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
E5088	801	0	1	40	14	E5088_801_0	5	1	Therapy	0100011000001000000010000000000000000000000000010	2			1	25.00	25.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	10	DME/Supplies	0000000000000000000000011100000000000000000000000	1	0	15	2			2	
E5088	801	0	1	40	14	E5088_801_0	5	11	Part B Drugs	0000000000000000000000000000000000000000000100000	1	10	10	2			2	
E5088	801	0	1	40	14	E5088_801_0	5	12	Eye Exams	0000000000000000000000000000000000000000000000100	2			1	0.00	25.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	2	Outpatient Alternative Care	0010000000000000000100000000000100000000000000000	1	20	20	2			2	
E5088	801	0	1	40	14	E5088_801_0	5	9	Ambulance	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	4		0000100000100000000000000000000000000000000000000	2			1	10.00	30.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	5	Physician Specialists	0000000101000000000000000000000000000000000001000	2			1	25.00	30.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	6	Screenings and Mental Health	0000000010010000000000000000000000000000000000001	2			1	10.00	25.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	7	Outpatient Radiology	0000000000000011100000000000000000000000000000000	2			1	25.00	50.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	8	Outpatient Hospital	0000000000000000011000000000000000000000000000000	2			1	0.00	100.00	2	
E5088	801	0	1	40	14	E5088_801_0	5	3		0001000000000100000000100011000001111111111000000	2			2			2	
H0084	001	0	1	04	01	H0084_001_0	5	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	10	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
H0084	001	0	1	04	01	H0084_001_0	5	11	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
H0084	001	0	1	04	01	H0084_001_0	5	12	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
H0084	001	0	1	04	01	H0084_001_0	5	13	$35 - $40 Copay	0000000010010000000000000000000000000000000000000	2			1	35.00	40.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	2	$10 Copay	0000000000000000000000000000000000000000000010100	2			1	10.00	10.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	9	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
H0084	001	0	1	04	01	H0084_001_0	5	4	$35 Copay	0000100000000000000100000000000000000000000000000	2			1	35.00	35.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	5	$40 Copay	0010000000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	6	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	7	$150 Copay	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	8	$175 Copay	0000000000000000011000000000000000000000000000000	2			1	175.00	175.00	2	
H0084	001	0	1	04	01	H0084_001_0	5	3	$15 Copay	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H0104	010	1	1	04	01	H0104_010_1	4	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	010	1	1	04	01	H0104_010_1	4	1	Part B - General	0111111111111111111110011111000001111111111111111	1	30	30	2			2	
H0104	010	2	1	04	01	H0104_010_2	4	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	010	2	1	04	01	H0104_010_2	4	1	Part B - General	0111111111111111111110011111000001111111111111111	1	30	30	2			2	
H0104	010	3	1	04	01	H0104_010_3	5	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	010	3	1	04	01	H0104_010_3	5	1	Part B - General	0111111111111111111110011111000001111111111111111	1	30	30	2			2	
H0104	010	4	1	04	01	H0104_010_4	4	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	010	4	1	04	01	H0104_010_4	4	1	Part B - General	0111111111111111111110011111000001111111111111111	1	30	30	2			2	
H0104	010	5	1	04	01	H0104_010_5	4	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	010	5	1	04	01	H0104_010_5	4	1	Part B - General	0111111111111111111110011111000001111111111111111	1	30	30	2			2	
H0104	011	1	1	04	01	H0104_011_1	5	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	011	1	1	04	01	H0104_011_1	5	1	Part B - General	0111111111111111111110011111000001111111111101111	1	30	30	2			2	
H0104	011	2	1	04	01	H0104_011_2	6	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	011	2	1	04	01	H0104_011_2	6	1	Part B - General	0111111111111111111110011111000001111111111101111	1	30	30	2			2	
H0104	011	3	1	04	01	H0104_011_3	6	1	Part B - General	0111111111111111111110011111000001111111111101111	1	30	30	2			2	
H0104	011	3	1	04	01	H0104_011_3	6	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	011	4	1	04	01	H0104_011_4	6	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	011	4	1	04	01	H0104_011_4	6	1	Part B - General	0111111111111111111110011111000001111111111101111	1	30	30	2			2	
H0104	011	5	1	04	01	H0104_011_5	6	1	Part B - General	0111111111111111111110011111000001111111111101111	1	30	30	2			2	
H0104	011	5	1	04	01	H0104_011_5	6	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	011	6	1	04	01	H0104_011_6	6	1	Part B - General	0111111111111111111110011111000001111111111101111	1	30	30	2			2	
H0104	011	6	1	04	01	H0104_011_6	6	2	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0104	801	0	1	04	01	H0104_801_0	2	2	No Cost-Sharing	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H0104	801	0	1	04	01	H0104_801_0	2	1	Part B Standard	0100111101101011111111011111000001110011111101111	1	20	20	2			2	
H0104	801	0	1	04	01	H0104_801_0	2	4	Variable Cost Sharing	0000000000000100000000000000000000001100000000000	1	0	20	2			2	
H0104	801	0	1	04	01	H0104_801_0	2	3	Mental Health	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H0104	802	0	1	04	01	H0104_802_0	3	1	Part B Standard	0100111101101011111111011111000001110011111101111	1	20	20	2			2	
H0104	802	0	1	04	01	H0104_802_0	3	4	Mental Health	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H0104	802	0	1	04	01	H0104_802_0	3	3	Variable Copays	0000000000000100000000000000000000001100000000000	1	0	20	2			2	
H0104	802	0	1	04	01	H0104_802_0	3	2	No Cost-Sharing	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H0104	804	0	1	04	01	H0104_804_0	2	4	Variable Cost Sharing	0000000000000100000000000000000000001100000000000	1	0	20	2			2	
H0104	804	0	1	04	01	H0104_804_0	2	1	Part B Standard	0100111101101011111111011111000001110011111101111	1	20	20	2			2	
H0104	804	0	1	04	01	H0104_804_0	2	2	No Cost-Sharing	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H0104	804	0	1	04	01	H0104_804_0	2	3	Mental Health	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	5		0000000000000000000000000000000000000000000100000	1	0	25	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H0248	001	0	1	04	01	H0248_001_0	4	3		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	2		0000000000000001010000000000000000000000000000000	1	20	25	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	9		0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	8		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H0248	001	0	1	04	01	H0248_001_0	4	7		0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H0248	001	0	1	04	01	H0248_001_0	4	1		0111111111111110101110000000100001011111111001101	1	25	25	2			2	
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H0248	002	0	1	04	01	H0248_002_0	3	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H0248	002	0	1	04	01	H0248_002_0	3	6		0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H0248	002	0	1	04	01	H0248_002_0	3	7		0000000000000000000000000100000000000000000000000	1	20	25	2			2	
H0248	002	0	1	04	01	H0248_002_0	3	8		0000000000000100000000000000000000000000000000000	2			1	0.00	50.00	2	
H0248	002	0	1	04	01	H0248_002_0	3	3		0000000000000010100000000000000000000000010000000	2			1	5.00	50.00	2	
H0248	002	0	1	04	01	H0248_002_0	3	2		0100111111111000000010000000000001000000001001101	2			1	5.00	5.00	2	
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H0248	002	0	1	04	01	H0248_002_0	3	14		0010000000000000000000000000000000000000000000000	2			1	45.00	45.00	2	
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H0319	001	0	1	04	01	H0319_001_0	4	2	Group 2	1000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
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H0370	001	0	1	04	01	H0370_001_0	10	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H0370	001	0	1	04	01	H0370_001_0	10	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H0370	001	0	1	04	01	H0370_001_0	10	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H0370	001	0	1	04	01	H0370_001_0	10	1	OON	0111111111111111111110000111000000000000000101111	1	20	20	2			2	
H0370	801	0	1	04	01	H0370_801_0	5	1	OON	0111111101101111111110000111000000000000000101111	1	20	20	2			2	
H0370	801	0	1	04	01	H0370_801_0	5	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0370	801	0	1	04	01	H0370_801_0	5	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H0370	801	0	1	04	01	H0370_801_0	5	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H0370	801	0	1	04	01	H0370_801_0	5	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H0370	801	0	1	04	01	H0370_801_0	5	6	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H0370	802	0	1	04	01	H0370_802_0	5	6	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H0370	802	0	1	04	01	H0370_802_0	5	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H0370	802	0	1	04	01	H0370_802_0	5	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H0370	802	0	1	04	01	H0370_802_0	5	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H0370	802	0	1	04	01	H0370_802_0	5	1	OON	0111111101101111111110000111000000000000000101111	1	20	20	2			2	
H0370	802	0	1	04	01	H0370_802_0	5	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0370	803	0	1	04	01	H0370_803_0	5	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H0370	803	0	1	04	01	H0370_803_0	5	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H0370	803	0	1	04	01	H0370_803_0	5	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H0370	803	0	1	04	01	H0370_803_0	5	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H0370	803	0	1	04	01	H0370_803_0	5	1	OON	0111111101101111111110000111000000000000000101111	1	20	20	2			2	
H0370	803	0	1	04	01	H0370_803_0	5	6	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H0620	002	0	1	04	01	H0620_002_0	4	4	Group 4	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H0620	002	0	1	04	01	H0620_002_0	4	3	Group 3	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H0620	002	0	1	04	01	H0620_002_0	4	2	Group 2	1000000000000000000000000010010000100000000010010	2			1	0.00	0.00	2	
H0620	002	0	1	04	01	H0620_002_0	4	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H0623	001	0	1	04	01	H0623_001_0	5	5		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H0623	001	0	1	04	01	H0623_001_0	5	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H0623	001	0	1	04	01	H0623_001_0	5	4		0000000000000000000000000000011001000000000000000	1	50	50	2			2	
H0623	001	0	1	04	01	H0623_001_0	5	3		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H0623	001	0	1	04	01	H0623_001_0	5	2		0000000000000000000001000010000000000000000000000	1	20	20	2			2	
H0623	001	0	1	04	01	H0623_001_0	5	1		0111111111111111111110011000000000011111111001101	1	30	30	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	1		0110111111111111111110000000000000011111111001101	1	30	30	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	2		0001000000000000000001011110000000000000000000000	1	20	20	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	3		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H0623	009	0	1	04	01	H0623_009_0	4	4		0000000000000000000000000000011001000000000000000	1	50	50	2			2	
H0623	009	0	1	04	01	H0623_009_0	4	5		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H0710	001	0	1	04	01	H0710_001_0	5	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H0710	001	0	1	04	01	H0710_001_0	5	2	Group 2	0000000000000000000000000000000000100000000010010	2			1	0.00	0.00	2	
H0710	001	0	1	04	01	H0710_001_0	5	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H0710	001	0	1	04	01	H0710_001_0	5	4	Group 4	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H0710	001	0	1	04	01	H0710_001_0	5	5	Group 5	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	3	Group 3	0000000000000000000000100000000000000000000010000	1	50	50	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H0710	002	0	1	04	01	H0710_002_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
H1108	001	0	1	04	01	H1108_001_0	5	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H1108	001	0	1	04	01	H1108_001_0	5	2	Group 2	0000000000000000000000000000000000100000000010010	2			1	0.00	0.00	2	
H1108	001	0	1	04	01	H1108_001_0	5	5	Group 5	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H1108	001	0	1	04	01	H1108_001_0	5	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1108	001	0	1	04	01	H1108_001_0	5	4	Group 4	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	1	Group 1	0111111111111011111111011101000000011111111101101	1	30	30	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	2	Group 2	0000000000000100000000000000000001000000000000000	1	0	30	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1108	002	0	1	04	01	H1108_002_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
H1108	002	0	1	04	01	H1108_002_0	4	3	Group 3	0000000000000000000000100000000000000000000010000	1	50	50	2			2	
H1110	001	0	1	04	01	H1110_001_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1110	001	0	1	04	01	H1110_001_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H1110	001	0	1	04	01	H1110_001_0	4	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1110	001	0	1	04	01	H1110_001_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	35	35	2			2	
H1110	801	0	1	04	01	H1110_801_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1110	801	0	1	04	01	H1110_801_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	801	0	1	04	01	H1110_801_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H1110	802	0	1	04	01	H1110_802_0	3	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1110	802	0	1	04	01	H1110_802_0	3	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H1110	802	0	1	04	01	H1110_802_0	3	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	805	0	2	04	01	H1110_805_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	805	0	2	04	01	H1110_805_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1110	805	0	2	04	01	H1110_805_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H1110	806	0	2	04	01	H1110_806_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1110	806	0	2	04	01	H1110_806_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1110	806	0	2	04	01	H1110_806_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H1291	001	0	1	09	04	H1291_001_0	5	5		0000000111110000000000000000000000000000000001001	2			1	35.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	15		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	3		0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	9		0000000000000000000010000000000000000000000000000	1	25	25	1	35.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	8		0000001000001000000100000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	7		0000000000000000100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	6		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H1291	001	0	1	09	04	H1291_001_0	5	1		0110000000000000001000011110000000000000000000000	1	20	20	2			2	
H1291	001	0	1	09	04	H1291_001_0	5	10		0000000000000000010000000000000000000000000000000	1	20	25	2			2	
H1291	001	0	1	09	04	H1291_001_0	5	11		0000000000000010000000000000000000000000000000000	1	20	25	1	15.00	75.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	12		0000000000000100000000000000000000000000000000000	1	20	25	1	0.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	13		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	14		0000000000000000000000000000000000000000000000010	2			1	25.00	25.00	2	
H1291	001	0	1	09	04	H1291_001_0	5	4		0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H1291	003	0	1	09	04	H1291_003_0	4	5		0000000000000000000000000000000000000000000000100	2			1	35.00	35.00	2	
H1291	003	0	1	09	04	H1291_003_0	4	4		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1291	003	0	1	09	04	H1291_003_0	4	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H1291	003	0	1	09	04	H1291_003_0	4	1		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H1291	003	0	1	09	04	H1291_003_0	4	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H1291	007	0	1	09	04	H1291_007_0	5	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H1291	007	0	1	09	04	H1291_007_0	5	2		0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H1291	007	0	1	09	04	H1291_007_0	5	1		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H1291	801	0	1	09	04	H1291_801_0	4	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H1291	801	0	1	09	04	H1291_801_0	4	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1291	801	0	1	09	04	H1291_801_0	4	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H1291	802	0	1	09	04	H1291_802_0	3	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H1291	802	0	1	09	04	H1291_802_0	3	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1291	802	0	1	09	04	H1291_802_0	3	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H1291	803	0	1	09	04	H1291_803_0	3	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H1291	803	0	1	09	04	H1291_803_0	3	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H1291	803	0	1	09	04	H1291_803_0	3	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1302	001	0	1	04	01	H1302_001_0	7	6	25% Coinsurace	0010000010010011100110000001000000000000000001000	1	25	25	2			2	
H1302	001	0	1	04	01	H1302_001_0	7	1	No Cost Share	0000000000000000000000000000000001111111111000010	2			1	0.00	0.00	2	
H1302	001	0	1	04	01	H1302_001_0	7	2	$30 Copay	0100111101101000000000000000000000000000000000101	2			1	30.00	30.00	2	
H1302	001	0	1	04	01	H1302_001_0	7	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1302	001	0	1	04	01	H1302_001_0	7	4	10% Coinsurance	0001000000000000000000000000000000000000000000000	1	10	10	2			2	
H1302	001	0	1	04	01	H1302_001_0	7	5	20% Coinsurance	0000000000000100011000011110000000000000000100000	1	20	20	2			2	
H1302	004	0	1	04	01	H1302_004_0	5	6	25% Coinsurace	0010000010010011100110000001000000000000000001000	1	25	25	2			2	
H1302	004	0	1	04	01	H1302_004_0	5	5	20% Coinsurance	0000000000000100011000011110000000000000000100000	1	20	20	2			2	
H1302	004	0	1	04	01	H1302_004_0	5	4	10% Coinsurance	0001000000000000000000000000000000000000000000000	1	10	10	2			2	
H1302	004	0	1	04	01	H1302_004_0	5	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1302	004	0	1	04	01	H1302_004_0	5	2	$30 Copay	0100111101101000000000000000000000000000000000101	2			1	30.00	30.00	2	
H1302	004	0	1	04	01	H1302_004_0	5	1	No Cost Share	0000000000000000000000000000000001111111111000010	2			1	0.00	0.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	40.00	40.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H1303	001	0	1	04	01	H1303_001_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	25.00	25.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H1303	001	0	1	04	01	H1303_001_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
H1303	004	0	1	04	01	H1303_004_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	3	Group 3	0000000000000000000000100000000000000000000010000	1	50	50	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H1303	004	0	1	04	01	H1303_004_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
H1304	001	0	1	04	01	H1304_001_0	4	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1304	001	0	1	04	01	H1304_001_0	4	9	$0 to $225	0000000000000000010000000000000000000000000000000	2			1	0.00	225.00	2	
H1304	001	0	1	04	01	H1304_001_0	4	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H1304	001	0	1	04	01	H1304_001_0	4	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H1304	001	0	1	04	01	H1304_001_0	4	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H1304	001	0	1	04	01	H1304_001_0	4	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H1304	001	0	1	04	01	H1304_001_0	4	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H1304	001	0	1	04	01	H1304_001_0	4	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1304	001	0	1	04	01	H1304_001_0	4	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H1304	001	0	1	04	01	H1304_001_0	4	10	$225 copay	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H1304	001	0	1	04	01	H1304_001_0	4	1	$35 copay	0000111111111000000110000000000000000000000001101	2			1	35.00	35.00	2	
H1304	002	0	1	04	01	H1304_002_0	6	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1304	002	0	1	04	01	H1304_002_0	6	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H1304	002	0	1	04	01	H1304_002_0	6	10	$225 copay	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H1304	002	0	1	04	01	H1304_002_0	6	1	$35 copay	0000111111111000000110000000000000000000000001101	2			1	35.00	35.00	2	
H1304	002	0	1	04	01	H1304_002_0	6	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H1304	002	0	1	04	01	H1304_002_0	6	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H1304	002	0	1	04	01	H1304_002_0	6	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H1304	002	0	1	04	01	H1304_002_0	6	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H1304	002	0	1	04	01	H1304_002_0	6	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H1304	002	0	1	04	01	H1304_002_0	6	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1304	002	0	1	04	01	H1304_002_0	6	9	$0 to $225	0000000000000000010000000000000000000000000000000	2			1	0.00	225.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	3	$0 copay	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	11	$500	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	9	30%	0000000000000010000000000000000000000000000000000	1	30	30	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	8	0% to 10%	0000000000000000000000000000000000000000000100000	1	0	10	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	7	$0 to $200	0000000000000000010000000000000000000000000000000	2			1	0.00	200.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	6	$200	0000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	5	20% coinsurance	0000000000000001000000011000000000000000000000000	1	20	20	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	4	10% coinsurance	0001000000000000100000000010000000000000000000000	1	10	10	2			2	
H1304	004	0	1	04	01	H1304_004_0	5	1	$25 copay	0000111111111000000110000000000000000000000001101	2			1	25.00	25.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	2	$100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1304	004	0	1	04	01	H1304_004_0	5	10	$200 vision hardware	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1304	803	0	1	04	01	H1304_803_0	3	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H1304	803	0	1	04	01	H1304_803_0	3	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1304	803	0	1	04	01	H1304_803_0	3	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H1304	803	0	1	04	01	H1304_803_0	3	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H1304	804	0	1	04	01	H1304_804_0	3	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H1304	804	0	1	04	01	H1304_804_0	3	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H1304	804	0	1	04	01	H1304_804_0	3	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1304	804	0	1	04	01	H1304_804_0	3	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H1355	001	0	1	04	01	H1355_001_0	4	3	Group 3	0110000010010000000110011100000000000000000000000	1	30	30	2			2	
H1355	001	0	1	04	01	H1355_001_0	4	2	Group 2	0001111101101111111001000011000000010000000101011	1	20	20	2			2	
H1355	001	0	1	04	01	H1355_001_0	4	1	Group 1	0000000000000000000000000000000001101111111010100	1	0	0	2			2	
H1355	002	0	1	04	01	H1355_002_0	4	4	Group 4	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H1355	002	0	1	04	01	H1355_002_0	4	5	Group 5	0000000001000000000000000000000000000000000000000	1	20	50	2			2	
H1355	002	0	1	04	01	H1355_002_0	4	3	Group 3	0110000010010000000110011100000000000000000000000	1	30	30	2			2	
H1355	002	0	1	04	01	H1355_002_0	4	6	Group 6	0000000000000000000000000000000000000000000001000	1	0	20	2			2	
H1355	002	0	1	04	01	H1355_002_0	4	1	Group 1	1000000000000000000000000000000001101111111010100	1	0	0	2			2	
H1355	002	0	1	04	01	H1355_002_0	4	2	Group 2	0001111100101111111001000011000000010000000100011	1	20	20	2			2	
H1355	801	0	1	04	01	H1355_801_0	2	1	Group 1	0110111101101011111111011111000000000000000101011	1	20	20	2			2	
H1355	801	0	1	04	01	H1355_801_0	2	2	Group 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1355	801	0	1	04	01	H1355_801_0	2	3	Group 3	0001000000000100000000000000000001111111111000100	1	0	0	2			2	
H1355	802	0	1	04	01	H1355_802_0	2	2	Group 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1355	802	0	1	04	01	H1355_802_0	2	3	Group 3	0001000000000100000000000000000001111111111000100	1	0	0	2			2	
H1355	802	0	1	04	01	H1355_802_0	2	1	Group 1	0110111101101011111111011111000000000000000101011	1	20	20	2			2	
H1365	001	0	1	04	01	H1365_001_0	9	1	Group 1	0000000000000100100000000001000000100000000000000	1	0	0	2			2	
H1365	001	0	1	04	01	H1365_001_0	9	2	Group 2	0001000000000000000000000010000000000000001100000	1	20	20	2			2	
H1365	001	0	1	04	01	H1365_001_0	9	5	Group 5	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H1365	001	0	1	04	01	H1365_001_0	9	4	Group 4	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1365	001	0	1	04	01	H1365_001_0	9	3	Group 3	0110011111111011011110011100000001011111110001111	1	30	30	2			2	
H1417	001	0	1	04	01	H1417_001_0	4	5	ASC	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	4	DME	0000000000000000000000011100000000000000000000000	1	20	20	2			2	
H1417	001	0	1	04	01	H1417_001_0	4	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	2	Renal Dialysis	0000000000000000000000000011000000000000000000000	2			1	0.00	0.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	1	Office Visits	0111111111111111100110000000000001111111111101101	2			1	30.00	30.00	2	
H1417	001	0	1	04	01	H1417_001_0	4	6	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	5	ASC	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	20	20	2			2	
H1417	002	0	1	04	01	H1417_002_0	5	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	2	Renal Dialysis	0000000000000000000000000011000000000000000000000	2			1	0.00	0.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	1	Office Visits	0111111111111111100110000000000001111111111101101	2			1	30.00	30.00	2	
H1417	002	0	1	04	01	H1417_002_0	5	6	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	003	0	1	04	01	H1417_003_0	4	4	DME	0000000000000000000000011100000000000000000000000	1	20	20	2			2	
H1417	003	0	1	04	01	H1417_003_0	4	5	ASC	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H1417	003	0	1	04	01	H1417_003_0	4	6	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	003	0	1	04	01	H1417_003_0	4	1	Office Visits	0111111111111111100110000000000001111111111101101	2			1	50.00	50.00	2	
H1417	003	0	1	04	01	H1417_003_0	4	2	Renal Dialysis	0000000000000000000000000011000000000000000000000	2			1	0.00	0.00	2	
H1417	003	0	1	04	01	H1417_003_0	4	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	2	Renal Dialysis	0000000000000000000000000011000000000000000000000	2			1	0.00	0.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	1	Office Visits	0111111111111111100110000000000001111111111101101	2			1	50.00	50.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	20	20	2			2	
H1417	004	0	1	04	01	H1417_004_0	5	5	ASC	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H1417	004	0	1	04	01	H1417_004_0	5	6	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	005	0	1	04	01	H1417_005_0	6	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H1417	005	0	1	04	01	H1417_005_0	6	2	Renal Dialysis	0000000000000000000000000011000000000000000000000	2			1	0.00	0.00	2	
H1417	005	0	1	04	01	H1417_005_0	6	1	Office Visits	0111111111111111100110000000000001111111111101101	2			1	30.00	30.00	2	
H1417	005	0	1	04	01	H1417_005_0	6	4	DME	0000000000000000000000011100000000000000000000000	1	20	20	2			2	
H1417	005	0	1	04	01	H1417_005_0	6	6	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H1417	005	0	1	04	01	H1417_005_0	6	5	ASC	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H1417	801	0	1	04	01	H1417_801_0	2	1	OON Medicare Covered Benefits	0000111101101111111011011110000001000011111101101	1	0	20	2			2	
H1417	801	0	1	04	01	H1417_801_0	2	2	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1417	801	0	1	04	01	H1417_801_0	2	3	Mental Health	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1417	801	0	1	04	01	H1417_801_0	2	4	OON Medicare Covered Benefits	0110000000000000000000000001000000111100000000010	1	20	20	2			2	
H1417	802	0	1	04	01	H1417_802_0	3	1	OON Medicare Covered Benefits	0000111101101111111011011110000001000011111101101	1	0	20	2			2	
H1417	802	0	1	04	01	H1417_802_0	3	3	Mental Health	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1417	802	0	1	04	01	H1417_802_0	3	2	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1417	802	0	1	04	01	H1417_802_0	3	4	OON Medicare Covered Benefits	0110000000000000000000000001000000111100000000010	1	20	20	2			2	
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H1418	002	0	1	04	01	H1418_002_0	6	8		0000000000000000000000000000001000100000000000010	2			1	0.00	0.00	2	
