_001_0	9	6	10% OON Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
R9943	001	0	1	31	11	R9943_001_0	9	9	20% to 30% OON Coinsurance Group	000000000000000000000000000000000000000000000100	1	20	30	2			2	
R9943	001	0	1	31	11	R9943_001_0	9	1	30% OON Coinsurance Group	011101101111110111111001110100000011111111000001	1	30	30	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	5	$100 OON Copayment Group	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
R9943	003	0	1	31	11	R9943_003_0	11	4	$150 OON Copayment Group	000000000000001000000000000000000000000000000000	2			1	150.00	150.00	2	
R9943	003	0	1	31	11	R9943_003_0	11	6	10% OON Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	7	$0 OON Copayment Group	100000000000000000000000000000001100000000001010	2			1	0.00	0.00	2	
R9943	003	0	1	31	11	R9943_003_0	11	8	50% OON Coinsurance Group	000000000000000000000000000010000000000000000000	1	50	50	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	9	30% to 50% OON Coinsurance Group	000001000000000000000000000000000000000000000000	1	30	50	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	10	20% OON Coinsurance Group	000000000000000000000000000000000000000000010000	1	20	20	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	11	25% OON Coinsurance Group	000000000000000000000000000000000000000000100000	1	25	25	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	12	20% to 30% coinsurance OON group	000000000000000000000000000000000000000000000100	1	20	30	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	1	30% OON Coinsurance Group	011100101111110111111011110100000011111111000001	1	30	30	2			2	
R9943	003	0	1	31	11	R9943_003_0	11	3	$40 OON Copayment Group	000000010000000000000000000000000000000000000000	2			1	40.00	40.00	2	
R9943	003	0	1	31	11	R9943_003_0	11	2	$25 OON Copayment Group	000010000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
R9943	004	0	1	31	11	R9943_004_0	7	4	$150 OON Copayment Group	000000000000001000000000000000000000000000000000	2			1	150.00	150.00	2	
R9943	004	0	1	31	11	R9943_004_0	7	8	50% OON Coinsurance Group	000000000000000000000000000010000000000000000000	1	50	50	2			2	
R9943	004	0	1	31	11	R9943_004_0	7	7	$0 OON Copayment Group	100000000000000000000000000000001100000000001010	2			1	0.00	0.00	2	
R9943	004	0	1	31	11	R9943_004_0	7	6	10% OON Coinsurance Group	000000000000000000000000001000000000000000000000	1	10	10	2			2	
R9943	004	0	1	31	11	R9943_004_0	7	5	$100 OON Copayment Group	000000000000000000000100000000000000000000000000	2			1	100.00	100.00	2	
R9943	004	0	1	31	11	R9943_004_0	7	9	30% to 50% OON Coinsurance Group	000001000000000000000000000000000000000000000000	1	30	50	2			2	
R9943	004	0	1	31	11	R9943_004_0	7	3	$45 OON Copayment Group	000000010000000000000000000000000000000000000000	2			1	45.00	45.00	2	
R9943	004	0	1	31	11	R9943_004_0	7	2	$30 OON Copayment Group	000010000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R9943	004	0	1	31	11	R9943_004_0	7	12	20% to 30% coinsurance OON group	000000000000000000000000000000000000000000000100	1	20	30	2			2	
R9943	004	0	1	31	11	R9943_004_0	7	11	25% OON Coinsurance Group	000000000000000000000000000000000000000000100000	1	25	25	2			2	
R9943	004	0	1	31	11	R9943_004_0	7	10	20% OON Coinsurance Group	000000000000000000000000000000000000000000010000	1	20	20	2			2	
R9943	004	0	1	31	11	R9943_004_0	7	1	30% OON Coinsurance Group	011100101111110111111001110100000011111111000001	1	30	30	2			2	
R9943	805	0	1	31	11	R9943_805_0	7	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R9943	805	0	1	31	11	R9943_805_0	7	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R9943	806	0	1	31	11	R9943_806_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R9943	806	0	1	31	11	R9943_806_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
R9943	807	0	1	31	11	R9943_807_0	6	1	Non Mental Health Services	011111110110111111111101111100001111111111101111	1	20	20	2			2	
R9943	807	0	1	31	11	R9943_807_0	6	2	Mental Health services	000000001001000000000000000000000000000000000000	1	45	45	2			2	