H1418	002	0	1	04	01	H1418_002_0	6	9		0000000000000001000000000000000000000000000000000	1	20	20	2			2	
H1418	002	0	1	04	01	H1418_002_0	6	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
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H1418	002	0	1	04	01	H1418_002_0	6	3		0000000000000000000000000000000001000000000000100	2			1	0.00	40.00	2	
H1418	002	0	1	04	01	H1418_002_0	6	4		0000001010001110100110000001000000000011111000000	1	30	30	1	40.00	40.00	2	
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H1418	007	0	1	04	01	H1418_007_0	5	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1418	007	0	1	04	01	H1418_007_0	5	4		0000001010001110100110000001000000000011111000000	1	30	30	1	35.00	35.00	2	
H1418	007	0	1	04	01	H1418_007_0	5	3		0000000000000000000000000000000001000000000000100	2			1	0.00	35.00	2	
H1418	007	0	1	04	01	H1418_007_0	5	2		0000110101110000000000000000000000011100000001001	2			1	35.00	35.00	2	
H1418	007	0	1	04	01	H1418_007_0	5	10		1000000000000000000000000000000000000000000010000	1	50	50	2			2	
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H1418	008	0	1	04	01	H1418_008_0	6	6		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
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H1418	008	0	1	04	01	H1418_008_0	6	4		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1418	008	0	1	04	01	H1418_008_0	6	1		0000110111110000000000000000000000011100000001101	2			1	35.00	35.00	2	
H1418	008	0	1	04	01	H1418_008_0	6	2		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H1418	008	0	1	04	01	H1418_008_0	6	3		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1418	008	0	1	04	01	H1418_008_0	6	9		0000001000001111100110000000000000000011111000000	1	30	30	1	35.00	35.00	2	
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H1418	009	0	1	04	01	H1418_009_0	4	3		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H1418	009	0	1	04	01	H1418_009_0	4	2		0000001000001111100110000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H1418	009	0	1	04	01	H1418_009_0	4	1		0000110111110000000000000000000000011100000001101	2			1	35.00	35.00	2	
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H1418	016	0	1	04	01	H1418_016_0	4	6		0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H1418	016	0	1	04	01	H1418_016_0	4	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1418	016	0	1	04	01	H1418_016_0	4	8		0000000000000000000000000000001000100000000000010	2			1	0.00	0.00	2	
H1418	016	0	1	04	01	H1418_016_0	4	4		0000001010001110100110000001000000000011111000000	1	30	30	1	35.00	35.00	2	
H1418	016	0	1	04	01	H1418_016_0	4	3		0000000000000000000000000000000001000000000000100	2			1	0.00	35.00	2	
H1418	016	0	1	04	01	H1418_016_0	4	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1418	016	0	1	04	01	H1418_016_0	4	1		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H1418	016	0	1	04	01	H1418_016_0	4	9		0000000000000001000000000000000000000000000000000	1	20	20	2			2	
H1418	017	0	1	04	01	H1418_017_0	9	4		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1418	017	0	1	04	01	H1418_017_0	9	1		0001000000000000000000000001001101111111111000000	2			1	0.00	0.00	2	
H1418	017	0	1	04	01	H1418_017_0	9	2		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H1418	017	0	1	04	01	H1418_017_0	9	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	20.00	20.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	12	Group 12	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	40.00	40.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	9	Group 9	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	4	Group 4	0000000000000000000000011100000000000000000100010	1	30	30	2			2	
H1509	001	0	1	04	01	H1509_001_0	5	5	Group 5	0000000000000100000000000000000000000000000000000	1	25	25	1	10.00	10.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	6	Group 6	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	7	Group 7	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	8	Group 8	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H1509	001	0	1	04	01	H1509_001_0	5	3	Group 3	0001000000000011011000000000000000001111111000000	1	25	25	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
H1509	004	0	1	04	01	H1509_004_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1509	004	0	1	04	01	H1509_004_0	4	3	Group 3	0000000000000000000000100000000000000000000010000	1	50	50	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	4	Group 4	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	5	Group 5	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H1509	006	0	1	04	01	H1509_006_0	4	2	Group 2	0000000000000000000000000000000000100000000010010	2			1	0.00	0.00	2	
H1509	006	0	1	04	01	H1509_006_0	4	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1509	007	0	1	04	01	H1509_007_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
H1509	007	0	1	04	01	H1509_007_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	11	Group 11	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1509	007	0	1	04	01	H1509_007_0	4	10	Group 10	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H1509	007	0	1	04	01	H1509_007_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	25.00	25.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	9	Group 9	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H1509	007	0	1	04	01	H1509_007_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	11	Group 11	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1509	009	0	1	04	01	H1509_009_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
H1509	009	0	1	04	01	H1509_009_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	9	Group 9	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	25.00	25.00	2	
H1509	009	0	1	04	01	H1509_009_0	4	10	Group 10	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H1509	801	0	1	04	01	H1509_801_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	801	0	1	04	01	H1509_801_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	801	0	1	04	01	H1509_801_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	801	0	1	04	01	H1509_801_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	803	0	1	04	01	H1509_803_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	803	0	1	04	01	H1509_803_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	803	0	1	04	01	H1509_803_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	803	0	1	04	01	H1509_803_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	804	0	1	04	01	H1509_804_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	804	0	1	04	01	H1509_804_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	804	0	1	04	01	H1509_804_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	804	0	1	04	01	H1509_804_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	806	0	2	04	01	H1509_806_0	1	3	Group 3	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H1509	806	0	2	04	01	H1509_806_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	806	0	2	04	01	H1509_806_0	1	2	Group 2	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	806	0	2	04	01	H1509_806_0	1	1	Group 1	0100111101101011111111011111000001010111111101111	1	20	20	2			2	
H1509	807	0	2	04	01	H1509_807_0	1	2	Group 2	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	807	0	2	04	01	H1509_807_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	807	0	2	04	01	H1509_807_0	1	3	Group 3	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H1509	807	0	2	04	01	H1509_807_0	1	1	Group 1	0100111101101011111111011111000001010111111101111	1	20	20	2			2	
H1509	808	0	2	04	01	H1509_808_0	1	3	Group 3	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H1509	808	0	2	04	01	H1509_808_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	808	0	2	04	01	H1509_808_0	1	2	Group 2	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H1509	808	0	2	04	01	H1509_808_0	1	1	Group 1	0100111101101011111111011111000001010111111101111	1	20	20	2			2	
H1509	809	0	1	04	01	H1509_809_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	809	0	1	04	01	H1509_809_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	809	0	1	04	01	H1509_809_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	809	0	1	04	01	H1509_809_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	810	0	1	04	01	H1509_810_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	810	0	1	04	01	H1509_810_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	810	0	1	04	01	H1509_810_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	810	0	1	04	01	H1509_810_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	811	0	1	04	01	H1509_811_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	811	0	1	04	01	H1509_811_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	811	0	1	04	01	H1509_811_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	811	0	1	04	01	H1509_811_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	812	0	1	04	01	H1509_812_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	812	0	1	04	01	H1509_812_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	812	0	1	04	01	H1509_812_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	812	0	1	04	01	H1509_812_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	813	0	1	04	01	H1509_813_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	813	0	1	04	01	H1509_813_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	813	0	1	04	01	H1509_813_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	813	0	1	04	01	H1509_813_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	814	0	1	04	01	H1509_814_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	814	0	1	04	01	H1509_814_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	814	0	1	04	01	H1509_814_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	814	0	1	04	01	H1509_814_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	815	0	1	04	01	H1509_815_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	815	0	1	04	01	H1509_815_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	815	0	1	04	01	H1509_815_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	815	0	1	04	01	H1509_815_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	816	0	1	04	01	H1509_816_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	816	0	1	04	01	H1509_816_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	816	0	1	04	01	H1509_816_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	816	0	1	04	01	H1509_816_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1509	817	0	1	04	01	H1509_817_0	1	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H1509	817	0	1	04	01	H1509_817_0	1	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
H1509	817	0	1	04	01	H1509_817_0	1	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
H1509	817	0	1	04	01	H1509_817_0	1	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H1510	001	0	1	04	01	H1510_001_0	6	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1510	001	0	1	04	01	H1510_001_0	6	1		0111111111111111111110011000000001011111111001101	1	30	30	2			2	
H1510	001	0	1	04	01	H1510_001_0	6	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1510	001	0	1	04	01	H1510_001_0	6	3		0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H1510	001	0	1	04	01	H1510_001_0	6	4		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H1510	001	0	1	04	01	H1510_001_0	6	5		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1510	001	0	1	04	01	H1510_001_0	6	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H1510	004	0	1	04	01	H1510_004_0	5	7		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H1510	004	0	1	04	01	H1510_004_0	5	6		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1510	004	0	1	04	01	H1510_004_0	5	5		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H1510	004	0	1	04	01	H1510_004_0	5	4		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1510	004	0	1	04	01	H1510_004_0	5	3		0000000000000000000000000001001000100000000000110	2			1	0.00	0.00	2	
H1510	004	0	1	04	01	H1510_004_0	5	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1510	004	0	1	04	01	H1510_004_0	5	1		0111111111111111111110011000000001011111111001101	1	30	30	2			2	
H1510	005	0	1	04	01	H1510_005_0	4	7		1000000000000000000000000000000000000000000000001	1	25	25	2			2	
H1510	005	0	1	04	01	H1510_005_0	4	8		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H1510	005	0	1	04	01	H1510_005_0	4	6		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1510	005	0	1	04	01	H1510_005_0	4	5		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H1510	005	0	1	04	01	H1510_005_0	4	4		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1510	005	0	1	04	01	H1510_005_0	4	3		0000000000000000000000000001001000100000000000110	2			1	0.00	0.00	2	
H1510	005	0	1	04	01	H1510_005_0	4	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1510	005	0	1	04	01	H1510_005_0	4	1		0111111111111111111110011000000001011111111001101	1	30	30	2			2	
H1510	007	0	1	04	01	H1510_007_0	4	6		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1510	007	0	1	04	01	H1510_007_0	4	7		1000000000000000000000000000000000000000000000001	1	25	25	2			2	
H1510	007	0	1	04	01	H1510_007_0	4	8		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H1510	007	0	1	04	01	H1510_007_0	4	1		0111111111111111111110011000000001011111111001101	1	30	30	2			2	
H1510	007	0	1	04	01	H1510_007_0	4	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1510	007	0	1	04	01	H1510_007_0	4	3		0000000000000000000000000001001000100000000000110	2			1	0.00	0.00	2	
H1510	007	0	1	04	01	H1510_007_0	4	4		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1510	007	0	1	04	01	H1510_007_0	4	5		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
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H1510	008	0	1	04	01	H1510_008_0	5	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1510	008	0	1	04	01	H1510_008_0	5	3		0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H1510	008	0	1	04	01	H1510_008_0	5	4		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H1510	008	0	1	04	01	H1510_008_0	5	5		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1510	008	0	1	04	01	H1510_008_0	5	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H1510	008	0	1	04	01	H1510_008_0	5	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1517	003	0	1	04	01	H1517_003_0	7	10	OON $0 Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	1	20% OON Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H1517	003	0	1	04	01	H1517_003_0	7	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	25.00	50.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	25.00	25.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	25.00	225.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	25	2			2	
H1517	003	0	1	04	01	H1517_003_0	7	2	25% OON Coinsurance	0000000000000010100000011100000000000000000000000	1	25	25	2			2	
H1517	003	0	1	04	01	H1517_003_0	7	13	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	12	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	20.00	25.00	2	
H1517	003	0	1	04	01	H1517_003_0	7	11	Other Health Care Professional Services	0000000000000000000000000000000000000000000000010	2			1	0.00	25.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	2	30% OON Coinsurance	0000000000000010100000000000000000000000011000000	1	30	30	2			2	
H1517	004	0	1	04	01	H1517_004_0	9	13	Diabetic Supplies	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H1517	004	0	1	04	01	H1517_004_0	9	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H1517	004	0	1	04	01	H1517_004_0	9	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	45.00	275.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	45.00	45.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	11	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	25.00	45.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	1	20% OON Coinsurance	0000000000000001000000000010000000000000000100000	1	20	20	2			2	
H1517	004	0	1	04	01	H1517_004_0	9	12	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	275.00	275.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	45.00	90.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H1517	004	0	1	04	01	H1517_004_0	9	10	OON $0 Copayment	0001000000000000000010000001000001111111100001010	2			1	0.00	0.00	2	
H1517	801	0	1	04	01	H1517_801_0	4	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H1517	801	0	1	04	01	H1517_801_0	4	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1517	802	0	1	04	01	H1517_802_0	4	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H1517	802	0	1	04	01	H1517_802_0	4	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1517	803	0	1	04	01	H1517_803_0	4	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1517	803	0	1	04	01	H1517_803_0	4	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H1595	001	0	1	04	01	H1595_001_0	9	1	OON-Group 1 General Services	0110111111111111111100000110000000111111111101101	1	30	30	2			2	
H1595	001	0	1	04	01	H1595_001_0	9	2	OON-Group 2 DME  Prosethetic Devices	0000000000000000000000011000000000000000000000000	1	50	50	2			2	
H1595	001	0	1	04	01	H1595_001_0	9	3	OON - Group 3 - Same as In-Network	1001000000000000000011101001111101000000000000010	1	30	30	2			2	
H1595	002	0	1	04	01	H1595_002_0	9	3	OON - Group 3 - Same as In-Network	1001000000000000000011101001111101000000000010010	1	20	20	2			2	
H1595	002	0	1	04	01	H1595_002_0	9	2	OON-Group 2 DME  Prosethetic Devices	0000000000000000000000011000000000000000000000000	1	50	50	2			2	
H1595	002	0	1	04	01	H1595_002_0	9	1	OON-Group 1 General Services	0110111111111111111100000110000000111111111101101	1	20	20	2			2	
H1595	801	0	1	04	01	H1595_801_0	6	1	OON Group 1 - Medicare covered	0111111111111111111111011111000001111111111101111	1	0	50	2			2	
H1595	802	0	1	04	01	H1595_802_0	5	1	OON Group 1 - Medicare covered	0111111111111111111111011111000001111111111101111	1	0	50	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	7	$40 - $80  PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	40.00	80.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	8	$50 Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	9	$100 Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	6	$40 Specialist	0100010101000000000000000000000000000000000000101	2			1	40.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	5	$30 PCP	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	4	$275 Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	275.00	275.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	1	20% Coinsurance	0000000000000001000000000010000000000000011100000	1	20	20	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	2	30% Coinsurance	0000000000000010100000000100000000000000000000000	1	30	30	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	14	25% Coinsurance	0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H1607	001	0	1	04	01	H1607_001_0	10	13	$40 - $275 Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	40.00	275.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	12	$0 - $40 Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	11	$30 - $40 Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	30.00	40.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H1607	001	0	1	04	01	H1607_001_0	10	3	0% - 30% Coinsurance Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H1607	004	0	1	04	01	H1607_004_0	9	3	0% - 25% Coinsurance Labs	0000000000000100000000000000000000000000000000000	1	0	25	2			2	
H1607	004	0	1	04	01	H1607_004_0	9	4	$225 Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	2	25% Coinsurance	0000000000000010100000011100000000000000000000000	1	25	25	2			2	
H1607	004	0	1	04	01	H1607_004_0	9	13	$30 - $225 Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	30.00	225.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	12	$0 - $30 Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	30.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	11	$20 - $30 Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	20.00	30.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	1	20% Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H1607	004	0	1	04	01	H1607_004_0	9	9	$100 Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	8	$50 Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	7	$30 - $60  PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	30.00	60.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	6	$30 Specialist	0100010101000000000000000000000000000000000000101	2			1	30.00	30.00	2	
H1607	004	0	1	04	01	H1607_004_0	9	5	$20 PCP	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H1607	804	0	1	04	01	H1607_804_0	4	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H1607	804	0	1	04	01	H1607_804_0	4	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1607	805	0	1	04	01	H1607_805_0	4	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1607	805	0	1	04	01	H1607_805_0	4	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H1607	806	0	1	04	01	H1607_806_0	4	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H1607	806	0	1	04	01	H1607_806_0	4	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H1608	001	0	1	04	01	H1608_001_0	11	1	OON	0111111111111111111110000111000000000000000101111	1	20	20	2			2	
H1608	001	0	1	04	01	H1608_001_0	11	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1608	001	0	1	04	01	H1608_001_0	11	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H1608	001	0	1	04	01	H1608_001_0	11	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H1608	001	0	1	04	01	H1608_001_0	11	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H1608	801	0	1	04	01	H1608_801_0	7	6	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1608	801	0	1	04	01	H1608_801_0	7	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1608	801	0	1	04	01	H1608_801_0	7	1	OON	0111111101101111111110000111000000000000000101111	1	20	20	2			2	
H1608	801	0	1	04	01	H1608_801_0	7	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H1608	801	0	1	04	01	H1608_801_0	7	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H1608	801	0	1	04	01	H1608_801_0	7	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H1608	802	0	1	04	01	H1608_802_0	7	1	OON	0111111101101111111110000111000000000000000101111	1	20	20	2			2	
H1608	802	0	1	04	01	H1608_802_0	7	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1608	802	0	1	04	01	H1608_802_0	7	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H1608	802	0	1	04	01	H1608_802_0	7	6	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1608	802	0	1	04	01	H1608_802_0	7	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H1608	802	0	1	04	01	H1608_802_0	7	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H1608	803	0	1	04	01	H1608_803_0	6	6	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1608	803	0	1	04	01	H1608_803_0	6	5	Preventative	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H1608	803	0	1	04	01	H1608_803_0	6	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H1608	803	0	1	04	01	H1608_803_0	6	3	DME	0000000000000000000000011000000000000000000000000	1	20	20	2			2	
H1608	803	0	1	04	01	H1608_803_0	6	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1608	803	0	1	04	01	H1608_803_0	6	1	OON	0111111101101111111110000111000000000000000101111	1	20	20	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	1		0100000000000000000000000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	10		0000000000000000000000000001000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	11		0000000000000000000000000000000001111111111000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	12		0000000000000000000000000000000000000000000100000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	13		0000000000000000000000000000000000000000000001000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	14		0000000000000000000000000000000000000000000000110	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	15		0000000000000000000000000000000000000000000000001	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	2		0010000000000000000000000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	3		0001000000000000000000000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	4		0000111111111000000000000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	5		0000000000000111100000000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	6		0000000000000000011110000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	7		0000000000000000000001000000000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	8		0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H1659	001	0	1	04	01	H1659_001_0	8	9		0000000000000000000000000010000000000000000000000	1	30	30	2			2	
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H1659	002	0	1	04	01	H1659_002_0	9	5		0000000000000111100000000000000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	8		0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	9		0000000000000000000000000010000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	1		0100000000000000000000000000000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	10		0000000000000000000000000001000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	11		0000000000000000000000000000000001111111111000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	12		0000000000000000000000000000000000000000000100000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	13		0000000000000000000000000000000000000000000001000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	14		0000000000000000000000000000000000000000000000110	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	15		0000000000000000000000000000000000000000000000001	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	2		0010000000000000000000000000000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	3		0001000000000000000000000000000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	4		0000111111111000000000000000000000000000000000000	1	30	30	2			2	
H1659	002	0	1	04	01	H1659_002_0	9	7		0000000000000000000001000000000000000000000000000	1	30	30	2			2	
H1681	001	0	1	04	01	H1681_001_0	6	1	PCP/SPC	0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H1681	001	0	1	04	01	H1681_001_0	6	2	Part B Drugs	0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	001	0	1	04	01	H1681_001_0	6	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1681	001	0	1	04	01	H1681_001_0	6	4	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1681	001	0	1	04	01	H1681_001_0	6	6	DMS	0000000000000000000000000100000000000000000000000	1	20	25	2			2	
H1681	001	0	1	04	01	H1681_001_0	6	8		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H1681	001	0	1	04	01	H1681_001_0	6	7		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H1681	001	0	1	04	01	H1681_001_0	6	5	DME	0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	1		0111111111111111111110011000000000011111111001101	1	30	30	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	2	Part B Drugs	0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1681	002	0	1	04	01	H1681_002_0	5	5		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H1681	002	0	1	04	01	H1681_002_0	5	4	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1681	002	0	1	04	01	H1681_002_0	5	6		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
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H1681	003	0	1	04	01	H1681_003_0	4	4	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
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H1681	003	0	1	04	01	H1681_003_0	4	2	Part B Drugs	0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	003	0	1	04	01	H1681_003_0	4	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1681	003	0	1	04	01	H1681_003_0	4	7		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
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H1681	003	0	1	04	01	H1681_003_0	4	6	DMS	0000000000000000000000000100000000000000000000000	1	20	25	2			2	
H1681	004	0	1	04	01	H1681_004_0	4	8		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H1681	004	0	1	04	01	H1681_004_0	4	7		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H1681	004	0	1	04	01	H1681_004_0	4	6	DMS	0000000000000000000000000100000000000000000000000	1	20	35	2			2	
H1681	004	0	1	04	01	H1681_004_0	4	1	PCP/SPC	0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H1681	004	0	1	04	01	H1681_004_0	4	2	Part B Drugs	0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H1681	004	0	1	04	01	H1681_004_0	4	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1681	004	0	1	04	01	H1681_004_0	4	5	DME	0000000000000000000000011000000000000000000000000	1	35	35	2			2	
H1681	004	0	1	04	01	H1681_004_0	4	4	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
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H1681	005	0	1	04	01	H1681_005_0	4	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1681	005	0	1	04	01	H1681_005_0	4	4	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H1681	005	0	1	04	01	H1681_005_0	4	5	DME	0000000000000000000000011000000000000000000000000	1	35	35	2			2	
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H1681	006	0	1	04	01	H1681_006_0	4	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
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H1806	001	0	1	04	01	H1806_001_0	5	1		0111111111111111111110011000000001011111111001101	1	30	30	2			2	
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H1806	002	0	1	04	01	H1806_002_0	7	5		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	6		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	8		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H1806	002	0	1	04	01	H1806_002_0	7	7		1000000000000000000000000000000000000000000000001	1	25	25	2			2	
H1806	005	0	1	04	01	H1806_005_0	6	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H1806	005	0	1	04	01	H1806_005_0	6	3		0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H1806	005	0	1	04	01	H1806_005_0	6	4		0001000000000000000000011100000000000000000000000	1	20	20	2			2	
H1806	005	0	1	04	01	H1806_005_0	6	5		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H1806	005	0	1	04	01	H1806_005_0	6	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H1806	005	0	1	04	01	H1806_005_0	6	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H1806	005	0	1	04	01	H1806_005_0	6	1		0110111111111111111110000000000001011111111001101	1	30	30	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	8	Group #8 Behavioral Health	0000000010010000000100000000000000000000000000000	2			1	40.00	45.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	9	Group #9 Opt Hosp Diag Services	0000000000000010100000000000000000000000000000000	2			1	45.00	45.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	7	Group #7 Outpatient Therapy	0000001000001000000010000000000000000000000000000	2			1	20.00	45.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	6	Group #6 Other Healthcare Professionals	0000000000100000000000000000000000000000000000000	2			1	20.00	40.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	5	Group #5 Preventive Services	0000000000000000000000000000000001111111111000000	2			1	20.00	45.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	4	Group #4 Chiropractic Services	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	3	Group #3- Specialist	0000000101000000000000000000000000000000000001101	2			1	40.00	40.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	2	Group #2 Primary Care	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	15	Group 15:  Other Outpt hospital services	0110000000000000010000000000000000000000000000000	2			1	45.00	250.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	14	Group #14 DME/Prosthetics and Part B	0000000000000000000000011000000000000000000100000	1	20	20	2			2	
H1846	001	0	1	04	01	H1846_001_0	6	13	Group # 13 Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	12	Group #12 Opt. Diag./tests/labs/ESRD	0000000000000100000000000010000000000000000000000	2			1	0.00	45.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	11	Group # 11 Therapeutic Radiological Serv	0000000000000001000000000000000000000000000000000	2			1	100.00	100.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	10	Group #10 ASC Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	250.00	250.00	2	
H1846	001	0	1	04	01	H1846_001_0	6	1	Group #1 No cost sharing	0001000000000000000000000101000000000000000000010	2			1	0.00	0.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	13	Group # 13 Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	8	Group #8 Behavioral Health	0000000010010000000100000000000000000000000000000	2			1	40.00	40.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	7	Group #7 Outpatient Therapy	0000001000001000000010000000000000000000000000000	2			1	20.00	40.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	6	Group #6 Other Healthcare Professionals	0000000000100000000000000000000000010000000000000	2			1	20.00	40.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	5	Group #5 Preventive Services	0000000000000000000000000000000001101111111000000	2			1	0.00	0.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	4	Group #4 Chiropractic Services	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	1	Group #1 No cost sharing	0001000000000000000000000101000000000000000000010	2			1	0.00	0.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	10	Group #10 ASC Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	250.00	250.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	11	Group # 11 Therapeutic Radiological Serv	0000000000000001000000000000000000000000000000000	2			1	80.00	80.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	12	Group #12 Opt. Diag. Proc./tests/labs	0000000000000100000000000000000000000000000000000	2			1	0.00	40.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	9	Group #9 Outpt Diagnostic Services/ESRD	0000000000000010100000000010000000000000000000000	2			1	40.00	40.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	14	Group #14 DME/Prosthetics and Part B	0000000000000000000000011000000000000000000100000	1	20	20	2			2	
H1846	003	0	1	04	01	H1846_003_0	7	15	Group 15:  Other Outpt Hospital Services	0110000000000000010000000000000000000000000000000	2			1	40.00	250.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	2	Group #2 Primary Care	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H1846	003	0	1	04	01	H1846_003_0	7	3	Group #3- Specialist	0000000101000000000000000000000000000000000001101	2			1	40.00	40.00	2	
H1846	801	0	1	04	01	H1846_801_0	4	3	OON Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1846	801	0	1	04	01	H1846_801_0	4	2	Home Health	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H1846	801	0	1	04	01	H1846_801_0	4	1	ON Medicare Covered Benefits	1110111101101111111111111111111111111111111111111	1	20	20	2			2	
H1846	802	0	1	04	01	H1846_802_0	3	3	OON Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H1846	802	0	1	04	01	H1846_802_0	3	2	Home Health	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H1846	802	0	1	04	01	H1846_802_0	3	1	ON Medicare Covered Benefits	1110111101101111111111111111111111111111111111111	1	20	20	2			2	
H2001	001	0	1	04	01	H2001_001_0	5	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
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H2001	001	0	1	04	01	H2001_001_0	5	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
H2001	001	0	1	04	01	H2001_001_0	5	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
H2001	001	0	1	04	01	H2001_001_0	5	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
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H2001	001	0	1	04	01	H2001_001_0	5	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	30.00	30.00	2	
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H2029	001	0	1	04	01	H2029_001_0	5	9		0000000000000001100000000000000000000001100000000	2			1	5.00	15.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	2		0000001010001100000110000000000000000010011000000	2			1	10.00	15.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	3		1001000000000000000000000001001000100000000000111	2			1	0.00	0.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	4		0000000000000010000000000000000000000000000000000	2			1	10.00	25.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	5		0000000000000000010000000000000000000000000000000	1	20	20	1	15.00	25.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	6		0000000000000000000001000000000000000000000000000	2			1	15.00	15.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	1		1110110101110000001000000000000000011100000001111	2			1	10.00	10.00	2	
H2029	001	0	1	04	01	H2029_001_0	5	10		0000000000000000000000000000000000000000000011000	1	20	50	2			2	
H2029	001	0	1	04	01	H2029_001_0	5	11		0000000000000000000000000000000001000000000000000	1	50	50	2			2	
H2029	001	0	1	04	01	H2029_001_0	5	8		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H2029	001	0	1	04	01	H2029_001_0	5	7		0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H2029	801	0	1	04	01	H2029_801_0	4	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H2029	801	0	1	04	01	H2029_801_0	4	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2029	801	0	1	04	01	H2029_801_0	4	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H2029	802	0	1	04	01	H2029_802_0	4	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H2029	802	0	1	04	01	H2029_802_0	4	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2029	802	0	1	04	01	H2029_802_0	4	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H2029	803	0	1	04	01	H2029_803_0	4	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2029	803	0	1	04	01	H2029_803_0	4	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H2029	803	0	1	04	01	H2029_803_0	4	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H2029	805	0	2	04	01	H2029_805_0	6	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H2029	805	0	2	04	01	H2029_805_0	6	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H2029	805	0	2	04	01	H2029_805_0	6	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2029	806	0	2	04	01	H2029_806_0	6	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2029	806	0	2	04	01	H2029_806_0	6	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H2029	806	0	2	04	01	H2029_806_0	6	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H2029	807	0	2	04	01	H2029_807_0	6	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H2029	807	0	2	04	01	H2029_807_0	6	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H2029	807	0	2	04	01	H2029_807_0	6	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	3	Group 3	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	2	Group 2	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H2111	001	0	1	04	01	H2111_001_0	4	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
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H2111	008	0	1	04	01	H2111_008_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
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H2111	008	0	1	04	01	H2111_008_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
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H2228	001	0	1	04	01	H2228_001_0	6	5	Group 5	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H2228	001	0	1	04	01	H2228_001_0	6	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
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H2228	002	0	1	04	01	H2228_002_0	5	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
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H2228	002	0	1	04	01	H2228_002_0	5	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
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H2944	184	0	1	09	04	H2944_184_0	5	2	Group 2	0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	185	0	1	09	04	H2944_185_0	5	1	Group 1	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	185	0	1	09	04	H2944_185_0	5	2	Group 2	0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	189	0	1	09	04	H2944_189_0	5	1	Group 1	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	189	0	1	09	04	H2944_189_0	5	2	Group 2	0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	192	0	1	09	04	H2944_192_0	4	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H2944	192	0	1	09	04	H2944_192_0	4	2		0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	192	0	1	09	04	H2944_192_0	4	1		0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	193	0	1	09	04	H2944_193_0	3	1		0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	193	0	1	09	04	H2944_193_0	3	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H2944	193	0	1	09	04	H2944_193_0	3	2		0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	194	0	1	09	04	H2944_194_0	4	2		0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	194	0	1	09	04	H2944_194_0	4	1		0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	195	0	1	09	04	H2944_195_0	4	1		0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	195	0	1	09	04	H2944_195_0	4	2		0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	195	0	1	09	04	H2944_195_0	4	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H2944	197	0	1	09	04	H2944_197_0	7	2		0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2944	197	0	1	09	04	H2944_197_0	7	1		0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	198	0	1	09	04	H2944_198_0	5	1		0000000000000100000000000000000000000000000000000	1	0	20	2			2	
H2944	198	0	1	09	04	H2944_198_0	5	2		0000000000000000000000010100000000000000000000000	1	20	20	2			2	
H2997	003	0	1	04	01	H2997_003_0	8	10	25% Coinsurance Group	0000000000000001000000000000000000000000000100000	1	25	25	2			2	
H2997	003	0	1	04	01	H2997_003_0	8	8	30% Coinsurance Group	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
H2997	003	0	1	04	01	H2997_003_0	8	7	$240 Copayment Group ASC	0000000000000000001000000000000000000000000000000	2			1	240.00	240.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	6	$40 - $268 Copayment Group OON Hospital	0000000000000000010000000000000000000000000000000	2			1	40.00	268.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	5	$150 Copayment Group OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	4	$40 Copayment Group	0110010111110000000110000000000000011111100000101	2			1	40.00	40.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	3	$40 - $80 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	40.00	80.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	2	$30 Copayment Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	1	20% Coinsurance Group	0000000000000000000000000011000000000000010001010	1	20	20	2			2	
H2997	003	0	1	04	01	H2997_003_0	8	9	$0 Copayment Group	0000000000000000000000000000000001100000001000000	2			1	0.00	0.00	2	
H2997	003	0	1	04	01	H2997_003_0	8	11	10% Coinsurance Group	0001000000000000000000000000000000000000000000000	1	10	10	2			2	
H2997	003	0	1	04	01	H2997_003_0	8	12	0%- 30% Coinsurance Group	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H2997	803	0	1	04	01	H2997_803_0	7	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2997	803	0	1	04	01	H2997_803_0	7	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H2997	804	0	1	04	01	H2997_804_0	7	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2997	804	0	1	04	01	H2997_804_0	7	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H2997	805	0	1	04	01	H2997_805_0	7	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2997	805	0	1	04	01	H2997_805_0	7	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H2997	806	0	1	04	01	H2997_806_0	7	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H2997	806	0	1	04	01	H2997_806_0	7	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	1	0.00	0001000000000000000000000011000001101111100000000	2			1	0.00	0.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	2	35.00	0100101000001000000010000000000000010000000000000	2			1	35.00	35.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	3	55.00	0000010101000000000000000000000000000000000001101	2			1	55.00	55.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	4	10%	0000000000000000100000000000000000000000001000000	1	10	10	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	5	20%	0000000000100111011000000000000000000000000100000	1	20	20	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	6	50%	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3206	001	0	1	04	01	H3206_001_0	5	7	150.00	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3206	001	0	1	04	01	H3206_001_0	5	8	25%	0000000000000000000000011100000000000000010000010	1	25	25	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	7	150.00	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	8	25%	0000000000000000000000011100000000000000010000010	1	25	25	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	6	50%	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	5	20%	0000000000100111011000000000000000000000000100000	1	20	20	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	4	10%	0000000000000000100000000000000000000000001000000	1	10	10	2			2	
H3206	002	0	1	04	01	H3206_002_0	4	3	55.00	0000010101000000000000000000000000000000000001101	2			1	55.00	55.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	2	35.00	0100101000001000000010000000000000010000000000000	2			1	35.00	35.00	2	
H3206	002	0	1	04	01	H3206_002_0	4	1	0.00	0001000000000000000000000011000001101111100000000	2			1	0.00	0.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	8	25%	0000000000000000000000011100000000000000010000010	1	25	25	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	7	150.00	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	6	50%	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	5	20%	0000000000100111011000000000000000000000000100000	1	20	20	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	4	10%	0000000000000000100000000000000000000000001000000	1	10	10	2			2	
H3206	003	0	1	04	01	H3206_003_0	2	3	55.00	0000010101000000000000000000000000000000000001101	2			1	55.00	55.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	2	35.00	0100101000001000000010000000000000010000000000000	2			1	35.00	35.00	2	
H3206	003	0	1	04	01	H3206_003_0	2	1	0.00	0001000000000000000000000011000001101111100000000	2			1	0.00	0.00	2	
H3206	801	0	1	04	01	H3206_801_0	4	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3206	801	0	1	04	01	H3206_801_0	4	1	20%	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3206	801	0	1	04	01	H3206_801_0	4	3	50%	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3206	802	0	1	04	01	H3206_802_0	4	1	20%	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3206	802	0	1	04	01	H3206_802_0	4	3	50%	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3206	802	0	1	04	01	H3206_802_0	4	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3206	803	0	1	04	01	H3206_803_0	4	1	20%	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3206	803	0	1	04	01	H3206_803_0	4	3	50%	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3206	803	0	1	04	01	H3206_803_0	4	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	2	Group 2	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	3	Group 3	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3209	001	0	1	04	01	H3209_001_0	4	5	Group 5	1000000000000000000000000000000000100000000010010	2			1	0.00	0.00	2	
H3209	002	0	1	04	01	H3209_002_0	4	3	Group 3	0000000000000000000000000000010000100000000010010	2			1	0.00	0.00	2	
H3209	002	0	1	04	01	H3209_002_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	2	Group 2	0000000000000100000000000000000001000000000001000	1	0	30	2			2	
H3209	002	0	1	04	01	H3209_002_0	4	1	Group 1	0111111111111011111111011101000000011111111100101	1	30	30	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	002	0	1	04	01	H3335_002_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	6	$45 Copayment	0000000100100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H3335	002	0	1	04	01	H3335_002_0	7	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	45.00	2	
H3335	005	0	1	04	01	H3335_005_0	8	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	005	0	1	04	01	H3335_005_0	8	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	005	0	1	04	01	H3335_005_0	8	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	005	0	1	04	01	H3335_005_0	8	2	$0 Copayment	0000000000000000000000000010000000000000000010000	2			1	0.00	0.00	2	
H3335	005	0	1	04	01	H3335_005_0	8	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	006	0	1	04	01	H3335_006_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	006	0	1	04	01	H3335_006_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	006	0	1	04	01	H3335_006_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	006	0	1	04	01	H3335_006_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	006	0	1	04	01	H3335_006_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	008	0	1	04	01	H3335_008_0	8	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	008	0	1	04	01	H3335_008_0	8	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	008	0	1	04	01	H3335_008_0	8	2	$0 Copayment	0000000000000000000000000010000000000000000010000	2			1	0.00	0.00	2	
H3335	008	0	1	04	01	H3335_008_0	8	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	008	0	1	04	01	H3335_008_0	8	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	009	0	1	04	01	H3335_009_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	009	0	1	04	01	H3335_009_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	009	0	1	04	01	H3335_009_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	009	0	1	04	01	H3335_009_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	009	0	1	04	01	H3335_009_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	014	0	1	04	01	H3335_014_0	8	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	014	0	1	04	01	H3335_014_0	8	2	$0 Copayment	0000000000000000000000000010000000000000000010000	2			1	0.00	0.00	2	
H3335	014	0	1	04	01	H3335_014_0	8	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	014	0	1	04	01	H3335_014_0	8	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	014	0	1	04	01	H3335_014_0	8	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	015	0	1	04	01	H3335_015_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	015	0	1	04	01	H3335_015_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	015	0	1	04	01	H3335_015_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	015	0	1	04	01	H3335_015_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	015	0	1	04	01	H3335_015_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	018	0	1	04	01	H3335_018_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	018	0	1	04	01	H3335_018_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	018	0	1	04	01	H3335_018_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	018	0	1	04	01	H3335_018_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	018	0	1	04	01	H3335_018_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	021	0	1	04	01	H3335_021_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	021	0	1	04	01	H3335_021_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	021	0	1	04	01	H3335_021_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	021	0	1	04	01	H3335_021_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	021	0	1	04	01	H3335_021_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	032	0	1	04	01	H3335_032_0	8	6	$45 Copayment	0000000100100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	45.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	032	0	1	04	01	H3335_032_0	8	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	032	0	1	04	01	H3335_032_0	8	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	037	0	1	04	01	H3335_037_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	037	0	1	04	01	H3335_037_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	037	0	1	04	01	H3335_037_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	037	0	1	04	01	H3335_037_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	037	0	1	04	01	H3335_037_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	038	0	1	04	01	H3335_038_0	7	5	Smoking Cessation	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3335	038	0	1	04	01	H3335_038_0	7	1	30% Coinsurance	0101111101101111111010011101000000111111111101111	1	30	30	2			2	
H3335	038	0	1	04	01	H3335_038_0	7	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	038	0	1	04	01	H3335_038_0	7	3	50% coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	038	0	1	04	01	H3335_038_0	7	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	041	0	1	04	01	H3335_041_0	6	6	$35 Copayment	0000000100100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	041	0	1	04	01	H3335_041_0	6	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	041	0	1	04	01	H3335_041_0	6	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	041	0	1	04	01	H3335_041_0	6	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	041	0	1	04	01	H3335_041_0	6	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	041	0	1	04	01	H3335_041_0	6	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	041	0	1	04	01	H3335_041_0	6	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	042	0	1	04	01	H3335_042_0	6	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	042	0	1	04	01	H3335_042_0	6	6	$35 Copayment	0000000100100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	042	0	1	04	01	H3335_042_0	6	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	042	0	1	04	01	H3335_042_0	6	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	042	0	1	04	01	H3335_042_0	6	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	042	0	1	04	01	H3335_042_0	6	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	042	0	1	04	01	H3335_042_0	6	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	043	0	1	04	01	H3335_043_0	6	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	043	0	1	04	01	H3335_043_0	6	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	043	0	1	04	01	H3335_043_0	6	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	043	0	1	04	01	H3335_043_0	6	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	043	0	1	04	01	H3335_043_0	6	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	043	0	1	04	01	H3335_043_0	6	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	043	0	1	04	01	H3335_043_0	6	6	$35 Copayment	0000000100100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	044	0	1	04	01	H3335_044_0	6	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	044	0	1	04	01	H3335_044_0	6	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	044	0	1	04	01	H3335_044_0	6	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	044	0	1	04	01	H3335_044_0	6	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	044	0	1	04	01	H3335_044_0	6	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	044	0	1	04	01	H3335_044_0	6	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	044	0	1	04	01	H3335_044_0	6	6	$35 Copayment	0000000100100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	5	$25 Copayment	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	4	$175 Copayment	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	3	50% Coinsurance	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H3335	045	0	1	04	01	H3335_045_0	5	2	$0 Copayment	0000000000000000000000000010000000000000000000000	2			1	0.00	0.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	1	30% Coinsurance	0101011001001111111010011101000000111111111101111	1	30	30	2			2	
H3335	045	0	1	04	01	H3335_045_0	5	6	$35 Copayment	0000000100100000000000000000000000000000000000000	2			1	35.00	35.00	2	
H3335	045	0	1	04	01	H3335_045_0	5	7	Smoking Cessation	0000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H3335	801	0	1	04	01	H3335_801_0	6	1	20% Coinsurance	0110111101101111111011011111000001111111111101111	1	20	20	2			2	
H3335	801	0	1	04	01	H3335_801_0	6	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3335	801	0	1	04	01	H3335_801_0	6	3	$0 Copayment	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3335	801	0	1	04	01	H3335_801_0	6	4	50% coinsurance	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3335	811	0	1	04	01	H3335_811_0	6	1	20% Coinsurance	0110111101101111111011011111000001111111111101111	1	20	20	2			2	
H3335	811	0	1	04	01	H3335_811_0	6	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3335	811	0	1	04	01	H3335_811_0	6	3	$0 Copayment	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3335	811	0	1	04	01	H3335_811_0	6	4	50% coinsurance	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3335	813	0	1	04	01	H3335_813_0	6	1	20% Coinsurance	0110111101101111111011011111000001111111111101111	1	20	20	2			2	
H3335	813	0	1	04	01	H3335_813_0	6	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3335	813	0	1	04	01	H3335_813_0	6	3	$0 Copayment	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3335	813	0	1	04	01	H3335_813_0	6	4	50% coinsurance	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3335	819	0	1	04	01	H3335_819_0	6	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3335	819	0	1	04	01	H3335_819_0	6	4	50% coinsurance	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3335	819	0	1	04	01	H3335_819_0	6	3	$0 Copayment	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3335	819	0	1	04	01	H3335_819_0	6	1	20% Coinsurance	0110111101101111111011011111000001111111111101111	1	20	20	2			2	
H3335	820	0	1	04	01	H3335_820_0	6	4	50% coinsurance	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3335	820	0	1	04	01	H3335_820_0	6	3	$0 Copayment	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3335	820	0	1	04	01	H3335_820_0	6	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3335	820	0	1	04	01	H3335_820_0	6	1	20% Coinsurance	0110111101101111111011011111000001111111111101111	1	20	20	2			2	
H3335	822	0	1	04	01	H3335_822_0	6	1	20% Coinsurance	0110111101101111111011011111000001111111111101111	1	20	20	2			2	
H3335	822	0	1	04	01	H3335_822_0	6	4	50% coinsurance	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H3335	822	0	1	04	01	H3335_822_0	6	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3335	822	0	1	04	01	H3335_822_0	6	3	$0 Copayment	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	1	$30.00 Copayment Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	10	$75 to $150 Copayment Group	0000000000000010100000000000000000000000000000000	2			1	75.00	150.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	9	$50 to $100 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	8	50% Coinsurance Group	1000000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	001	0	1	04	01	H3342_001_0	6	7	20% Coinsurance Group	0000000000000001000000011101000000000000011111000	1	20	20	2			2	
H3342	001	0	1	04	01	H3342_001_0	6	6	10% Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3342	001	0	1	04	01	H3342_001_0	6	5	$75 Copayment Group	0000000000000000001000000000000000000000000000000	2			1	75.00	75.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	4	$100 Copayment Group	0010000010010000000110000000000000000001100000000	2			1	100.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	3	$50 Copayment Group	0101010101000000000000000000000000001110000000000	2			1	50.00	50.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	2	$30 to $50 Copayment Group	0000000000100000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	14	$200 Copayment Group	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	13	$0 to $100	0000000000000100000000000000000000000000000000000	2			1	0.00	100.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	12	$50 - $75 Copayment Group	0000000000000000010000000000000000000000000000000	2			1	50.00	75.00	2	
H3342	001	0	1	04	01	H3342_001_0	6	11	$0 Copayment Group	0000000000000000000000000000000000100000000000110	2			1	0.00	0.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	1	$30.00 Copayment Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	8	50% Coinsurance Group	1000000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	002	0	1	04	01	H3342_002_0	7	7	20% Coinsurance Group	0000000000000001000000011101000000000000011111000	1	20	20	2			2	
H3342	002	0	1	04	01	H3342_002_0	7	6	10% Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3342	002	0	1	04	01	H3342_002_0	7	5	$75 Copayment Group	0000000000000000001000000000000000000000000000000	2			1	75.00	75.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	4	$100 Copayment Group	0010000010010000000110000000000000000001100000000	2			1	100.00	100.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	9	$50 to $100 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	2	$30 to $50 Copayment Group	0000000000100000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	14	$200 Copayment Group	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	13	$0 to $100	0000000000000100000000000000000000000000000000000	2			1	0.00	100.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	12	$50 - $75 Copayment Group	0000000000000000010000000000000000000000000000000	2			1	50.00	75.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	11	$0 Copayment Group	0000000000000000000000000000000000100000000000110	2			1	0.00	0.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	10	$75 to $150 Copayment Group	0000000000000010100000000000000000000000000000000	2			1	75.00	150.00	2	
H3342	002	0	1	04	01	H3342_002_0	7	3	$50 Copayment Group	0101010101000000000000000000000000001110000000000	2			1	50.00	50.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	1	$30.00 Copayment Group	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	9	$50 to $100 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	8	50% Coinsurance Group	0000000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	012	0	1	04	01	H3342_012_0	8	7	20% Coinsurance Group	0000000000000001000000011101000000000000011101000	1	20	20	2			2	
H3342	012	0	1	04	01	H3342_012_0	8	6	10% Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3342	012	0	1	04	01	H3342_012_0	8	5	$500 Copayment Group	0000000000000000001000000000000000000000000000000	2			1	500.00	500.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	4	$100 Copayment Group	0010000010010000000110000000000000000001100000000	2			1	100.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	3	$50 Copayment Group	0101010000000000000000000000000000001110000000000	2			1	50.00	50.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	2	$30 to $60 Copayment Group	0000000000100000000000000000000000000000000000000	2			1	30.00	60.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	15	$0 to $100	0000000000000100000000000000000000000000000000000	2			1	0.00	100.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	14	$60 Copayment Group	0000000101000000000000000000000000000000000000000	2			1	60.00	60.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	13	$250 Copayment Group	0000000000000000000001000000000000000000000000000	2			1	250.00	250.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	12	$60 - $500 Copayment Group	0000000000000000010000000000000000000000000000000	2			1	60.00	500.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	11	$0 Copayment Group	0000000000000000000000000000000000100000000000110	2			1	0.00	0.00	2	
H3342	012	0	1	04	01	H3342_012_0	8	10	$125 to $150 Copayment Group	0000000000000010100000000000000000000000000000000	2			1	125.00	150.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	7	$200 Copayment Group	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	6	$125 Copayment Group	0000000000000000001000000000000000000000000000000	2			1	125.00	125.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	5	$100 Copayment Group	0010000010010000000110000000000000000001100000000	2			1	100.00	100.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	4	$50 Copayment Group	0101010101000000000000000000000000001110000000000	2			1	50.00	50.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	3	$30 Copayment Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	2	50% Coinsurance Group	1000000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	013	0	1	04	01	H3342_013_0	8	9	$50 to $100 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	13	20% Coinsurance Group	0000000000000001000000011101000000000000011111000	1	20	20	2			2	
H3342	013	0	1	04	01	H3342_013_0	8	12	10% Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3342	013	0	1	04	01	H3342_013_0	8	11	$75 to $150 Copayment Group	0000000000000010100000000000000000000000000000000	2			1	75.00	150.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	10	$50 to $125 Copayment Group	0000000000000000010000000000000000000000000000000	2			1	50.00	125.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	1	$0 Copayment Group	0000000000000000000000000000000000100000000000110	2			1	0.00	0.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	8	$30 to $50 Copayment Group	0000000000100000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	013	0	1	04	01	H3342_013_0	8	14	$0 to $100	0000000000000100000000000000000000000000000000000	2			1	0.00	100.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	10	$50 to $125 Copayment Group	0000000000000000010000000000000000000000000000000	2			1	50.00	125.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	11	$75 to $150 Copayment Group	0000000000000010100000000000000000000000000000000	2			1	75.00	150.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	12	10% Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3342	014	0	1	04	01	H3342_014_0	6	13	20% Coinsurance Group	0000000000000001000000011101000000000000011111000	1	20	20	2			2	
H3342	014	0	1	04	01	H3342_014_0	6	14	$0 to $100	0000000000000100000000000000000000000000000000000	2			1	0.00	100.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	2	50% Coinsurance Group	1000000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	014	0	1	04	01	H3342_014_0	6	3	$30 Copayment Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	4	$50 Copayment Group	0101010101000000000000000000000000001110000000000	2			1	50.00	50.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	5	$100 Copayment Group	0010000010010000000110000000000000000001100000000	2			1	100.00	100.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	6	$125 Copayment Group	0000000000000000001000000000000000000000000000000	2			1	125.00	125.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	7	$200 Copayment Group	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	8	$30 to $50 Copayment Group	0000000000100000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	9	$50 to $100 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	014	0	1	04	01	H3342_014_0	6	1	$0 Copayment Group	0000000000000000000000000000000000100000000000110	2			1	0.00	0.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	7	$200 Copayment Group	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	9	$50 to $100 Copayment Group	0000001000001000000000000000000000000000000000000	2			1	50.00	100.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	8	$30 to $50 Copayment Group	0000000000100000000000000000000000010000000000000	2			1	30.00	50.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	1	$0 Copayment Group	0000000000000000000000000000000000100000000000110	2			1	0.00	0.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	10	$50 to $125 Copayment Group	0000000000000000010000000000000000000000000000000	2			1	50.00	125.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	11	$75 to $150 Copayment Group	0000000000000010100000000000000000000000000000000	2			1	75.00	150.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	6	$125 Copayment Group	0000000000000000001000000000000000000000000000000	2			1	125.00	125.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	13	20% Coinsurance Group	0000000000000001000000011101000000000000011111000	1	20	20	2			2	
H3342	015	0	1	04	01	H3342_015_0	6	14	$0 to $100	0000000000000100000000000000000000000000000000000	2			1	0.00	100.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	2	50% Coinsurance Group	1000000000000000000000000000000001000000000000001	1	50	50	2			2	
H3342	015	0	1	04	01	H3342_015_0	6	3	$30 Copayment Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	4	$50 Copayment Group	0101010101000000000000000000000000001110000000000	2			1	50.00	50.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	5	$100 Copayment Group	0010000010010000000110000000000000000001100000000	2			1	100.00	100.00	2	
H3342	015	0	1	04	01	H3342_015_0	6	12	10% Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3342	808	0	1	04	01	H3342_808_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3342	808	0	1	04	01	H3342_808_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3342	809	0	1	04	01	H3342_809_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3342	809	0	1	04	01	H3342_809_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3342	810	0	1	04	01	H3342_810_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3342	810	0	1	04	01	H3342_810_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3342	811	0	1	04	01	H3342_811_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H3342	811	0	1	04	01	H3342_811_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3344	003	0	1	04	01	H3344_003_0	6	8	0 - 30%	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3344	003	0	1	04	01	H3344_003_0	6	1	30%	0101001000001111111010000101000000001111111001001	1	30	30	2			2	
H3344	003	0	1	04	01	H3344_003_0	6	2	45%	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3344	003	0	1	04	01	H3344_003_0	6	7	$100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3344	003	0	1	04	01	H3344_003_0	6	4	$0	0000000000000000000000000010000000000000000000010	1	0	0	2			2	
H3344	003	0	1	04	01	H3344_003_0	6	5	0 -20%	0000000000000000000000000000000000100000000100000	1	0	20	2			2	
H3344	003	0	1	04	01	H3344_003_0	6	6	$30	0000100101100000000000000000000000010000000000100	2			1	30.00	30.00	2	
H3344	003	0	1	04	01	H3344_003_0	6	3	50%	0000010000000000000000011000000000000000000010000	1	50	50	2			2	
H3344	005	0	1	04	01	H3344_005_0	4	1	$0	0000000000000000000000000010000000000000000000010	1	0	0	2			2	
H3344	005	0	1	04	01	H3344_005_0	4	2	$150	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3344	005	0	1	04	01	H3344_005_0	4	3	30%	0101101101101111111010000101000000011111111001101	1	30	30	2			2	
H3344	005	0	1	04	01	H3344_005_0	4	4	45%	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3344	005	0	1	04	01	H3344_005_0	4	5	50%	0000010000000000000000011000000000000000000010000	1	50	50	2			2	
H3344	005	0	1	04	01	H3344_005_0	4	6	0 - 20%	0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H3344	005	0	1	04	01	H3344_005_0	4	7	0 -30%	0000000000000000000000000000000001100000000000000	1	0	30	2			2	
H3344	006	0	1	04	01	H3344_006_0	4	7	0-30%	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
H3344	006	0	1	04	01	H3344_006_0	4	6	0 - 20%	0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H3344	006	0	1	04	01	H3344_006_0	4	8	$40	0000100101100000000000000000000000010000000000100	2			1	40.00	40.00	2	
H3344	006	0	1	04	01	H3344_006_0	4	1	$0	0000000000000000000000000010000000000000000000010	1	0	0	2			2	
H3344	006	0	1	04	01	H3344_006_0	4	2	$180	0000000000000000000001000000000000000000000000000	2			1	180.00	180.00	2	
H3344	006	0	1	04	01	H3344_006_0	4	3	30%	0101001000001111111010000101000000101111111001001	1	30	30	2			2	
H3344	006	0	1	04	01	H3344_006_0	4	4	45%	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3344	006	0	1	04	01	H3344_006_0	4	5	50%	0000010000000000000000011000000000000000000000000	1	50	50	2			2	
H3344	801	0	1	04	01	H3344_801_0	3	3	OON $0 copay	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3344	801	0	1	04	01	H3344_801_0	3	1	OON 20% coinsurance	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H3344	801	0	1	04	01	H3344_801_0	3	2	OON 45%	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3344	803	0	1	04	01	H3344_803_0	4	1	OON 20% coinsurance	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H3344	803	0	1	04	01	H3344_803_0	4	2	OON 45%	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3344	803	0	1	04	01	H3344_803_0	4	3	OON $0 copay	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3344	804	0	1	04	01	H3344_804_0	5	1	OON 20% coinsurance	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H3344	804	0	1	04	01	H3344_804_0	5	2	OON 45%	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3344	804	0	1	04	01	H3344_804_0	5	3	OON $0 copay	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	1	20% Coinsurance	0101000000000111011000011100000000000000000100000	1	20	20	2			2	
H3346	002	0	1	04	01	H3346_002_0	7	10	No Coverage	0000000000100000000000100000000000000000000000000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	2	$25 Copay	0010101111011000100110000000000000010000000001101	2			1	25.00	25.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	3	$600 Allowance	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	9	$20 Copay	0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	5	50%	0000000000000000000000000000100000000000000000000	1	50	50	2			2	
H3346	002	0	1	04	01	H3346_002_0	7	6	$0 Copay	0000000000000000000000000011000001101111111000000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	7	$300 Allowance	0000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	8	$100 Allowance	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3346	002	0	1	04	01	H3346_002_0	7	4	$35 Copay	0000000000000000000001000000000000000000000000000	2			1	35.00	35.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	6	$0 Copay	0000000000000000000000000011000001101111111000000	2			1	0.00	0.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	5	50%	0000000000000000000000000000100000000000000000000	1	50	50	2			2	
H3346	007	0	1	04	01	H3346_007_0	7	4	$35 Copay	0000000000000000000001000000000000000000000000000	2			1	35.00	35.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	3	$600 Allowance	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	2	$25 Copay	0010101111011000100110000000000000010000000001101	2			1	25.00	25.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	10	No Coverage	0000000000100000000000100000000000000000000000000	2			1	0.00	0.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	1	20% Coinsurance	0101000000000111011000011100000000000000000100000	1	20	20	2			2	
H3346	007	0	1	04	01	H3346_007_0	7	8	$100 Allowance	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	9	$20 Copay	0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3346	007	0	1	04	01	H3346_007_0	7	7	$300 Allowance	0000000000000000000000000000000000000000000010000	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	5	50%	0000000000000000000000000000100000000000000000000	1	50	50	2			2	
H3346	802	0	1	04	01	H3346_802_0	4	2	$25 Copay	0010101111011000100110000000000000010000000001101	2			1	25.00	25.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	7	$100 Allowance	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	8	No Coverage	0000000000100000000000100000000000000000000010000	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	9	$20	0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	1	20% Coinsurance	0101000000000111011000011100000000000000000100000	1	20	20	2			2	
H3346	802	0	1	04	01	H3346_802_0	4	6	$0 Copay	0000000000000000000000000011000001101111111000000	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	3	$600 Allowance	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3346	802	0	1	04	01	H3346_802_0	4	4	$35 Copay	0000000000000000000001000000000000000000000000000	2			1	35.00	35.00	2	
H3346	803	0	1	04	01	H3346_803_0	5	7	$20 Copay	0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3346	803	0	1	04	01	H3346_803_0	5	6	No Coverage	1000000000100000000000100000000000000000000010010	2			1	0.00	0.00	2	
H3346	803	0	1	04	01	H3346_803_0	5	5	50%	0000000000000000000000000000100000000000000000000	1	50	50	2			2	
H3346	803	0	1	04	01	H3346_803_0	5	4	$25 Copay	0000100000000000000000000000000000010000000000000	2			1	25.00	25.00	2	
H3346	803	0	1	04	01	H3346_803_0	5	3	20% Coinsurance	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3346	803	0	1	04	01	H3346_803_0	5	1	$0	0001000000000101011000000011000001101111111000000	2			1	0.00	0.00	2	
H3346	803	0	1	04	01	H3346_803_0	5	2	$50 Copay	0110001111011010100111000000000000000000000001101	2			1	50.00	50.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	7	No Coverage	1000000000100000000000100000000000000000000010010	2			1	0.00	0.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	8	$20 Copay	0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	1	$40 copay	0110001111011010100110000000000000000000000001101	2			1	40.00	40.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	6	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	3	$20 Copay	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	2	$0 Copay	0001000000000101011000000011000001111111111000000	2			1	0.00	0.00	2	
H3346	804	0	1	04	01	H3346_804_0	3	5	50% Coinsurance	0000000000000000000000000000100000000000000000000	1	50	50	2			2	
H3346	804	0	1	04	01	H3346_804_0	3	4	20% Coinsurance	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3346	805	0	1	04	01	H3346_805_0	4	4	20% Coinsurance	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3346	805	0	1	04	01	H3346_805_0	4	5	50% Coinsurance	0000000000000000000000000000100000000000000000000	1	50	50	2			2	
H3346	805	0	1	04	01	H3346_805_0	4	6	$35 Copay	0000000000000000000001000000000000000000000000000	2			1	35.00	35.00	2	
H3346	805	0	1	04	01	H3346_805_0	4	7	No Coverage	1000000000100000000000100000000000000000000010010	2			1	0.00	0.00	2	
H3346	805	0	1	04	01	H3346_805_0	4	3	$15 Copay	0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H3346	805	0	1	04	01	H3346_805_0	4	2	$0 Copay	0001000000000101011000000011000001111111111000000	2			1	0.00	0.00	2	
H3346	805	0	1	04	01	H3346_805_0	4	1	$20 copay	0110011111011010100110000000000000000000000001101	2			1	20.00	20.00	2	
H3404	001	0	1	04	01	H3404_001_0	9	1	20% Coinsurance	0111111111111111111110011101000000111111111101111	1	20	20	2			2	
H3404	001	0	1	04	01	H3404_001_0	9	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3404	001	0	1	04	01	H3404_001_0	9	3	No Cost Sharing	0000000000000000000000000010000001000000000000000	2			1	0.00	0.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	2	20% Coinsurance	0100000000000111100000011100000000000000000100010	1	20	20	2			2	
H3404	002	0	1	04	01	H3404_002_0	13	3	$100 Copay	0000000000000000001001000000000000000000000000000	2			1	100.00	100.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	5	Primary Care	0000000000000000010000000000000000000000000000000	2			1	0.00	100.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	1	$40 Copay Level	0100111111011000000100000000000000000000000001101	2			1	40.00	40.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	4	No Cost Sharing	0011000000100000000010000011000001111111111000000	2			1	0.00	0.00	2	
H3404	002	0	1	04	01	H3404_002_0	13	6	CORF	0100000000000000000000000000000000000000000000000	1	20	20	1	40.00	40.00	2	
H3404	801	0	1	04	01	H3404_801_0	9	1	Medicare Covered Services 20% Coin Level	1110111101101111111011111111111111111111111111111	1	20	20	2			2	
H3404	801	0	1	04	01	H3404_801_0	9	2	Medicare Covered Services 0% Coin Level	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H3404	801	0	1	04	01	H3404_801_0	9	3	Medicare Covered Services 45% Coin Level	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3404	803	0	1	04	01	H3404_803_0	8	3	Medicare Covered Services 45% Coin Level	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3404	803	0	1	04	01	H3404_803_0	8	2	Medicare Covered Services 0% Coin Level	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H3404	803	0	1	04	01	H3404_803_0	8	1	Medicare Covered Services 20% Coin Level	1110111101101111111011111111111111111111111111111	1	20	20	2			2	
H3404	807	0	1	04	01	H3404_807_0	8	1	Medicare Covered Services 20% Coin Level	1110111101101111111011111111111111111111111111111	1	20	20	2			2	
H3404	807	0	1	04	01	H3404_807_0	8	2	Medicare Covered Services 0% Coin Level	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H3404	807	0	1	04	01	H3404_807_0	8	3	Medicare Covered Services 45% Coin Level	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3404	808	0	1	04	01	H3404_808_0	8	1	Medicare Covered Services 20% Coin Level	1110111101101111111011111111111111111111111111111	1	20	20	2			2	
H3404	808	0	1	04	01	H3404_808_0	8	3	Medicare Covered Services 45% Coin Level	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3404	808	0	1	04	01	H3404_808_0	8	2	Medicare Covered Services 0% Coin Level	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H3405	001	0	1	04	01	H3405_001_0	7	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H3405	001	0	1	04	01	H3405_001_0	7	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H3405	001	0	1	04	01	H3405_001_0	7	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H3405	001	0	1	04	01	H3405_001_0	7	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H3405	001	0	1	04	01	H3405_001_0	7	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3405	001	0	1	04	01	H3405_001_0	7	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H3405	001	0	1	04	01	H3405_001_0	7	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H3405	001	0	1	04	01	H3405_001_0	7	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	9		0000000000000000000000000000000000000000000000100	2			1	35.00	35.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3405	002	0	1	04	01	H3405_002_0	5	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H3405	002	0	1	04	01	H3405_002_0	5	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3405	005	0	1	04	01	H3405_005_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3405	005	0	1	04	01	H3405_005_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H3405	005	0	1	04	01	H3405_005_0	4	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3405	005	0	1	04	01	H3405_005_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H3405	005	0	1	04	01	H3405_005_0	4	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H3405	005	0	1	04	01	H3405_005_0	4	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H3405	005	0	1	04	01	H3405_005_0	4	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H3405	005	0	1	04	01	H3405_005_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
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H3405	006	0	1	04	01	H3405_006_0	4	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H3405	006	0	1	04	01	H3405_006_0	4	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H3405	006	0	1	04	01	H3405_006_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H3405	006	0	1	04	01	H3405_006_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H3405	006	0	1	04	01	H3405_006_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H3405	006	0	1	04	01	H3405_006_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3405	006	0	1	04	01	H3405_006_0	4	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3405	007	0	1	04	01	H3405_007_0	4	8		0000000000000000000000011000000000000000000000000	1	35	35	2			2	
H3405	007	0	1	04	01	H3405_007_0	4	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H3405	007	0	1	04	01	H3405_007_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H3405	007	0	1	04	01	H3405_007_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H3405	007	0	1	04	01	H3405_007_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H3405	007	0	1	04	01	H3405_007_0	4	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3405	007	0	1	04	01	H3405_007_0	4	6		0000000000000000000000000100000000000000000000000	1	20	35	2			2	
H3405	007	0	1	04	01	H3405_007_0	4	9		0000000000000000000000000000000000000000000000100	2			1	35.00	35.00	2	
H3405	007	0	1	04	01	H3405_007_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3410	001	1	1	09	04	H3410_001_1	8	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	15	15	2			2	
H3410	001	1	1	09	04	H3410_001_1	8	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	001	1	1	09	04	H3410_001_1	8	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	20.00	40.00	2	
H3410	001	1	1	09	04	H3410_001_1	8	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3410	001	1	1	09	04	H3410_001_1	8	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H3410	001	1	1	09	04	H3410_001_1	8	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	001	1	1	09	04	H3410_001_1	8	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	001	1	1	09	04	H3410_001_1	8	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3410	001	1	1	09	04	H3410_001_1	8	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
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H3410	001	2	1	09	04	H3410_001_2	8	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	001	2	1	09	04	H3410_001_2	8	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	20.00	40.00	2	
H3410	001	2	1	09	04	H3410_001_2	8	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3410	001	2	1	09	04	H3410_001_2	8	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H3410	001	2	1	09	04	H3410_001_2	8	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	001	2	1	09	04	H3410_001_2	8	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	001	2	1	09	04	H3410_001_2	8	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3410	001	2	1	09	04	H3410_001_2	8	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	001	3	1	09	04	H3410_001_3	8	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	40	40	2			2	
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H3410	001	3	1	09	04	H3410_001_3	8	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H3410	001	3	1	09	04	H3410_001_3	8	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	001	3	1	09	04	H3410_001_3	8	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H3410	001	3	1	09	04	H3410_001_3	8	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3410	001	3	1	09	04	H3410_001_3	8	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	20.00	40.00	2	
H3410	001	3	1	09	04	H3410_001_3	8	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	001	3	1	09	04	H3410_001_3	8	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	15	15	2			2	
H3410	001	3	1	09	04	H3410_001_3	8	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	001	3	1	09	04	H3410_001_3	8	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3410	001	4	1	09	04	H3410_001_4	8	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
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H3410	001	4	1	09	04	H3410_001_4	8	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	001	4	1	09	04	H3410_001_4	8	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	20.00	40.00	2	
H3410	001	4	1	09	04	H3410_001_4	8	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3410	001	4	1	09	04	H3410_001_4	8	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H3410	001	4	1	09	04	H3410_001_4	8	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	001	4	1	09	04	H3410_001_4	8	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	001	5	1	09	04	H3410_001_5	8	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	001	5	1	09	04	H3410_001_5	8	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3410	001	5	1	09	04	H3410_001_5	8	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	40	40	2			2	
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H3410	001	5	1	09	04	H3410_001_5	8	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H3410	001	5	1	09	04	H3410_001_5	8	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	001	5	1	09	04	H3410_001_5	8	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H3410	001	5	1	09	04	H3410_001_5	8	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3410	001	5	1	09	04	H3410_001_5	8	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	20.00	40.00	2	
H3410	001	5	1	09	04	H3410_001_5	8	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	001	5	1	09	04	H3410_001_5	8	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	15	15	2			2	
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H3410	002	1	1	09	04	H3410_002_1	6	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	002	1	1	09	04	H3410_002_1	6	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	10.00	25.00	2	
H3410	002	1	1	09	04	H3410_002_1	6	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H3410	002	1	1	09	04	H3410_002_1	6	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3410	002	1	1	09	04	H3410_002_1	6	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	002	1	1	09	04	H3410_002_1	6	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	002	1	1	09	04	H3410_002_1	6	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3410	002	1	1	09	04	H3410_002_1	6	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	002	2	1	09	04	H3410_002_2	6	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	002	2	1	09	04	H3410_002_2	6	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	10	10	2			2	
H3410	002	2	1	09	04	H3410_002_2	6	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	002	2	1	09	04	H3410_002_2	6	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	10.00	25.00	2	
H3410	002	2	1	09	04	H3410_002_2	6	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H3410	002	2	1	09	04	H3410_002_2	6	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	25.00	25.00	2	
H3410	002	2	1	09	04	H3410_002_2	6	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	002	2	1	09	04	H3410_002_2	6	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	002	2	1	09	04	H3410_002_2	6	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3410	002	3	1	09	04	H3410_002_3	6	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	002	3	1	09	04	H3410_002_3	6	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	10	10	2			2	
H3410	002	3	1	09	04	H3410_002_3	6	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	002	3	1	09	04	H3410_002_3	6	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
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H3410	002	3	1	09	04	H3410_002_3	6	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	002	3	1	09	04	H3410_002_3	6	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	002	4	1	09	04	H3410_002_4	6	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
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H3410	002	4	1	09	04	H3410_002_4	6	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	002	4	1	09	04	H3410_002_4	6	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	25.00	25.00	2	
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H3410	002	4	1	09	04	H3410_002_4	6	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	002	4	1	09	04	H3410_002_4	6	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
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H3410	002	5	1	09	04	H3410_002_5	6	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	10.00	25.00	2	
H3410	002	5	1	09	04	H3410_002_5	6	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	002	5	1	09	04	H3410_002_5	6	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	10	10	2			2	
H3410	002	5	1	09	04	H3410_002_5	6	4	DME and Part B drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	002	5	1	09	04	H3410_002_5	6	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	002	5	1	09	04	H3410_002_5	6	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3410	002	5	1	09	04	H3410_002_5	6	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	40	40	2			2	
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H3410	002	5	1	09	04	H3410_002_5	6	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	003	1	1	09	04	H3410_003_1	9	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H3410	003	1	1	09	04	H3410_003_1	9	4	DME and Part B Drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	003	1	1	09	04	H3410_003_1	9	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	003	1	1	09	04	H3410_003_1	9	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H3410	003	1	1	09	04	H3410_003_1	9	9	E-Consultations	0000000000000000000000000000000100000000000000000	2			1	0.00	0.00	2	
H3410	003	1	1	09	04	H3410_003_1	9	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3410	003	1	1	09	04	H3410_003_1	9	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	15.00	30.00	2	
H3410	003	1	1	09	04	H3410_003_1	9	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	30.00	30.00	2	
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H3410	003	2	1	09	04	H3410_003_2	9	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H3410	003	2	1	09	04	H3410_003_2	9	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3410	003	2	1	09	04	H3410_003_2	9	4	DME and Part B Drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	003	2	1	09	04	H3410_003_2	9	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H3410	003	2	1	09	04	H3410_003_2	9	10	No Cost Sharing	0001000000000100000010000000000001010000000011111	2			1	0.00	0.00	2	
H3410	003	2	1	09	04	H3410_003_2	9	1	Outpatient Services	0100001000001011111000000011000000000000000000000	1	15	15	2			2	
H3410	003	2	1	09	04	H3410_003_2	9	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
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H3410	003	3	1	09	04	H3410_003_3	9	4	DME and Part B Drugs	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H3410	003	3	1	09	04	H3410_003_3	9	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	003	4	1	09	04	H3410_003_4	9	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
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H3410	003	4	1	09	04	H3410_003_4	9	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
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H3410	003	4	1	09	04	H3410_003_4	9	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	30.00	30.00	2	
H3410	003	4	1	09	04	H3410_003_4	9	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H3410	003	4	1	09	04	H3410_003_4	9	11	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	15	1	15.00	30.00	2	
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H3410	003	5	1	09	04	H3410_003_5	9	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
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H3813	003	0	1	04	01	H3813_003_0	10	2	$10.00	0000000000000000000000000100000000000000000000000	2			1	10.00	10.00	2	
H3813	003	0	1	04	01	H3813_003_0	10	3	$200 copayment	0000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H3813	003	0	1	04	01	H3813_003_0	10	4	$20 copayment	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H3813	802	0	1	04	01	H3813_802_0	7	7	$50 copayment	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H3813	802	0	1	04	01	H3813_802_0	7	4	$20 copayment	0110011111111000000110000000000000000000000001001	2			1	20.00	20.00	2	
H3813	802	0	1	04	01	H3813_802_0	7	3	$125 copayment	0000000000000000011000000000000000000000000000000	2			1	125.00	125.00	2	
H3813	802	0	1	04	01	H3813_802_0	7	2	$10.00	0000000000000000000000000100000000000000000000000	2			1	10.00	10.00	2	
H3813	802	0	1	04	01	H3813_802_0	7	1	zero copay	0001000000000100000000000001000001111111111000110	2			1	0.00	0.00	2	
H3813	802	0	1	04	01	H3813_802_0	7	6	10% coinsurance	0000000000000011100000011010000000000000000100000	1	10	10	2			2	
H3813	802	0	1	04	01	H3813_802_0	7	5	$15.00  copayment	0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	1	$35 copay	0000111111111000000110000000000000000000000001101	2			1	35.00	35.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	9	$0 to $225	0000000000000000010000000000000000000000000000000	2			1	0.00	225.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	10	$225 copay	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H3817	001	0	1	04	01	H3817_001_0	5	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3817	001	0	1	04	01	H3817_001_0	5	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3817	001	0	1	04	01	H3817_001_0	5	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H3817	001	0	1	04	01	H3817_001_0	5	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H3817	001	0	1	04	01	H3817_001_0	5	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3817	002	0	1	04	01	H3817_002_0	8	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H3817	002	0	1	04	01	H3817_002_0	8	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H3817	002	0	1	04	01	H3817_002_0	8	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H3817	002	0	1	04	01	H3817_002_0	8	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H3817	002	0	1	04	01	H3817_002_0	8	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3817	002	0	1	04	01	H3817_002_0	8	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3817	002	0	1	04	01	H3817_002_0	8	10	$225 copay	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H3817	002	0	1	04	01	H3817_002_0	8	1	$35 copay	0000111111111000000110000000000000000000000001101	2			1	35.00	35.00	2	
H3817	002	0	1	04	01	H3817_002_0	8	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H3817	002	0	1	04	01	H3817_002_0	8	9	$0 to $225	0000000000000000010000000000000000000000000000000	2			1	0.00	225.00	2	
H3817	002	0	1	04	01	H3817_002_0	8	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	8	0% to 10%	0000000000000000000000000000000000000000000100000	1	0	10	2			2	
H3817	003	0	1	04	01	H3817_003_0	6	9	30%	0000000000000010000000000000000000000000000000000	1	30	30	2			2	
H3817	003	0	1	04	01	H3817_003_0	6	7	$0 to $200	0000000000000000010000000000000000000000000000000	2			1	0.00	200.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	6	$200	0000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	5	20% coinsurance	0000000000000001000000011000000000000000000000000	1	20	20	2			2	
H3817	003	0	1	04	01	H3817_003_0	6	4	10% coinsurance	0001000000000000100000000010000000000000000000000	1	10	10	2			2	
H3817	003	0	1	04	01	H3817_003_0	6	3	$0 copay	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	2	$100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	1	$25 copay	0000111111111000000110000000000000000000000001101	2			1	25.00	25.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	10	$200 vision hardware	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3817	003	0	1	04	01	H3817_003_0	6	11	$500	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3817	801	0	1	04	01	H3817_801_0	7	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H3817	801	0	1	04	01	H3817_801_0	7	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H3817	801	0	1	04	01	H3817_801_0	7	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H3817	801	0	1	04	01	H3817_801_0	7	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3817	802	0	1	04	01	H3817_802_0	5	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H3817	802	0	1	04	01	H3817_802_0	5	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H3817	802	0	1	04	01	H3817_802_0	5	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H3817	802	0	1	04	01	H3817_802_0	5	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H3832	001	0	1	04	01	H3832_001_0	7	7		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3832	001	0	1	04	01	H3832_001_0	7	3		0010000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H3832	001	0	1	04	01	H3832_001_0	7	2		0100111101101000000010000000000000010000000000101	2			1	35.00	35.00	2	
H3832	001	0	1	04	01	H3832_001_0	7	1		0001000000000111011000011100000000001111111100010	1	30	30	2			2	
H3832	001	0	1	04	01	H3832_001_0	7	8		0000000000000000000000000000000000000000000001000	2			1	45.00	45.00	2	
H3832	001	0	1	04	01	H3832_001_0	7	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H3832	001	0	1	04	01	H3832_001_0	7	6		0000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H3832	001	0	1	04	01	H3832_001_0	7	5		0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H3832	801	0	1	04	01	H3832_801_0	4	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
H3832	801	0	1	04	01	H3832_801_0	4	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3832	801	0	1	04	01	H3832_801_0	4	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3832	801	0	1	04	01	H3832_801_0	4	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
H3832	802	0	1	04	01	H3832_802_0	4	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3832	802	0	1	04	01	H3832_802_0	4	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
H3832	802	0	1	04	01	H3832_802_0	4	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3832	802	0	1	04	01	H3832_802_0	4	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
H3832	805	0	1	04	01	H3832_805_0	4	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
H3832	805	0	1	04	01	H3832_805_0	4	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3832	805	0	1	04	01	H3832_805_0	4	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3832	805	0	1	04	01	H3832_805_0	4	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
H3832	806	0	1	04	01	H3832_806_0	4	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
H3832	806	0	1	04	01	H3832_806_0	4	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H3832	806	0	1	04	01	H3832_806_0	4	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3832	806	0	1	04	01	H3832_806_0	4	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
H3909	001	0	1	04	01	H3909_001_0	9	2	Group 2	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H3909	001	0	1	04	01	H3909_001_0	9	4	Group 4	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3909	001	0	1	04	01	H3909_001_0	9	3	Group 3	0000000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
H3909	001	0	1	04	01	H3909_001_0	9	1	Group 1	0111111111111111111110011101000000111111111101111	1	30	30	2			1	500.00
H3909	007	0	1	04	01	H3909_007_0	8	4	Group 4	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H3909	007	0	1	04	01	H3909_007_0	8	3	Group 3	0000000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
H3909	007	0	1	04	01	H3909_007_0	8	2	Group 2	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H3909	007	0	1	04	01	H3909_007_0	8	1	Group 1	0111111111111111111110011101000000111111111101111	1	30	30	2			1	500.00
H3909	801	0	1	04	01	H3909_801_0	3	1		0101111101101111111011011111000001111111111101111	1	30	30	2			1	500.00
H3909	801	0	1	04	01	H3909_801_0	3	2		0010000010010000000100000000000000000000000000000	1	45	45	2			1	500.00
H3909	802	0	1	04	01	H3909_802_0	3	2		0010000010010000000100000000000000000000000000000	1	45	45	2			1	500.00
H3909	802	0	1	04	01	H3909_802_0	3	1		0101111101101111111011011111000001111111111101111	1	30	30	2			1	500.00
H3912	001	0	1	04	01	H3912_001_0	4	2	Group 2	0000000000000000000000000000000000100000000010010	2			1	0.00	0.00	2	
H3912	001	0	1	04	01	H3912_001_0	4	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3912	001	0	1	04	01	H3912_001_0	4	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H3912	001	0	1	04	01	H3912_001_0	4	5	Group 5	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H3912	001	0	1	04	01	H3912_001_0	4	4	Group 4	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	3	Group 3	0000000000000000000000100000000000000000000010000	1	50	50	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	5	Group 5	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H3912	005	0	1	04	01	H3912_005_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
H3912	005	0	1	04	01	H3912_005_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H3916	001	0	1	04	01	H3916_001_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	001	0	1	04	01	H3916_001_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	001	0	1	04	01	H3916_001_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	100.00	100.00	2	
H3916	001	0	1	04	01	H3916_001_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	001	0	1	04	01	H3916_001_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H3916	001	0	1	04	01	H3916_001_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	001	0	1	04	01	H3916_001_0	11	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	001	0	1	04	01	H3916_001_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	001	0	1	04	01	H3916_001_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H3916	002	0	1	04	01	H3916_002_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	002	0	1	04	01	H3916_002_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	002	0	1	04	01	H3916_002_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	002	0	1	04	01	H3916_002_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	002	0	1	04	01	H3916_002_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H3916	002	0	1	04	01	H3916_002_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	002	0	1	04	01	H3916_002_0	11	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	002	0	1	04	01	H3916_002_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	100.00	100.00	2	
H3916	002	0	1	04	01	H3916_002_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H3916	005	0	1	04	01	H3916_005_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	005	0	1	04	01	H3916_005_0	11	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	005	0	1	04	01	H3916_005_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H3916	005	0	1	04	01	H3916_005_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	005	0	1	04	01	H3916_005_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	005	0	1	04	01	H3916_005_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	005	0	1	04	01	H3916_005_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	50.00	50.00	2	
H3916	005	0	1	04	01	H3916_005_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H3916	012	0	1	04	01	H3916_012_0	9	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H3916	012	0	1	04	01	H3916_012_0	9	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	012	0	1	04	01	H3916_012_0	9	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	012	0	1	04	01	H3916_012_0	9	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	012	0	1	04	01	H3916_012_0	9	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	012	0	1	04	01	H3916_012_0	9	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	012	0	1	04	01	H3916_012_0	9	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	012	0	1	04	01	H3916_012_0	9	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H3916	015	0	1	04	01	H3916_015_0	11	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H3916	015	0	1	04	01	H3916_015_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	75.00	75.00	2	
H3916	015	0	1	04	01	H3916_015_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	015	0	1	04	01	H3916_015_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	015	0	1	04	01	H3916_015_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H3916	015	0	1	04	01	H3916_015_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	015	0	1	04	01	H3916_015_0	11	1	Group 1	0111111111111011111110000001000000000000000001011	1	20	20	2			2	
H3916	015	0	1	04	01	H3916_015_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	11	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H3916	018	0	1	04	01	H3916_018_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	018	0	1	04	01	H3916_018_0	11	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H3916	018	0	1	04	01	H3916_018_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	018	0	1	04	01	H3916_018_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	018	0	1	04	01	H3916_018_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	018	0	1	04	01	H3916_018_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	019	0	1	04	01	H3916_019_0	11	8	Group 8	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	019	0	1	04	01	H3916_019_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	30	30	2			2	
H3916	019	0	1	04	01	H3916_019_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	019	0	1	04	01	H3916_019_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	019	0	1	04	01	H3916_019_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	019	0	1	04	01	H3916_019_0	11	5	Group 5	0000000000000000000000010000000001000000000000000	1	0	50	2			2	
H3916	019	0	1	04	01	H3916_019_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	019	0	1	04	01	H3916_019_0	11	7	Group 7	0000000000000000000000000000000000000000000001000	1	30	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	11	7	Group 7	0000000000000000000000000000000000000000000001000	1	30	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	020	0	1	04	01	H3916_020_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	11	5	Group 5	0000000000000000000000010000000001000000000000000	1	0	50	2			2	
H3916	020	0	1	04	01	H3916_020_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	020	0	1	04	01	H3916_020_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	30	30	2			2	
H3916	020	0	1	04	01	H3916_020_0	11	8	Group 8	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	022	0	1	04	01	H3916_022_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	022	0	1	04	01	H3916_022_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	022	0	1	04	01	H3916_022_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	022	0	1	04	01	H3916_022_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	022	0	1	04	01	H3916_022_0	11	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H3916	022	0	1	04	01	H3916_022_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	022	0	1	04	01	H3916_022_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	100.00	100.00	2	
H3916	022	0	1	04	01	H3916_022_0	11	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H3916	024	0	1	04	01	H3916_024_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	100.00	100.00	2	
H3916	024	0	1	04	01	H3916_024_0	11	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H3916	024	0	1	04	01	H3916_024_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	024	0	1	04	01	H3916_024_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	024	0	1	04	01	H3916_024_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	024	0	1	04	01	H3916_024_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	024	0	1	04	01	H3916_024_0	11	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	11	8	Group 8	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H3916	025	0	1	04	01	H3916_025_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H3916	025	0	1	04	01	H3916_025_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	025	0	1	04	01	H3916_025_0	11	5	Group 5	0000000000000000000000010000000001000000000000000	1	0	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	025	0	1	04	01	H3916_025_0	11	7	Group 7	0000000000000000000000000000000000000000000001000	1	30	50	2			2	
H3916	025	0	1	04	01	H3916_025_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	30	30	2			2	
H3916	026	0	1	04	01	H3916_026_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H3916	026	0	1	04	01	H3916_026_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	026	0	1	04	01	H3916_026_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	026	0	1	04	01	H3916_026_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	026	0	1	04	01	H3916_026_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	25.00	25.00	2	
H3916	026	0	1	04	01	H3916_026_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H3916	026	0	1	04	01	H3916_026_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	026	0	1	04	01	H3916_026_0	11	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	027	0	1	04	01	H3916_027_0	11	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H3916	027	0	1	04	01	H3916_027_0	11	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	25.00	25.00	2	
H3916	027	0	1	04	01	H3916_027_0	11	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H3916	027	0	1	04	01	H3916_027_0	11	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H3916	027	0	1	04	01	H3916_027_0	11	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H3916	027	0	1	04	01	H3916_027_0	11	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H3916	027	0	1	04	01	H3916_027_0	11	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H3916	027	0	1	04	01	H3916_027_0	11	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H3916	027	0	1	04	01	H3916_027_0	11	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H3916	801	0	1	04	01	H3916_801_0	8	1	Group 1	0111111101101111111011011111000001011111111101111	1	20	20	2			2	
H3916	801	0	1	04	01	H3916_801_0	8	2	Group 2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3916	801	0	1	04	01	H3916_801_0	8	3	Group 3	0000000000000000000000000000000000100000000000000	1	0	20	2			2	
H3916	802	0	1	04	01	H3916_802_0	8	1	Group 1	0111111101101111111011011111000001011111111101111	1	20	20	2			2	
H3916	802	0	1	04	01	H3916_802_0	8	3	Group 3	0000000000000000000000000000000000100000000000000	1	0	20	2			2	
H3916	802	0	1	04	01	H3916_802_0	8	2	Group 2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3916	804	0	1	04	01	H3916_804_0	8	2	Group 2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3916	804	0	1	04	01	H3916_804_0	8	3	Group 3	0000000000000000000000000000000000100000000000000	1	0	20	2			2	
H3916	804	0	1	04	01	H3916_804_0	8	1	Group 1	0111111101101111111011011111000001011111111101111	1	20	20	2			2	
H3921	001	0	1	04	01	H3921_001_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3921	001	0	1	04	01	H3921_001_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	11	Group 11	0000000000000000000000011100000000000000000100010	1	30	30	2			2	
H3921	001	0	1	04	01	H3921_001_0	4	12	Group 12	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H3921	001	0	1	04	01	H3921_001_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	40.00	40.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	3	Group 3	0001000000000011011000000000000000001111111000000	1	25	25	2			2	
H3921	001	0	1	04	01	H3921_001_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	25	25	1	10.00	10.00	2	
H3921	001	0	1	04	01	H3921_001_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H3921	008	0	1	04	01	H3921_008_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	11	Group 11	0000000000000000000000011100000000000000000100010	1	30	30	2			2	
H3921	008	0	1	04	01	H3921_008_0	4	12	Group 12	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H3921	008	0	1	04	01	H3921_008_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	40.00	40.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	3	Group 3	0001000000000011011000000000000000001111111000000	1	25	25	2			2	
H3921	008	0	1	04	01	H3921_008_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	25	25	1	10.00	10.00	2	
H3921	008	0	1	04	01	H3921_008_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H3923	013	0	1	04	01	H3923_013_0	7	1	Out of Network	1111111111111111111111011111000000111111111111111	1	30	30	2			2	
H3923	013	0	1	04	01	H3923_013_0	7	2	Wellness and Fitness	0000000000000000000000000000000001000000000000000	1	50	50	2			2	
H3923	017	0	1	04	01	H3923_017_0	8	2	Wellness and Fitness	0000000000000000000000000000000001000000000000000	1	50	50	2			2	
H3923	017	0	1	04	01	H3923_017_0	8	1	Out of Network	1111111111111111111111011111000000111111111111111	1	20	20	2			2	
H3923	801	0	1	04	01	H3923_801_0	5	1	Out of Network	1111111101101111111011011111000001111111111111111	1	30	30	2			2	
H3923	801	0	1	04	01	H3923_801_0	5	2	MHSA	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3923	802	0	1	04	01	H3923_802_0	5	2	MHSA	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3923	802	0	1	04	01	H3923_802_0	5	1	Out of Network	1111111101101111111011011111000001111111111111111	1	30	30	2			2	
H3923	803	0	1	04	01	H3923_803_0	5	1	Out of Network	1111111101101111111011011111000001111111111111111	1	30	30	2			2	
H3923	803	0	1	04	01	H3923_803_0	5	2	MHSA	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H3924	001	0	1	04	01	H3924_001_0	4	2	Specialty OON Services	0000010101000000000000000000000000001111110001101	2			1	35.00	35.00	2	
H3924	001	0	1	04	01	H3924_001_0	4	3	All Other Medicare Services	0111001010111111111111011111000001100000001100000	1	20	20	2			2	
H3924	001	0	1	04	01	H3924_001_0	4	4	Preventive Dental OON	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	001	0	1	04	01	H3924_001_0	4	5	Eyewear and Hearing Aids OON	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	001	0	1	04	01	H3924_001_0	4	1	Primary Care Physician Services	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	003	0	1	04	01	H3924_003_0	6	4	Preventive Dental OON	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	003	0	1	04	01	H3924_003_0	6	3	All Other Medicare Services	0111001010111111111111011111000001100000001100000	1	20	20	2			2	
H3924	003	0	1	04	01	H3924_003_0	6	5	Eyewear and Hearing Aids OON	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	003	0	1	04	01	H3924_003_0	6	2	Specialty OON Services	0000010101000000000000000000000000001111110001101	2			1	35.00	35.00	2	
H3924	003	0	1	04	01	H3924_003_0	6	1	Primary Care Physician Services	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	021	0	1	04	01	H3924_021_0	4	1	Primary Care Physician Services	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	021	0	1	04	01	H3924_021_0	4	2	Specialty OON Services	0000010101000000000000000000000000001111110001101	2			1	35.00	35.00	2	
H3924	021	0	1	04	01	H3924_021_0	4	3	All Other Medicare Services	0111001010111111111111011111000001100000001100000	1	20	20	2			2	
H3924	021	0	1	04	01	H3924_021_0	4	4	Preventive Dental OON	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	021	0	1	04	01	H3924_021_0	4	5	Eyewear and Hearing Aids OON	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	023	0	1	04	01	H3924_023_0	5	1	Primary Care Physician Services	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H3924	023	0	1	04	01	H3924_023_0	5	2	Specialty OON Services	0000010101000000000000000000000000001111110001101	2			1	35.00	35.00	2	
H3924	023	0	1	04	01	H3924_023_0	5	3	All Other Medicare Services	0111001010111111111111011111000001100000001100000	1	20	20	2			2	
H3924	023	0	1	04	01	H3924_023_0	5	4	Preventive Dental OON	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H3924	023	0	1	04	01	H3924_023_0	5	5	Eyewear and Hearing Aids OON	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	045	0	1	04	01	H3924_045_0	4	1	Primary Care Physician Care Services	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
H3924	045	0	1	04	01	H3924_045_0	4	6	Eyewear and Hearing Aids	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	045	0	1	04	01	H3924_045_0	4	4	Mental Health Services	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3924	045	0	1	04	01	H3924_045_0	4	5	Preventive Dental	0000000000000000000000000000000000000000000010000	1	25	25	2			2	
H3924	045	0	1	04	01	H3924_045_0	4	3	Other OON Services	0101001000101111111011011111000001100000000100000	1	25	25	2			2	
H3924	045	0	1	04	01	H3924_045_0	4	2	Specialty OON Services	0000010101000000000000000100000000001111111001101	2			1	45.00	45.00	2	
H3924	046	0	1	04	01	H3924_046_0	5	2	Specialty OON Services	0000010101000000000000000100000000001111111001101	2			1	45.00	45.00	2	
H3924	046	0	1	04	01	H3924_046_0	5	1	Primary Care Physician Care Services	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
H3924	046	0	1	04	01	H3924_046_0	5	3	Other OON Services	0101001000101111111011011111000001100000000100000	1	25	25	2			2	
H3924	046	0	1	04	01	H3924_046_0	5	4	Mental Health Services	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3924	046	0	1	04	01	H3924_046_0	5	5	Preventive Dental	0000000000000000000000000000000000000000000010000	1	25	25	2			2	
H3924	046	0	1	04	01	H3924_046_0	5	6	Eyewear and Hearing Aids	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	047	0	1	04	01	H3924_047_0	4	6	Eyewear and Hearing Aids	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	047	0	1	04	01	H3924_047_0	4	5	Preventive Dental	0000000000000000000000000000000000000000000010000	1	25	25	2			2	
H3924	047	0	1	04	01	H3924_047_0	4	4	Mental Health Services	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3924	047	0	1	04	01	H3924_047_0	4	2	Specialty OON Services	0000010101000000000000000100000000001111111001101	2			1	45.00	45.00	2	
H3924	047	0	1	04	01	H3924_047_0	4	1	Primary Care Physician Care Services	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
H3924	047	0	1	04	01	H3924_047_0	4	3	Other OON Services	0101001000101111111011011111000001100000000100000	1	25	25	2			2	
H3924	048	0	1	04	01	H3924_048_0	6	6	Eyewear and Hearing Aids	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H3924	048	0	1	04	01	H3924_048_0	6	4	Mental Health Services	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3924	048	0	1	04	01	H3924_048_0	6	3	Other OON Services	0101001000101111111011011111000001100000000100000	1	25	25	2			2	
H3924	048	0	1	04	01	H3924_048_0	6	2	Specialty OON Services	0000010101000000000000000100000000001111111001101	2			1	45.00	45.00	2	
H3924	048	0	1	04	01	H3924_048_0	6	5	Preventive Dental	0000000000000000000000000000000000000000000010000	1	25	25	2			2	
H3924	048	0	1	04	01	H3924_048_0	6	1	Primary Care Physician Care Services	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
H3924	801	0	1	04	01	H3924_801_0	2	1	OON Medicare Covered Services	0101111101101111111011011111000001111111111101111	1	20	20	2			2	
H3924	801	0	1	04	01	H3924_801_0	2	2	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H3924	802	0	1	04	01	H3924_802_0	3	1	OON Medicare Covered Medical Services	0101111101101111111011011111000001111111111101111	1	20	20	2			2	
H3924	802	0	1	04	01	H3924_802_0	3	2	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H4005	001	0	1	04	01	H4005_001_0	1	3	Group 3	1000000000000000000000000010000001000000000000000	1	0	0	2			2	
H4005	001	0	1	04	01	H4005_001_0	1	2	Group 2	0100011011001000000110000000000000000000011000000	1	25	25	2			2	
H4005	001	0	1	04	01	H4005_001_0	1	1	Group 1	0011100100110111111001011101000000111111100111111	1	20	20	2			2	
H4005	004	0	1	04	01	H4005_004_0	3	3	Group 3	1000000000000000000000000010000001000000000000000	1	0	0	2			2	
H4005	004	0	1	04	01	H4005_004_0	3	2	Group 2	0100011011001000000110000000000000000000011000000	1	25	25	2			2	
H4005	004	0	1	04	01	H4005_004_0	3	1	Group 1	0011100100110111111001011101000000111111100111111	1	20	20	2			2	
H4005	801	0	1	04	01	H4005_801_0	3	1	Group 1	0111111111111111111111111111000001111111111101111	1	20	20	2			2	
H4005	802	0	1	04	01	H4005_802_0	3	1	Group 1	0111111111111111111111111111000001111111111101111	1	20	20	2			2	
H4005	804	0	1	04	01	H4005_804_0	3	1	Group 1	0111111111111111111111111111000001111111111101111	1	20	20	2			2	
H4005	807	0	1	04	01	H4005_807_0	3	1	Group 1	0111111111111111111111111111000001111111111101111	1	20	20	2			2	
H4011	001	0	1	04	01	H4011_001_0	9	3	Out-of-Network Benefits	0000000010010000000100000000000000000000000000010	1	50	50	2			2	
H4011	001	0	1	04	01	H4011_001_0	9	2	Out-of-network Benefits	1000000000000000000000000000000000000000000000000	1	0	0	2			2	
H4011	001	0	1	04	01	H4011_001_0	9	1	Out-of-network Benefits	0111111101101111111011011111000001111111111111101	1	20	20	2			2	
H4011	003	0	1	04	01	H4011_003_0	10	1	Out-of-network Benefits	0111111101101111111011011111000001111111111111101	1	20	20	2			2	
H4011	003	0	1	04	01	H4011_003_0	10	3	Out-of-Network Benefits	0000000010010000000100000000000000000000000000010	1	50	50	2			2	
H4011	003	0	1	04	01	H4011_003_0	10	2	Out-of-network Benefits	1000000000000000000000000000000000000000000000000	1	0	0	2			2	
H4011	801	0	1	04	01	H4011_801_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	801	0	1	04	01	H4011_801_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	802	0	1	04	01	H4011_802_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	802	0	1	04	01	H4011_802_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	803	0	1	04	01	H4011_803_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	803	0	1	04	01	H4011_803_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	805	0	1	04	01	H4011_805_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	805	0	1	04	01	H4011_805_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	806	0	1	04	01	H4011_806_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	806	0	1	04	01	H4011_806_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	807	0	1	04	01	H4011_807_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	807	0	1	04	01	H4011_807_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	809	0	1	04	01	H4011_809_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	809	0	1	04	01	H4011_809_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	810	0	1	04	01	H4011_810_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	810	0	1	04	01	H4011_810_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	811	0	1	04	01	H4011_811_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	811	0	1	04	01	H4011_811_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	813	0	1	04	01	H4011_813_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	813	0	1	04	01	H4011_813_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	814	0	1	04	01	H4011_814_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	814	0	1	04	01	H4011_814_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	815	0	1	04	01	H4011_815_0	9	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	815	0	1	04	01	H4011_815_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
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H4011	817	0	1	04	01	H4011_817_0	9	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	818	0	1	04	01	H4011_818_0	8	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4011	818	0	1	04	01	H4011_818_0	8	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	819	0	1	04	01	H4011_819_0	8	2	Group #2	1111111101101111111011111111000001111111111111111	1	20	20	2			2	
H4011	819	0	1	04	01	H4011_819_0	8	1	Group #1	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4036	003	0	1	04	01	H4036_003_0	7	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	30.00	60.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	30.00	30.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	1	20% OON Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H4036	003	0	1	04	01	H4036_003_0	7	10	OON $0 Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	12	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	15.00	30.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	13	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	2	25% OON Coinsurance	0000000000000010100000011100000000000000000000000	1	25	25	2			2	
H4036	003	0	1	04	01	H4036_003_0	7	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	25	2			2	
H4036	003	0	1	04	01	H4036_003_0	7	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	30.00	225.00	2	
H4036	003	0	1	04	01	H4036_003_0	7	11	OON Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	30.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	45.00	90.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	45.00	45.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	45.00	275.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	1	20% OON Coinsurance	0000000000000001000000000010000000000000000100000	1	20	20	2			2	
H4036	004	0	1	04	01	H4036_004_0	7	10	OON $0 Copayment	0001000000000000000010000001000001111111100001010	2			1	0.00	0.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	11	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	35.00	45.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	12	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	275.00	275.00	2	
H4036	004	0	1	04	01	H4036_004_0	7	2	30% OON Coinsurance	0000000000000010100000011100000000000000011000000	1	30	30	2			2	
H4036	004	0	1	04	01	H4036_004_0	7	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H4036	801	0	1	04	01	H4036_801_0	3	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4036	801	0	1	04	01	H4036_801_0	3	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H4036	802	0	1	04	01	H4036_802_0	3	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
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H4036	803	0	1	04	01	H4036_803_0	3	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H4036	803	0	1	04	01	H4036_803_0	3	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4209	001	0	1	04	01	H4209_001_0	5	4	Vision - See OON General Notes	0000000000000000000000000000000000000000000000110	1	0	50	2			2	
H4209	001	0	1	04	01	H4209_001_0	5	1	Thirty Percent Coinsurance Group	0111011111111111111110011111000001111111111101001	1	30	30	2			2	
H4209	001	0	1	04	01	H4209_001_0	5	2	Primary Care	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4209	001	0	1	04	01	H4209_001_0	5	3	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	2	Primary Care	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	4	Vision - See OON General Notes	0000000000000000000000000000000000000000000000110	1	0	50	2			2	
H4209	003	0	1	04	01	H4209_003_0	5	3	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H4209	003	0	1	04	01	H4209_003_0	5	1	Thirty Percent Coinsurance Group	0111011111111111111110011111000001111111111101001	1	30	30	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	4	Preventive Dental	0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	1	Twenty Percent Coinsurance Group	0110011111111111111110000111000001111111111101001	1	20	20	2			2	
H4209	004	0	1	04	01	H4209_004_0	5	3	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H4209	004	0	1	04	01	H4209_004_0	5	5	Vision - See OON General Notes	0000000000000000000000000000000000000000000000110	1	0	50	2			2	
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H4209	004	0	1	04	01	H4209_004_0	5	6	Primary Care Physician Services	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
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H4209	006	0	1	04	01	H4209_006_0	5	4	Preventive Dental	0000000000000000000000000000000000000000000010000	1	50	50	2			2	
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H4209	006	0	1	04	01	H4209_006_0	5	2	Thirty Percent Coinsurance Group	0001000000000000000000011000000000000000000000000	1	30	30	2			2	
H4209	006	0	1	04	01	H4209_006_0	5	1	Twenty Percent Coinsurance Group	0110011111111111111110000111000001111111111101001	1	20	20	2			2	
H4209	007	0	1	04	01	H4209_007_0	4	4	Preventive Dental	0000000000000000000000000000000000000000000010000	1	50	50	2			2	
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H4209	007	0	1	04	01	H4209_007_0	4	2	Primary Care	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
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H4209	007	0	1	04	01	H4209_007_0	4	5	Vision - See OON General Notes	0000000000000000000000000000000000000000000000110	1	0	50	2			2	
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H4524	001	0	1	04	01	H4524_001_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H4524	001	0	1	04	01	H4524_001_0	4	4	Tier 4	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	007	0	1	04	01	H4524_007_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H4524	007	0	1	04	01	H4524_007_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4524	007	0	1	04	01	H4524_007_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
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H4524	013	0	1	04	01	H4524_013_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H4524	013	0	1	04	01	H4524_013_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
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H4524	801	0	1	04	01	H4524_801_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	802	0	1	04	01	H4524_802_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H4524	802	0	1	04	01	H4524_802_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H4524	802	0	1	04	01	H4524_802_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	805	0	2	04	01	H4524_805_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H4524	805	0	2	04	01	H4524_805_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4524	805	0	2	04	01	H4524_805_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H4524	806	0	2	04	01	H4524_806_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H4524	806	0	2	04	01	H4524_806_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H4524	806	0	2	04	01	H4524_806_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
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H4605	001	0	1	04	01	H4605_001_0	5	1	$35 copay	0000111111111000000110000000000000000000000001101	2			1	35.00	35.00	2	
H4605	001	0	1	04	01	H4605_001_0	5	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4605	001	0	1	04	01	H4605_001_0	5	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H4605	001	0	1	04	01	H4605_001_0	5	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H4605	001	0	1	04	01	H4605_001_0	5	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H4605	001	0	1	04	01	H4605_001_0	5	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H4605	001	0	1	04	01	H4605_001_0	5	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	5	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4605	001	0	1	04	01	H4605_001_0	5	9	$0 to $225	0000000000000000010000000000000000000000000000000	2			1	0.00	225.00	2	
H4605	001	0	1	04	01	H4605_001_0	5	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
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H4605	002	0	1	04	01	H4605_002_0	6	1	$35 copay	0000111111111000000110000000000000000000000001101	2			1	35.00	35.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	10	$225 copay	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H4605	002	0	1	04	01	H4605_002_0	6	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4605	002	0	1	04	01	H4605_002_0	6	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H4605	002	0	1	04	01	H4605_002_0	6	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H4605	002	0	1	04	01	H4605_002_0	6	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H4605	002	0	1	04	01	H4605_002_0	6	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
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H4605	004	0	1	04	01	H4605_004_0	6	9	30%	0000000000000010000000000000000000000000000000000	1	30	30	2			2	
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H4605	004	0	1	04	01	H4605_004_0	6	6	$200	0000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H4605	004	0	1	04	01	H4605_004_0	6	5	20% coinsurance	0000000000000001000000011000000000000000000000000	1	20	20	2			2	
H4605	004	0	1	04	01	H4605_004_0	6	4	10% coinsurance	0001000000000000100000000010000000000000000000000	1	10	10	2			2	
H4605	004	0	1	04	01	H4605_004_0	6	3	$0 copay	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H4605	004	0	1	04	01	H4605_004_0	6	2	$100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4605	004	0	1	04	01	H4605_004_0	6	11	$500	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H4605	004	0	1	04	01	H4605_004_0	6	10	$200 vision hardware	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4605	004	0	1	04	01	H4605_004_0	6	1	$25 copay	0000111111111000000110000000000000000000000001101	2			1	25.00	25.00	2	
H4605	004	0	1	04	01	H4605_004_0	6	8	0% to 10%	0000000000000000000000000000000000000000000100000	1	0	10	2			2	
H4605	801	0	1	04	01	H4605_801_0	3	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H4605	801	0	1	04	01	H4605_801_0	3	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H4605	801	0	1	04	01	H4605_801_0	3	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H4605	801	0	1	04	01	H4605_801_0	3	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H4605	802	0	1	04	01	H4605_802_0	3	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H4605	802	0	1	04	01	H4605_802_0	3	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H4605	802	0	1	04	01	H4605_802_0	3	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H4605	802	0	1	04	01	H4605_802_0	3	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H4606	001	0	1	04	01	H4606_001_0	4	7	Group 7	0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H4606	001	0	1	04	01	H4606_001_0	4	8	Group 8	0000000000000000000000000000000000000000000010000	1	50	80	2			2	
H4606	001	0	1	04	01	H4606_001_0	4	6	Group 6	0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H4606	001	0	1	04	01	H4606_001_0	4	5	Group 5	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H4606	001	0	1	04	01	H4606_001_0	4	4	Group 4	0000000000000000010000000100000000000000000000000	1	20	30	2			2	
H4606	001	0	1	04	01	H4606_001_0	4	3	Group 3	0000000000000001000000000010000000000000000000000	1	20	20	2			2	
H4606	001	0	1	04	01	H4606_001_0	4	2	Group 2	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H4606	001	0	1	04	01	H4606_001_0	4	1	Group 1	0110111111111110101110011000000001011111111001101	1	30	30	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	10	Group 10	0000000000000000000000000000000000000000000010000	1	50	80	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	1	Group 1	0110111111111110101110000000000001011111111001101	1	30	30	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	2	Group 2	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	3	Group 3	0000000000000001000000000010000000000000000000000	1	20	20	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	9	Group 9	0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	5	Group 5	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H4606	006	0	1	04	01	H4606_006_0	3	6	Group 6	0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	7	Group 7	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H4606	006	0	1	04	01	H4606_006_0	3	8	Group 8	0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H4606	006	0	1	04	01	H4606_006_0	3	4	Group 4	0000000000000000010000000000000000000000000000000	1	20	30	2			2	
H4738	001	0	1	04	01	H4738_001_0	4	2	100	1000000000000000000000000000000001000000000011111	1	50	50	2			1	0.00
H4738	001	0	1	04	01	H4738_001_0	4	1	20%	0111111111111111111111100111000000111111111100000	1	20	20	2			2	
H4738	001	0	1	04	01	H4738_001_0	4	3		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H4738	002	0	1	04	01	H4738_002_0	6	3		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H4738	002	0	1	04	01	H4738_002_0	6	2	100	1000000000000000000000000000000001000000000001111	1	50	50	2			1	0.00
H4738	002	0	1	04	01	H4738_002_0	6	1	20%	0111111111111111111111100111000000111111111100000	1	20	20	2			2	
H4754	001	0	1	04	01	H4754_001_0	7	7	Alternative Care	0000000000000000000000000000000100000000000000000	2			1	15.00	15.00	2	
H4754	001	0	1	04	01	H4754_001_0	7	6	Eye wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H4754	001	0	1	04	01	H4754_001_0	7	5	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H4754	001	0	1	04	01	H4754_001_0	7	4	20% coinsurance	0000000000000000000000011000000000000000000100000	1	20	20	2			2	
H4754	001	0	1	04	01	H4754_001_0	7	3	$40 Copay	0000000100000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H4754	001	0	1	04	01	H4754_001_0	7	2	$30 copay	0000110000000000000000000010000000000000000000000	2			1	30.00	30.00	2	
H4754	001	0	1	04	01	H4754_001_0	7	8	$0 Cost Share	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H4754	001	0	1	04	01	H4754_001_0	7	1	15% Coinsurance	0110001011111111111110000101000001111111111001101	1	15	15	2			2	
H4785	001	0	1	09	04	H4785_001_0	6	1		0010000000100000001001011110000000000000000000000	1	20	20	2			2	
H4785	001	0	1	09	04	H4785_001_0	6	10		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H4785	001	0	1	09	04	H4785_001_0	6	11		0000000100000000000000000000000000000000000000000	2			1	15.00	35.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	12		0000000000000100000000000000000000000000000000000	1	0	25	1	0.00	35.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	13		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	3		0100100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	4		0000010011010000000000000000000000000000000001001	2			1	35.00	35.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	5		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	6		0000000000000000000100000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	7		0000001000001000000010000000000000000000000000000	1	25	25	1	15.00	15.00	2	
H4785	001	0	1	09	04	H4785_001_0	6	8		0000000000000000010000000000000000000000000000000	1	20	25	2			2	
H4785	001	0	1	09	04	H4785_001_0	6	9		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H4785	003	0	1	09	04	H4785_003_0	2	3		0000000000000100000000000000000000000000000000100	1	0	20	2			2	
H4785	003	0	1	09	04	H4785_003_0	2	1		0110111111111011111111011110000000000000000101001	1	20	20	2			2	
H4785	003	0	1	09	04	H4785_003_0	2	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H4785	801	0	1	09	04	H4785_801_0	2	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4785	801	0	1	09	04	H4785_801_0	2	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H4785	801	0	1	09	04	H4785_801_0	2	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H4785	802	0	1	09	04	H4785_802_0	2	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H4785	802	0	1	09	04	H4785_802_0	2	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H4785	802	0	1	09	04	H4785_802_0	2	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4785	803	0	1	09	04	H4785_803_0	2	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H4785	803	0	1	09	04	H4785_803_0	2	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4785	803	0	1	09	04	H4785_803_0	2	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H4875	011	0	1	04	01	H4875_011_0	7	1	$75 Copay	0000000000000000011000000000000000000000000000000	2			1	75.00	75.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	4	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	11	20% Coinsurance	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H4875	011	0	1	04	01	H4875_011_0	7	12	Covered in Full	0001000000000000000000000001000100000000000000010	2			1	0.00	0.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	2	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	3	$40 Copay	0000111111111110000100000000000000000000000001101	2			1	40.00	40.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	10	30% Coinsurance	0000000000000000000000011000000010000000000000000	1	30	30	2			2	
H4875	011	0	1	04	01	H4875_011_0	7	5	$25 Copay	0000000000000001100000000000000000000000000000000	2			1	25.00	25.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	6	$20 Copay	0000000000000100000000000000000000010000000000000	2			1	20.00	20.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	7	$15 Copay	0000000000000000000000000000000001000000000000000	2			1	15.00	15.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	8	$10 Copay	0000000000000000000010000110000000101111111000000	2			1	10.00	10.00	2	
H4875	011	0	1	04	01	H4875_011_0	7	9	40% Coinsurance	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H4875	012	0	1	04	01	H4875_012_0	6	1	$75 Copay	0000000000000000011000000000000000000000000000000	2			1	75.00	75.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	10	30% Coinsurance	0000000000000000000000011000000010000000000000000	1	30	30	2			2	
H4875	012	0	1	04	01	H4875_012_0	6	9	40% Coinsurance	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H4875	012	0	1	04	01	H4875_012_0	6	8	$10 Copay	0000000000000000000010000110000000101111111000000	2			1	10.00	10.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	7	$15 Copay	0000000000000000000000000000000001000000000000000	2			1	15.00	15.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	6	$20 Copay	0000000000000100000000000000000000010000000000000	2			1	20.00	20.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	5	$25 Copay	0000000000000001100000000000000000000000000000000	2			1	25.00	25.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	4	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	3	$40 Copay	0000111111111110000100000000000000000000000001101	2			1	40.00	40.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	2	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	12	Covered in Full	0001000000000000000000000001000100000000000000010	2			1	0.00	0.00	2	
H4875	012	0	1	04	01	H4875_012_0	6	11	20% Coinsurance	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H4875	013	0	1	04	01	H4875_013_0	6	11	20% Coinsurance	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H4875	013	0	1	04	01	H4875_013_0	6	3	$40 Copay	0000111111111110000100000000000000000000000001101	2			1	40.00	40.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	4	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	5	$25 Copay	0000000000000001100000000000000000000000000000000	2			1	25.00	25.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	6	$20 Copay	0000000000000100000000000000000000010000000000000	2			1	20.00	20.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	2	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	10	30% Coinsurance	0000000000000000000000011000000010000000000000000	1	30	30	2			2	
H4875	013	0	1	04	01	H4875_013_0	6	1	$75 Copay	0000000000000000011000000000000000000000000000000	2			1	75.00	75.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	9	40% Coinsurance	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H4875	013	0	1	04	01	H4875_013_0	6	8	$10 Copay	0000000000000000000010000110000000101111111000000	2			1	10.00	10.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	12	Covered in Full	0001000000000000000000000001000100000000000000010	2			1	0.00	0.00	2	
H4875	013	0	1	04	01	H4875_013_0	6	7	$15 Copay	0000000000000000000000000000000001000000000000000	2			1	15.00	15.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	9	40% Coinsurance	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H4875	014	0	1	04	01	H4875_014_0	6	3	$40 Copay	0000111111111110000100000000000000000000000001101	2			1	40.00	40.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	7	$15 Copay	0000000000000000000000000000000001000000000000000	2			1	15.00	15.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	6	$20 Copay	0000000000000100000000000000000000010000000000000	2			1	20.00	20.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	5	$25 Copay	0000000000000001100000000000000000000000000000000	2			1	25.00	25.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	4	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	8	$10 Copay	0000000000000000000010000110000000101111111000000	2			1	10.00	10.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	2	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	12	Covered in Full	0001000000000000000000000001000100000000000000010	2			1	0.00	0.00	2	
H4875	014	0	1	04	01	H4875_014_0	6	11	20% Coinsurance	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H4875	014	0	1	04	01	H4875_014_0	6	10	30% Coinsurance	0000000000000000000000011000000010000000000000000	1	30	30	2			2	
H4875	014	0	1	04	01	H4875_014_0	6	1	$75 Copay	0000000000000000011000000000000000000000000000000	2			1	75.00	75.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	3	$40 Copay	0000111111111110000100000000000000000000000001101	2			1	40.00	40.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	2	$50 Copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	12	Covered in Full	0001000000000000000000000001000100000000000000010	2			1	0.00	0.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	11	20% Coinsurance	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H4875	015	0	1	04	01	H4875_015_0	6	10	30% Coinsurance	0000000000000000000000011000000010000000000000000	1	30	30	2			2	
H4875	015	0	1	04	01	H4875_015_0	6	7	$15 Copay	0000000000000000000000000000000001000000000000000	2			1	15.00	15.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	8	$10 Copay	0000000000000000000010000110000000101111111000000	2			1	10.00	10.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	9	40% Coinsurance	0010000000000000000000000000000000000000000000000	1	40	40	2			2	
H4875	015	0	1	04	01	H4875_015_0	6	4	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	5	$25 Copay	0000000000000001100000000000000000000000000000000	2			1	25.00	25.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	6	$20 Copay	0000000000000100000000000000000000010000000000000	2			1	20.00	20.00	2	
H4875	015	0	1	04	01	H4875_015_0	6	1	$75 Copay	0000000000000000011000000000000000000000000000000	2			1	75.00	75.00	2	
H4875	801	0	1	04	01	H4875_801_0	5	1	20% - 40% Coinsurance	0111111111111111111111011111000001111111111101111	1	20	45	2			2	
H4875	802	0	1	04	01	H4875_802_0	3	1	20% - 40% Coinsurance	0111111111111111111111011111000001111111111101111	1	20	45	2			2	
H4908	005	0	1	04	01	H4908_005_0	5	3	$0 Copay	0000000000000000000000000000000000111111110000000	2			1	0.00	0.00	2	
H4908	005	0	1	04	01	H4908_005_0	5	2	30% Coinsurance	0110111111111111111111011101000001000000001101111	1	30	30	2			2	
H4908	005	0	1	04	01	H4908_005_0	5	1	$15 Copay	0001000000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4908	005	0	1	04	01	H4908_005_0	5	4	20% Coinsurance	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H4908	006	0	1	04	01	H4908_006_0	6	3	$0 Copay	0000000000000000000000000000000000111111110000000	2			1	0.00	0.00	2	
H4908	006	0	1	04	01	H4908_006_0	6	2	35% Coinsurance	0110111111111111111111011101000001000000001101111	1	35	35	2			2	
H4908	006	0	1	04	01	H4908_006_0	6	1	$15 Copay	0001000000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H4908	006	0	1	04	01	H4908_006_0	6	4	20% Coinsurance	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H4909	001	0	1	04	01	H4909_001_0	10	10	$40 - $225	0000000000000000010000000000000000000000000000000	2			1	40.00	225.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	11	$90	0000000000000000100000000000000000000000000000000	2			1	90.00	90.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	12	$90 - $135	0000000000000010000000000000000000000000000000000	2			1	90.00	135.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	2	$40 Copay	0110000111010000000100000000000000000000000000001	2			1	40.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	3	$0 Copay	0001100000000000000010000101000001111111111001010	2			1	0.00	0.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	4	$10	0000010000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	5	$40 - $55	0000001000001000000000000000000000000000000000000	2			1	40.00	55.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	6	$225	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	7	$175	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	8	$0 - $40	0000000000100000000000000000000000000000000000110	2			1	0.00	40.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	9	$0 - $125	0000000000000100000000000000000000000000000000000	2			1	0.00	125.00	2	
H4909	001	0	1	04	01	H4909_001_0	10	1	20% Coinsurance	0000000000000001000000011010000000000000000100000	1	20	20	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	11	$20 - $35 Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	20.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	13	$40 - $250 Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	40.00	250.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	14	25% Coinsurance	0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	2	30% Coinsurance	0000000000000010100000000100000000000000000000000	1	30	30	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	3	0% - 30% Coinsurance Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H4909	004	0	1	04	01	H4909_004_0	9	4	$250 Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	250.00	250.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	5	$20 PCP	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	6	$35 Specialist	0100010101000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	7	$35 - $70  PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	35.00	70.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	8	$50 Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	9	$100 Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	12	$0 - $35 Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	35.00	2	
H4909	004	0	1	04	01	H4909_004_0	9	1	20% Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H4909	007	0	1	04	01	H4909_007_0	6	4	$225 Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	9	$100 Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	8	$50 Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	7	$35 - $70  PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	35.00	70.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	6	$35 Specialist	0100010101000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	5	$25 PCP	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	3	0% - 30% Coinsurance Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H4909	007	0	1	04	01	H4909_007_0	6	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	11	$25 - $35 Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	25.00	35.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	12	$0 - $35 Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	35.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	13	$35 - $225 Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	35.00	225.00	2	
H4909	007	0	1	04	01	H4909_007_0	6	2	30% Coinsurance	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
H4909	007	0	1	04	01	H4909_007_0	6	1	20% Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H4909	804	0	1	04	01	H4909_804_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H4909	804	0	1	04	01	H4909_804_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4909	805	0	1	04	01	H4909_805_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4909	805	0	1	04	01	H4909_805_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H4909	806	0	1	04	01	H4909_806_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H4909	806	0	1	04	01	H4909_806_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4909	807	0	1	04	01	H4909_807_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H4909	807	0	1	04	01	H4909_807_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	4		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H4956	001	0	1	04	01	H4956_001_0	5	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H4956	001	0	1	04	01	H4956_001_0	5	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H4956	001	0	1	04	01	H4956_001_0	5	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H4956	002	0	1	04	01	H4956_002_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H4956	002	0	1	04	01	H4956_002_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H4956	002	0	1	04	01	H4956_002_0	4	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H4956	003	0	1	04	01	H4956_003_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H4956	003	0	1	04	01	H4956_003_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H4956	003	0	1	04	01	H4956_003_0	4	8		0000000000000000000000011000000000000000000000000	1	35	35	2			2	
H4956	003	0	1	04	01	H4956_003_0	4	7		0000000000000000000000000000000001000000000000000	1	50	50	2			2	
H4956	003	0	1	04	01	H4956_003_0	4	6		0000000000000000000000000100000000000000000000000	1	20	35	2			2	
H4956	003	0	1	04	01	H4956_003_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H4956	003	0	1	04	01	H4956_003_0	4	4		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H4956	003	0	1	04	01	H4956_003_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	004	0	1	04	01	H4956_004_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H4956	004	0	1	04	01	H4956_004_0	4	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H4956	004	0	1	04	01	H4956_004_0	4	6		0000000000000000000000000100000000000000000000000	1	20	35	2			2	
H4956	004	0	1	04	01	H4956_004_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H4956	004	0	1	04	01	H4956_004_0	4	4		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H4956	004	0	1	04	01	H4956_004_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H4956	004	0	1	04	01	H4956_004_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H4956	004	0	1	04	01	H4956_004_0	4	8		0000000000000000000000011000000000000000000000000	1	35	35	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	10	$300 copay	0000000000000000001000000000000000000000000000000	2			1	300.00	300.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	9	$0 to $300	0000000000000000010000000000000000000000000000000	2			1	0.00	300.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	1	$40 copay	0000111111111000000110000000000000000000000001101	2			1	40.00	40.00	2	
H5009	001	0	1	04	01	H5009_001_0	4	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	10	$300 copay	0000000000000000001000000000000000000000000000000	2			1	300.00	300.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	1	$40 copay	0000111111111000000110000000000000000000000001101	2			1	40.00	40.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	9	$0 to $300	0000000000000000010000000000000000000000000000000	2			1	0.00	300.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H5009	002	0	1	04	01	H5009_002_0	7	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H5009	002	0	1	04	01	H5009_002_0	7	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5009	004	0	1	04	01	H5009_004_0	7	2	$100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5009	004	0	1	04	01	H5009_004_0	7	11	$500	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H5009	004	0	1	04	01	H5009_004_0	7	4	10% coinsurance	0001000000000000100000000010000000000000000000000	1	10	10	2			2	
H5009	004	0	1	04	01	H5009_004_0	7	5	20% coinsurance	0000000000000001000000011000000000000000000000000	1	20	20	2			2	
H5009	004	0	1	04	01	H5009_004_0	7	6	$200	0000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H5009	004	0	1	04	01	H5009_004_0	7	7	$0 to $200	0000000000000000010000000000000000000000000000000	2			1	0.00	200.00	2	
H5009	004	0	1	04	01	H5009_004_0	7	8	0% to 10%	0000000000000000000000000000000000000000000100000	1	0	10	2			2	
H5009	004	0	1	04	01	H5009_004_0	7	9	30%	0000000000000010000000000000000000000000000000000	1	30	30	2			2	
H5009	004	0	1	04	01	H5009_004_0	7	10	$200 vision hardware	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5009	004	0	1	04	01	H5009_004_0	7	1	$30 copay	0000111111111000000110000000000000000000000001101	2			1	30.00	30.00	2	
H5009	004	0	1	04	01	H5009_004_0	7	3	$0 copay	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H5009	801	0	1	04	01	H5009_801_0	3	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H5009	801	0	1	04	01	H5009_801_0	3	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5009	801	0	1	04	01	H5009_801_0	3	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H5009	801	0	1	04	01	H5009_801_0	3	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H5009	802	0	1	04	01	H5009_802_0	3	4	20%	0110111101101011111111011110000001010111111101101	1	20	20	2			2	
H5009	802	0	1	04	01	H5009_802_0	3	3	0% to 20%	0000000000000100000000000000000000101000000000000	1	0	20	2			2	
H5009	802	0	1	04	01	H5009_802_0	3	2	45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5009	802	0	1	04	01	H5009_802_0	3	1	$0	0001000000000000000000000001000000000000000000010	2			1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	1	$40 copay	0000111111111000000110000000000000000000000001101	2			1	40.00	40.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	10	$300 copay	0000000000000000001000000000000000000000000000000	2			1	300.00	300.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H5010	001	0	1	04	01	H5010_001_0	4	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H5010	001	0	1	04	01	H5010_001_0	4	9	$0 to $300	0000000000000000010000000000000000000000000000000	2			1	0.00	300.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H5010	001	0	1	04	01	H5010_001_0	4	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H5010	001	0	1	04	01	H5010_001_0	4	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5010	001	0	1	04	01	H5010_001_0	4	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	9	$0 to $300	0000000000000000010000000000000000000000000000000	2			1	0.00	300.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	8	$100	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	7	$0 - no cost sharing	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	6	10% to 20%	0000000000000000000000000000000000000000000100000	1	10	20	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	5	30% coinsurance	0000000000000010000000011000000000000000000000000	1	30	30	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	4	20% coinsurance	0001000000000001100000000000000000000000000000000	1	20	20	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	3	10% coinsurance	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	2	$100 copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	11	$500 preventive dental	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H5010	002	0	1	04	01	H5010_002_0	7	1	$40 copay	0000111111111000000110000000000000000000000001101	2			1	40.00	40.00	2	
H5010	002	0	1	04	01	H5010_002_0	7	10	$300 copay	0000000000000000001000000000000000000000000000000	2			1	300.00	300.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	2	$100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	11	$500	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
H5010	004	0	1	04	01	H5010_004_0	7	10	$200 vision hardware	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	1	$30 copay	0000111111111000000110000000000000000000000001101	2			1	30.00	30.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	8	0% to 10%	0000000000000000000000000000000000000000000100000	1	0	10	2			2	
H5010	004	0	1	04	01	H5010_004_0	7	3	$0 copay	0110000000000100000000000101000001111111111000000	2			1	0.00	0.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	7	$0 to $200	0000000000000000010000000000000000000000000000000	2			1	0.00	200.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	6	$200	0000000000000000001000000000000000000000000000000	2			1	200.00	200.00	2	
H5010	004	0	1	04	01	H5010_004_0	7	5	20% coinsurance	0000000000000001000000011000000000000000000000000	1	20	20	2			2	
H5010	004	0	1	04	01	H5010_004_0	7	4	10% coinsurance	0001000000000000100000000010000000000000000000000	1	10	10	2			2	
H5010	004	0	1	04	01	H5010_004_0	7	9	30%	0000000000000010000000000000000000000000000000000	1	30	30	2			2	
H5016	001	0	1	04	01	H5016_001_0	8	11	Diabetes Self Monitoring	0000000000000000000000000000000000000000010000000	2			1	25.00	25.00	2	
H5016	001	0	1	04	01	H5016_001_0	8	12	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5016	001	0	1	04	01	H5016_001_0	8	13	Blood	0000000000000000000000000001000000000000000000000	2			1	0.00	0.00	2	
H5016	001	0	1	04	01	H5016_001_0	8	10	Prosthetic Devices	0000000000000000000000001000000000000000000000000	1	20	20	2			2	
H5016	001	0	1	04	01	H5016_001_0	8	1	Home Health Services/Radiology Services	0001000000000011100000000000000000000000000100000	1	10	10	2			2	
H5016	001	0	1	04	01	H5016_001_0	8	5	End Stage Renal Disease	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
H5016	001	0	1	04	01	H5016_001_0	8	4	Ambulatory Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5016	001	0	1	04	01	H5016_001_0	8	3	Durable Medical Equipment	0000000000000000000000010000000000000000000000000	1	20	20	2			2	
H5016	001	0	1	04	01	H5016_001_0	8	2	Doctor Office Visits/Provider Services	0000111111111000000000000000000000010000000001101	2			1	25.00	25.00	2	
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H5042	002	0	1	04	01	H5042_002_0	5	8	$0 - $35 Copayment	0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H5042	002	0	1	04	01	H5042_002_0	5	7	20% coinsurance	0000000000000000000000011100000000000000000000010	1	20	20	2			2	
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H5042	004	0	1	04	01	H5042_004_0	4	6	$0-$20 copayment	0000000000000000000000000000000001000000000000000	2			1	0.00	20.00	2	
H5042	004	0	1	04	01	H5042_004_0	4	8	$0 - $20 copayment	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5042	004	0	1	04	01	H5042_004_0	4	7	20% coinsurance	0000000000000000000000011100000000000000000000010	1	20	20	2			2	
H5042	005	0	1	04	01	H5042_005_0	7	6	$0-$35 copayment	0000000000000000000000000000000001000000000000000	2			1	0.00	35.00	2	
H5042	005	0	1	04	01	H5042_005_0	7	5	$250 copayment	0000000000000000011000000000000000000000000000000	2			1	250.00	250.00	2	
H5042	005	0	1	04	01	H5042_005_0	7	4	$125 copayment	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5042	005	0	1	04	01	H5042_005_0	7	3	$15 copayment	0000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	005	0	1	04	01	H5042_005_0	7	2	$35 copayment	0010111111111111100110000010000000000000000000001	2			1	35.00	35.00	2	
H5042	005	0	1	04	01	H5042_005_0	7	1	$0 copayment	0101000000000000000000100001000000111111111011000	2			1	0.00	0.00	2	
H5042	005	0	1	04	01	H5042_005_0	7	7	20% coinsurance	0000000000000000000000011100000000000000000000010	1	20	20	2			2	
H5042	005	0	1	04	01	H5042_005_0	7	8	$0 - $35 Copayment	0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H5042	006	0	1	04	01	H5042_006_0	3	1	$0 copayment	1111100000000111100000100001000000111111111011000	2			1	0.00	0.00	2	
H5042	006	0	1	04	01	H5042_006_0	3	2	$10 copayment	0000011111111000000110000010000000000000000000001	2			1	10.00	10.00	2	
H5042	006	0	1	04	01	H5042_006_0	3	3	$15 copayment	0000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	006	0	1	04	01	H5042_006_0	3	4	$50 copayment	0000000000000000011001000000000000000000000000000	2			1	50.00	50.00	2	
H5042	006	0	1	04	01	H5042_006_0	3	5	20% coinsurance	0000000000000000000000011100000000000000000000010	1	20	20	2			2	
H5042	006	0	1	04	01	H5042_006_0	3	6	$0-$10 copayment	0000000000000000000000000000000001000000000000000	2			1	0.00	10.00	2	
H5042	006	0	1	04	01	H5042_006_0	3	7	$0 - $10 Copayment	0000000000000000000000000000000000000000000000100	2			1	0.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	5	1	$0 copayment	1111100000000111100000100001000000111111111011000	2			1	0.00	0.00	2	
H5042	007	0	1	04	01	H5042_007_0	5	2	$10 copayment	0000011111111000000110000010000000000000000000001	2			1	10.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	5	3	$15 copayment	0000000000000000000000000000000000000000000100000	2			1	15.00	15.00	2	
H5042	007	0	1	04	01	H5042_007_0	5	4	$50 copayment	0000000000000000011001000000000000000000000000000	2			1	50.00	50.00	2	
H5042	007	0	1	04	01	H5042_007_0	5	5	20% coinsurance	0000000000000000000000011100000000000000000000010	1	20	20	2			2	
H5042	007	0	1	04	01	H5042_007_0	5	7	$0 - $10 Copayment	0000000000000000000000000000000000000000000000100	2			1	0.00	10.00	2	
H5042	007	0	1	04	01	H5042_007_0	5	6	$0-$10 copayment	0000000000000000000000000000000001000000000000000	2			1	0.00	10.00	2	
H5042	801	0	1	04	01	H5042_801_0	2	1	0%-50% Coinsurance	0111111111111111111111011111000001111111111101111	1	0	50	2			2	
H5042	802	0	1	04	01	H5042_802_0	3	1	0%-50% Coinsurance	0111111111111111111111011111000001111111111101111	1	0	50	2			2	
H5042	803	0	1	04	01	H5042_803_0	2	1	0%-50% Coinsurance	0111111111111111111111011111000001111111111101111	1	0	50	2			2	
H5106	013	0	1	04	01	H5106_013_0	10	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H5106	013	0	1	04	01	H5106_013_0	10	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H5106	013	0	1	04	01	H5106_013_0	10	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	013	0	1	04	01	H5106_013_0	10	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H5106	013	0	1	04	01	H5106_013_0	10	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	013	0	1	04	01	H5106_013_0	10	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H5106	013	0	1	04	01	H5106_013_0	10	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H5106	013	0	1	04	01	H5106_013_0	10	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H5106	014	0	1	04	01	H5106_014_0	10	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H5106	014	0	1	04	01	H5106_014_0	10	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H5106	014	0	1	04	01	H5106_014_0	10	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	014	0	1	04	01	H5106_014_0	10	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H5106	014	0	1	04	01	H5106_014_0	10	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	014	0	1	04	01	H5106_014_0	10	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H5106	014	0	1	04	01	H5106_014_0	10	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	75.00	75.00	2	
H5106	014	0	1	04	01	H5106_014_0	10	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H5106	014	0	1	04	01	H5106_014_0	10	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H5106	015	0	1	04	01	H5106_015_0	9	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	015	0	1	04	01	H5106_015_0	9	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H5106	015	0	1	04	01	H5106_015_0	9	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H5106	015	0	1	04	01	H5106_015_0	9	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H5106	015	0	1	04	01	H5106_015_0	9	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H5106	015	0	1	04	01	H5106_015_0	9	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H5106	015	0	1	04	01	H5106_015_0	9	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	015	0	1	04	01	H5106_015_0	9	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H5106	016	0	1	04	01	H5106_016_0	9	9	Group 9	0000000000000000000000000000000000000000000001000	1	20	50	2			2	
H5106	016	0	1	04	01	H5106_016_0	9	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H5106	016	0	1	04	01	H5106_016_0	9	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	20	2			2	
H5106	016	0	1	04	01	H5106_016_0	9	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	016	0	1	04	01	H5106_016_0	9	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H5106	016	0	1	04	01	H5106_016_0	9	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	016	0	1	04	01	H5106_016_0	9	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H5106	016	0	1	04	01	H5106_016_0	9	1	Group 1	0111111111111011111110000001000000000000000000011	1	20	20	2			2	
H5106	016	0	1	04	01	H5106_016_0	9	2	Group 2	0000000000000000000001000000000000000000000000000	1	20	20	1	75.00	75.00	2	
H5106	017	0	1	04	01	H5106_017_0	10	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	017	0	1	04	01	H5106_017_0	10	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H5106	017	0	1	04	01	H5106_017_0	10	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H5106	017	0	1	04	01	H5106_017_0	10	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H5106	017	0	1	04	01	H5106_017_0	10	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	100.00	100.00	2	
H5106	017	0	1	04	01	H5106_017_0	10	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H5106	017	0	1	04	01	H5106_017_0	10	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	017	0	1	04	01	H5106_017_0	10	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H5106	018	0	1	04	01	H5106_018_0	10	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	10	3	Group 3	0000000000000000000000101100000000000000000000000	1	50	50	2			2	
H5106	018	0	1	04	01	H5106_018_0	10	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	100.00	100.00	2	
H5106	018	0	1	04	01	H5106_018_0	10	1	Group 1	0111111111111011111110000001000000000000000001011	1	30	30	2			2	
H5106	018	0	1	04	01	H5106_018_0	10	8	Group 8	0000000000000000000000010000000000000000000000000	1	0	50	2			2	
H5106	018	0	1	04	01	H5106_018_0	10	7	Group 7	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H5106	018	0	1	04	01	H5106_018_0	10	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	018	0	1	04	01	H5106_018_0	10	5	Group 5	0000000000000000000000000000000001000000000000000	1	0	50	2			1	500.00
H5106	025	0	1	04	01	H5106_025_0	10	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	025	0	1	04	01	H5106_025_0	10	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H5106	025	0	1	04	01	H5106_025_0	10	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H5106	025	0	1	04	01	H5106_025_0	10	1	Group 1	0111111111111011111110000001000000000000000000011	1	30	30	2			2	
H5106	025	0	1	04	01	H5106_025_0	10	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	025	0	1	04	01	H5106_025_0	10	5	Group 5	0000000000000000000000010000000001000000000000000	1	0	50	2			2	
H5106	025	0	1	04	01	H5106_025_0	10	8	Group 8	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H5106	025	0	1	04	01	H5106_025_0	10	7	Group 7	0000000000000000000000000000000000000000000001000	1	30	50	2			2	
H5106	026	0	1	04	01	H5106_026_0	10	7	Group 7	0000000000000000000000000000000000000000000001000	1	30	50	2			2	
H5106	026	0	1	04	01	H5106_026_0	10	8	Group 8	0000000000000100000000000010000000000000000100100	1	0	30	2			2	
H5106	026	0	1	04	01	H5106_026_0	10	6	Group 6	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5106	026	0	1	04	01	H5106_026_0	10	5	Group 5	0000000000000000000000010000000001000000000000000	1	0	50	2			2	
H5106	026	0	1	04	01	H5106_026_0	10	4	Group 4	0000000000000000000000000000000000111111111000000	2			1	0.00	0.00	2	
H5106	026	0	1	04	01	H5106_026_0	10	3	Group 3	0000000000000000000000101100000000000000000010000	1	50	50	2			2	
H5106	026	0	1	04	01	H5106_026_0	10	2	Group 2	0000000000000000000001000000000000000000000000000	1	30	30	1	75.00	75.00	2	
H5106	026	0	1	04	01	H5106_026_0	10	1	Group 1	0111111111111011111110000001000000000000000000011	1	30	30	2			2	
H5106	806	0	1	04	01	H5106_806_0	6	1	Group 1	0111111101101111111011011111000001011111111101111	1	20	20	2			2	
H5106	806	0	1	04	01	H5106_806_0	6	3	Group 3	0000000000000000000000000000000000100000000000000	1	0	20	2			2	
H5106	806	0	1	04	01	H5106_806_0	6	2	Group 2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5106	807	0	1	04	01	H5106_807_0	6	2	Group 2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5106	807	0	1	04	01	H5106_807_0	6	1	Group 1	0111111101101111111011011111000001011111111101111	1	20	20	2			2	
H5106	807	0	1	04	01	H5106_807_0	6	3	Group 3	0000000000000000000000000000000000100000000000000	1	0	20	2			2	
H5106	808	0	1	04	01	H5106_808_0	6	1	Group 1	0111111101101111111011011111000001011111111101111	1	20	20	2			2	
H5106	808	0	1	04	01	H5106_808_0	6	3	Group 3	0000000000000000000000000000000000100000000000000	1	0	20	2			2	
H5106	808	0	1	04	01	H5106_808_0	6	2	Group 2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5162	001	0	1	04	01	H5162_001_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	001	0	1	04	01	H5162_001_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	001	0	1	04	01	H5162_001_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	001	0	1	04	01	H5162_001_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	001	0	1	04	01	H5162_001_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	001	0	1	04	01	H5162_001_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	001	0	1	04	01	H5162_001_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	001	0	1	04	01	H5162_001_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H5162	001	0	1	04	01	H5162_001_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	001	0	1	04	01	H5162_001_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	002	0	1	04	01	H5162_002_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5162	002	0	1	04	01	H5162_002_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	002	0	1	04	01	H5162_002_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	002	0	1	04	01	H5162_002_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	002	0	1	04	01	H5162_002_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	002	0	1	04	01	H5162_002_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	002	0	1	04	01	H5162_002_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	002	0	1	04	01	H5162_002_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H5162	002	0	1	04	01	H5162_002_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	002	0	1	04	01	H5162_002_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H5162	003	0	1	04	01	H5162_003_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	003	0	1	04	01	H5162_003_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	003	0	1	04	01	H5162_003_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	003	0	1	04	01	H5162_003_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	004	0	1	04	01	H5162_004_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	004	0	1	04	01	H5162_004_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5162	004	0	1	04	01	H5162_004_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	004	0	1	04	01	H5162_004_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	004	0	1	04	01	H5162_004_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	004	0	1	04	01	H5162_004_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	004	0	1	04	01	H5162_004_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	004	0	1	04	01	H5162_004_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	004	0	1	04	01	H5162_004_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H5162	004	0	1	04	01	H5162_004_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	005	0	1	04	01	H5162_005_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H5162	005	0	1	04	01	H5162_005_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	005	0	1	04	01	H5162_005_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	005	0	1	04	01	H5162_005_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	005	0	1	04	01	H5162_005_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	005	0	1	04	01	H5162_005_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	005	0	1	04	01	H5162_005_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	006	0	1	04	01	H5162_006_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	006	0	1	04	01	H5162_006_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H5162	006	0	1	04	01	H5162_006_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	006	0	1	04	01	H5162_006_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5162	006	0	1	04	01	H5162_006_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
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H5162	006	0	1	04	01	H5162_006_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	006	0	1	04	01	H5162_006_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	006	0	1	04	01	H5162_006_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	006	0	1	04	01	H5162_006_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	007	0	1	04	01	H5162_007_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	007	0	1	04	01	H5162_007_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	007	0	1	04	01	H5162_007_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	007	0	1	04	01	H5162_007_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	007	0	1	04	01	H5162_007_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	007	0	1	04	01	H5162_007_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	007	0	1	04	01	H5162_007_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	007	0	1	04	01	H5162_007_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	007	0	1	04	01	H5162_007_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H5162	007	0	1	04	01	H5162_007_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	008	0	1	04	01	H5162_008_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	008	0	1	04	01	H5162_008_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5162	008	0	1	04	01	H5162_008_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	008	0	1	04	01	H5162_008_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H5162	008	0	1	04	01	H5162_008_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H5162	008	0	1	04	01	H5162_008_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	008	0	1	04	01	H5162_008_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	008	0	1	04	01	H5162_008_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	008	0	1	04	01	H5162_008_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
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H5162	009	0	1	04	01	H5162_009_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	009	0	1	04	01	H5162_009_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	009	0	1	04	01	H5162_009_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	009	0	1	04	01	H5162_009_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	009	0	1	04	01	H5162_009_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	009	0	1	04	01	H5162_009_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
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H5162	009	0	1	04	01	H5162_009_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	009	0	1	04	01	H5162_009_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	009	0	1	04	01	H5162_009_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H5162	010	0	1	04	01	H5162_010_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
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H5162	010	0	1	04	01	H5162_010_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	010	0	1	04	01	H5162_010_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	010	0	1	04	01	H5162_010_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	010	0	1	04	01	H5162_010_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	010	0	1	04	01	H5162_010_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5162	010	0	1	04	01	H5162_010_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
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H5162	010	0	1	04	01	H5162_010_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	011	0	1	04	01	H5162_011_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
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H5162	011	0	1	04	01	H5162_011_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	011	0	1	04	01	H5162_011_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	011	0	1	04	01	H5162_011_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
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H5162	011	0	1	04	01	H5162_011_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H5162	011	0	1	04	01	H5162_011_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H5162	011	0	1	04	01	H5162_011_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	011	0	1	04	01	H5162_011_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H5162	012	0	1	04	01	H5162_012_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	012	0	1	04	01	H5162_012_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5162	012	0	1	04	01	H5162_012_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
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H5162	012	0	1	04	01	H5162_012_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	012	0	1	04	01	H5162_012_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	012	0	1	04	01	H5162_012_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H5162	012	0	1	04	01	H5162_012_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5162	012	0	1	04	01	H5162_012_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H5162	012	0	1	04	01	H5162_012_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H5162	013	0	1	04	01	H5162_013_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
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H5162	013	0	1	04	01	H5162_013_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	013	0	1	04	01	H5162_013_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	013	0	1	04	01	H5162_013_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	013	0	1	04	01	H5162_013_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
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H5162	013	0	1	04	01	H5162_013_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	013	0	1	04	01	H5162_013_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	014	0	1	04	01	H5162_014_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
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H5162	014	0	1	04	01	H5162_014_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H5162	014	0	1	04	01	H5162_014_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5162	014	0	1	04	01	H5162_014_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H5162	014	0	1	04	01	H5162_014_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H5162	014	0	1	04	01	H5162_014_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	014	0	1	04	01	H5162_014_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	014	0	1	04	01	H5162_014_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H5162	014	0	1	04	01	H5162_014_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H5162	801	0	1	04	01	H5162_801_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5162	801	0	1	04	01	H5162_801_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
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H5162	801	0	1	04	01	H5162_801_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H5162	801	0	1	04	01	H5162_801_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H5162	801	0	1	04	01	H5162_801_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5162	801	0	1	04	01	H5162_801_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5162	801	0	1	04	01	H5162_801_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
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H5215	002	0	1	04	01	H5215_002_0	7	4	$45 Cost Share Group	0000011101101000000000000000000000000000000001111	2			1	45.00	45.00	2	
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H5215	006	0	1	04	01	H5215_006_0	7	5	$100 Cost Share Group	0000000000000000011000000000000000000000000000000	2			1	100.00	100.00	2	
H5215	006	0	1	04	01	H5215_006_0	7	4	$40 Cost Share Group	0001000000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5215	006	0	1	04	01	H5215_006_0	7	2	$30 Cost Share Group	0000100000000100100000000000000000000000000001000	2			1	30.00	30.00	2	
H5215	006	0	1	04	01	H5215_006_0	7	3	$35 Cost Share Group	0110011111111001000110000011000100011111111000111	2			1	35.00	35.00	2	
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H5215	008	0	1	04	01	H5215_008_0	9	13	$35 Cost Share Group	0000100000000000000000000000000000010000000000000	2			1	35.00	35.00	2	
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H5215	008	0	1	04	01	H5215_008_0	9	7	$75 Cost Share Group	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5215	008	0	1	04	01	H5215_008_0	9	8	$25 Cost Share Group	0000000000000100000000000000000000000000000000000	2			1	25.00	25.00	2	
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H5215	008	0	1	04	01	H5215_008_0	9	12	$215 Cost Share Group	0000000000000000011000000000000000000000000000000	2			1	215.00	215.00	2	
H5215	008	0	1	04	01	H5215_008_0	9	11	$125 Cost Share Group	0000000000000010000000000000000000000000000000000	2			1	125.00	125.00	2	
H5215	008	0	1	04	01	H5215_008_0	9	10	$40 Cost Share Group	0001000010010000000000000000000000000000000000000	2			1	40.00	40.00	2	
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H5415	807	0	2	04	01	H5415_807_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H5415	808	0	2	04	01	H5415_808_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
H5415	808	0	2	04	01	H5415_808_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5415	808	0	2	04	01	H5415_808_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
H5417	001	0	1	04	01	H5417_001_0	5	2	Group 2	0000000000000000000000000000000000100000000010010	2			1	0.00	0.00	2	
H5417	001	0	1	04	01	H5417_001_0	5	1	Group 1	0111111111111011111111011101000001011111111100101	1	30	30	2			2	
H5417	001	0	1	04	01	H5417_001_0	5	4	Group 4	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
H5417	001	0	1	04	01	H5417_001_0	5	3	Group 3	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5417	001	0	1	04	01	H5417_001_0	5	5	Group 5	0000000000000100000000000000000000000000000001000	1	0	30	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	11	Group 11	0000000000000000000000000000000000000000000000010	1	0	30	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	3	Group 3	0001000000000011011000011100000000001111111100000	1	30	30	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	12	Group 12	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H5424	001	0	1	04	01	H5424_001_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H5424	001	0	1	04	01	H5424_001_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	25.00	25.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	11	Group 11	0000000000000000000000000000000000000000000000010	1	0	30	2			2	
H5424	003	0	1	04	01	H5424_003_0	1	12	Group 12	0000010000000000000000000000100000000000000000000	1	50	50	2			2	
H5424	003	0	1	04	01	H5424_003_0	1	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5424	003	0	1	04	01	H5424_003_0	1	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	25.00	25.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5424	003	0	1	04	01	H5424_003_0	1	3	Group 3	0001000000000011011000011100000000001111111100000	1	30	30	2			2	
H5424	005	0	1	04	01	H5424_005_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
H5424	005	0	1	04	01	H5424_005_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
H5424	005	0	1	04	01	H5424_005_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5424	005	0	1	04	01	H5424_005_0	4	3	Group 3	0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5424	005	0	1	04	01	H5424_005_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H5429	001	0	1	04	01	H5429_001_0	10	8		0000000000000000000000000000000000000000000100000	1	23	23	2			2	
H5429	001	0	1	04	01	H5429_001_0	10	9		0000001000001000000010000000000000000000000000000	1	25	25	1	25.00	25.00	2	
H5429	001	0	1	04	01	H5429_001_0	10	7		0010000000000000000000000000000000000000000000000	2			1	269.00	269.00	2	
H5429	001	0	1	04	01	H5429_001_0	10	6		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5429	001	0	1	04	01	H5429_001_0	10	5		0000010111110000000100000000000000000000001000000	2			1	40.00	40.00	2	
H5429	001	0	1	04	01	H5429_001_0	10	4		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5429	001	0	1	04	01	H5429_001_0	10	3		0000000000000000001000000000000000000000000000000	1	10	10	2			2	
H5429	001	0	1	04	01	H5429_001_0	10	2		0100000000000000010000011000000000000000000000000	1	25	25	2			2	
H5429	001	0	1	04	01	H5429_001_0	10	10		0000000000000000000000000000000001111111110000000	1	0	0	2			2	
H5429	001	0	1	04	01	H5429_001_0	10	1		1001000000000111100000000111000000000000000011111	1	30	30	2			2	
H5429	053	0	1	04	01	H5429_053_0	9	1		1001000000000111100000000111000000000000000011111	1	30	30	2			2	
H5429	053	0	1	04	01	H5429_053_0	9	10		0000000000000000000000000000000001111111110000000	1	0	0	2			2	
H5429	053	0	1	04	01	H5429_053_0	9	2		0100000000000000010000011000000000000000000000000	1	25	25	2			2	
H5429	053	0	1	04	01	H5429_053_0	9	3		0000000000000000001000000000000000000000000000000	1	10	10	2			2	
H5429	053	0	1	04	01	H5429_053_0	9	8		0000000000000000000000000000000000000000000100000	1	23	23	2			2	
H5429	053	0	1	04	01	H5429_053_0	9	5		0000010111110000000100000000000000000000001000000	2			1	40.00	40.00	2	
H5429	053	0	1	04	01	H5429_053_0	9	6		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5429	053	0	1	04	01	H5429_053_0	9	7		0010000000000000000000000000000000000000000000000	2			1	269.00	269.00	2	
H5429	053	0	1	04	01	H5429_053_0	9	9		0000001000001000000010000000000000000000000000000	1	25	25	1	25.00	25.00	2	
H5429	053	0	1	04	01	H5429_053_0	9	4		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5434	002	0	1	04	01	H5434_002_0	10	1	30% coinsurance	0110111111111111111110011101000000111111111101111	1	30	30	2			2	
H5434	002	0	1	04	01	H5434_002_0	10	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5434	002	0	1	04	01	H5434_002_0	10	3	Renal Dialysis	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5434	002	0	1	04	01	H5434_002_0	10	4	Zero copayment	0001000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
H5434	801	0	1	04	01	H5434_801_0	11	2	All Other	0110111111111111111111011111000001011111111101111	1	23	23	2			2	
H5434	801	0	1	04	01	H5434_801_0	11	1	Zero coinsurance	0001000000000000000000000000000000100000000000000	1	0	0	2			2	
H5434	802	0	1	04	01	H5434_802_0	8	1	Zero Coinsurance	0001000000000000000000000000000000100000000000000	1	0	0	2			2	
H5434	802	0	1	04	01	H5434_802_0	8	2	All Other	0110111111111111111111011111000001011111111101111	1	23	23	2			2	
H5439	001	0	1	04	01	H5439_001_0	3	7	Coinsurance 20%	0000000000000000000000011100000000000000000100000	1	20	20	2			2	
H5439	001	0	1	04	01	H5439_001_0	3	6	Copayment $50	0010010010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5439	001	0	1	04	01	H5439_001_0	3	5	Copayment $15	0000000000000000000000000010000000000000000000000	2			1	15.00	15.00	2	
H5439	001	0	1	04	01	H5439_001_0	3	4	No Cost	0001000000000000000000000000000001000000000000010	2			1	0.00	0.00	2	
H5439	001	0	1	04	01	H5439_001_0	3	3	Copayment $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5439	001	0	1	04	01	H5439_001_0	3	2	Copayment $200	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5439	001	0	1	04	01	H5439_001_0	3	1	Coinsurance 10%	0000100100100111111000000001000000111111111001101	1	10	10	2			2	
H5439	002	0	1	04	01	H5439_002_0	3	7	Coinsurance 20%	0000000000000000000000000100000000000000000000000	1	20	20	2			2	
H5439	002	0	1	04	01	H5439_002_0	3	6	Coinsurance 30%	0001000000000111111100011001000000111111111100101	1	30	30	2			2	
H5439	002	0	1	04	01	H5439_002_0	3	5	Copayment $20	0000000000000000000000000010000000000000000000000	2			1	20.00	20.00	2	
H5439	002	0	1	04	01	H5439_002_0	3	4	No Cost	0000000000000000000000000000000001000000000001010	2			1	0.00	0.00	2	
H5439	002	0	1	04	01	H5439_002_0	3	3	Copayment $40	0110011111111000000010000000000000000000000000000	2			1	40.00	40.00	2	
H5439	002	0	1	04	01	H5439_002_0	3	1	Copayment $30	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5439	002	0	1	04	01	H5439_002_0	3	2	Copayment $250	0000000000000000000001000000000000000000000000000	2			1	250.00	250.00	2	
H5439	003	0	1	04	01	H5439_003_0	3	2	Copayment $250	0000000000000000000001000000000000000000000000000	2			1	250.00	250.00	2	
H5439	003	0	1	04	01	H5439_003_0	3	1	Copayment $30	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5439	003	0	1	04	01	H5439_003_0	3	3	Copayment $40	0110011111111000000010000000000000000000000000000	2			1	40.00	40.00	2	
H5439	003	0	1	04	01	H5439_003_0	3	4	No Cost	0000000000000000000000000000000001000000000001010	2			1	0.00	0.00	2	
H5439	003	0	1	04	01	H5439_003_0	3	5	Copayment $20	0000000000000000000000000010000000000000000000000	2			1	20.00	20.00	2	
H5439	003	0	1	04	01	H5439_003_0	3	6	Coinsurance 30%	0001000000000111111100011001000000111111111100101	1	30	30	2			2	
H5439	003	0	1	04	01	H5439_003_0	3	7	Coinsurance 20%	0000000000000000000000000100000000000000000000000	1	20	20	2			2	
H5439	801	0	1	04	01	H5439_801_0	1	3	Coinsurance 0% - 20%	0000000000000100000000000000000001000000000000000	1	0	20	2			2	
H5439	801	0	1	04	01	H5439_801_0	1	4	Coinsurance 45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5439	801	0	1	04	01	H5439_801_0	1	2	Coinsurance 20%	0110111101101011111111011111000000111111111101111	1	20	20	2			2	
H5439	801	0	1	04	01	H5439_801_0	1	1	Coinsurance 0%	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5439	802	0	1	04	01	H5439_802_0	1	1	Coinsurance 0%	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5439	802	0	1	04	01	H5439_802_0	1	2	Coinsurance 20%	0110111101101011111111011111000000111111111101111	1	20	20	2			2	
H5439	802	0	1	04	01	H5439_802_0	1	3	Coinsurance 0% - 20%	0000000000000100000000000000000001000000000000000	1	0	20	2			2	
H5439	802	0	1	04	01	H5439_802_0	1	4	Coinsurance 45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5439	803	0	1	04	01	H5439_803_0	1	4	Coinsurance 45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5439	803	0	1	04	01	H5439_803_0	1	3	Coinsurance 0% - 20%	0000000000000100000000000000000001000000000000000	1	0	20	2			2	
H5439	803	0	1	04	01	H5439_803_0	1	2	Coinsurance 20%	0110111101101011111111011111000000111111111101111	1	20	20	2			2	
H5439	803	0	1	04	01	H5439_803_0	1	1	Coinsurance 0%	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	10		0000000000000000000000000100000000000000000000000	1	20	25	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	11		0000000000000001000000000000000000000000000000000	1	20	20	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	12		0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	2		0000110101110000000000000000000000011100000001001	2			1	35.00	35.00	2	
H5470	002	0	1	04	01	H5470_002_0	8	3		0000000000000000000000000000000001000000000000100	2			1	0.00	35.00	2	
H5470	002	0	1	04	01	H5470_002_0	8	4		0000001010001110100110000001000000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	002	0	1	04	01	H5470_002_0	8	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5470	002	0	1	04	01	H5470_002_0	8	6		0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	8		0000000000000000000000000000001000100000000000010	2			1	0.00	0.00	2	
H5470	002	0	1	04	01	H5470_002_0	8	9		0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H5470	002	0	1	04	01	H5470_002_0	8	1		0111000000000000011000000000000000000000000000000	1	30	30	2			2	
H5470	005	0	1	04	01	H5470_005_0	8	1		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H5470	005	0	1	04	01	H5470_005_0	8	10		0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5470	005	0	1	04	01	H5470_005_0	8	2		0000110101110000000000000000000000011100000001001	2			1	35.00	35.00	2	
H5470	005	0	1	04	01	H5470_005_0	8	3		0000000000000000000000000000000001000000000000100	2			1	0.00	35.00	2	
H5470	005	0	1	04	01	H5470_005_0	8	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H5470	005	0	1	04	01	H5470_005_0	8	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5470	005	0	1	04	01	H5470_005_0	8	6		0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H5470	005	0	1	04	01	H5470_005_0	8	9		0000000000000001000000000000000000000000000000000	1	20	20	2			2	
H5470	005	0	1	04	01	H5470_005_0	8	8		0000000000000000000000000000001000100000000000010	2			1	0.00	0.00	2	
H5470	005	0	1	04	01	H5470_005_0	8	4		0000001010001110100110000001000000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	007	0	1	04	01	H5470_007_0	7	8		0000000000000000000000000000001000100000000000010	2			1	0.00	0.00	2	
H5470	007	0	1	04	01	H5470_007_0	7	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H5470	007	0	1	04	01	H5470_007_0	7	6		0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H5470	007	0	1	04	01	H5470_007_0	7	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5470	007	0	1	04	01	H5470_007_0	7	4		0000001010001110100110000001000000000011111000000	1	30	30	1	35.00	35.00	2	
H5470	007	0	1	04	01	H5470_007_0	7	3		0000000000000000000000000000000001000000000000100	2			1	0.00	35.00	2	
H5470	007	0	1	04	01	H5470_007_0	7	2		0000110101110000000000000000000000011100000001001	2			1	35.00	35.00	2	
H5470	007	0	1	04	01	H5470_007_0	7	10		0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5470	007	0	1	04	01	H5470_007_0	7	9		0000000000000001000000000000000000000000000000000	1	20	20	2			2	
H5470	007	0	1	04	01	H5470_007_0	7	1		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H5480	801	0	1	09	04	H5480_801_0	3	3	0 Percent	0001000000000000000000000000000000000000000000000	2			2			2	
H5480	801	0	1	09	04	H5480_801_0	3	2	45 Percent	0000000010010000000100000000000000000000000000000	1	0	45	2			2	
H5480	801	0	1	09	04	H5480_801_0	3	1	20 Percent	1110111101101111111011111111111111111111111111111	1	0	20	2			2	
H5480	802	0	1	09	04	H5480_802_0	3	2	45 Percent	0000000010010000000100000000000000000000000000000	1	0	45	2			2	
H5480	802	0	1	09	04	H5480_802_0	3	3	0 Percent	0001000000000000000000000000000000000000000000000	2			2			2	
H5480	802	0	1	09	04	H5480_802_0	3	1	20 Percent	1110111101101111111011111111111111111111111111111	1	0	20	2			2	
H5480	803	0	1	09	04	H5480_803_0	3	1	20 Percent	1110111101101111111011111111111111111111111111111	1	0	20	2			2	
H5480	803	0	1	09	04	H5480_803_0	3	3	0 Percent	0001000000000000000000000000000000000000000000000	2			2			2	
H5480	803	0	1	09	04	H5480_803_0	3	2	45 Percent	0000000010010000000100000000000000000000000000000	1	0	45	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	4	Group 4	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	5	Group 5	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	6	Group 6	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	7	Group 7	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	3	Group 3	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	9	Group 9	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	1	Group 1	0101101101101011011010011100000000011111111101111	1	30	30	2			2	
H5507	001	0	1	04	01	H5507_001_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5507	001	0	1	04	01	H5507_001_0	4	8	Group 8	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5508	001	0	1	04	01	H5508_001_0	9	4	Group 4	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	001	0	1	04	01	H5508_001_0	9	1	Group 1	0110111101111111111111011111000000000000011101111	1	20	20	2			2	
H5508	001	0	1	04	01	H5508_001_0	9	2	Group 2	0001000000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	001	0	1	04	01	H5508_001_0	9	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	002	0	1	04	01	H5508_002_0	5	1	Group 1	0110111101111111111111011111000000000000011101111	1	20	20	2			2	
H5508	002	0	1	04	01	H5508_002_0	5	2	Group 2	0001000000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	002	0	1	04	01	H5508_002_0	5	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	002	0	1	04	01	H5508_002_0	5	4	Group 4	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	004	0	1	04	01	H5508_004_0	9	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	004	0	1	04	01	H5508_004_0	9	1	Group 1	0110111101111111111111011111000000000000011101111	1	20	20	2			2	
H5508	004	0	1	04	01	H5508_004_0	9	2	Group 2	0001000000000000000000000000000001111111100000000	2			1	0.00	0.00	2	
H5508	004	0	1	04	01	H5508_004_0	9	4	Group 4	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
H5508	801	0	1	04	01	H5508_801_0	3	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	801	0	1	04	01	H5508_801_0	3	1	Group 1	0110111101111111111111011111000001010111111101111	1	20	20	2			2	
H5508	801	0	1	04	01	H5508_801_0	3	2	Group 2	0001000000000000000000000000000000101000000000000	2			1	0.00	0.00	2	
H5508	802	0	1	04	01	H5508_802_0	3	1	Group 1	0110111101111111111111011111000001010111111101111	1	20	20	2			2	
H5508	802	0	1	04	01	H5508_802_0	3	2	Group 2	0001000000000000000000000000000000101000000000000	2			1	0.00	0.00	2	
H5508	802	0	1	04	01	H5508_802_0	3	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	803	0	1	04	01	H5508_803_0	3	1	Group 1	0110111101111111111111011111000001010111111101111	1	20	20	2			2	
H5508	803	0	1	04	01	H5508_803_0	3	2	Group 2	0001000000000000000000000000000000101000000000000	2			1	0.00	0.00	2	
H5508	803	0	1	04	01	H5508_803_0	3	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	804	0	1	04	01	H5508_804_0	3	1	Group 1	0110111101111111111111011111000001010111111101111	1	20	20	2			2	
H5508	804	0	1	04	01	H5508_804_0	3	3	Group 3	0000000010000000000000000000000000000000000000000	1	45	45	2			2	
H5508	804	0	1	04	01	H5508_804_0	3	2	Group 2	0001000000000000000000000000000000101000000000000	2			1	0.00	0.00	2	
H5509	001	0	1	04	01	H5509_001_0	12	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	001	0	1	04	01	H5509_001_0	12	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	001	0	1	04	01	H5509_001_0	12	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	001	0	1	04	01	H5509_001_0	12	1		0110111111111111111110011111000000111111111101111	1	30	30	2			2	
H5509	003	0	1	04	01	H5509_003_0	8	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	003	0	1	04	01	H5509_003_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	003	0	1	04	01	H5509_003_0	8	1		0110111111111111111110011111000000111111111101111	1	20	20	2			2	
H5509	003	0	1	04	01	H5509_003_0	8	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	010	0	1	04	01	H5509_010_0	8	1		0110111111111111111110011111000000111111111101111	1	25	25	2			2	
H5509	010	0	1	04	01	H5509_010_0	8	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	010	0	1	04	01	H5509_010_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	010	0	1	04	01	H5509_010_0	8	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	011	0	1	04	01	H5509_011_0	8	1		0110111111111111111110011111000000111111111101111	1	25	25	2			2	
H5509	011	0	1	04	01	H5509_011_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	011	0	1	04	01	H5509_011_0	8	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	011	0	1	04	01	H5509_011_0	8	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	012	0	1	04	01	H5509_012_0	8	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	012	0	1	04	01	H5509_012_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	012	0	1	04	01	H5509_012_0	8	1		0110111111111111111110011111000000111111111101111	1	20	20	2			2	
H5509	012	0	1	04	01	H5509_012_0	8	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	014	0	1	04	01	H5509_014_0	8	1		0110111111111111111110011111000000111111111101111	1	20	20	2			2	
H5509	014	0	1	04	01	H5509_014_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	014	0	1	04	01	H5509_014_0	8	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	014	0	1	04	01	H5509_014_0	8	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	015	0	1	04	01	H5509_015_0	9	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	015	0	1	04	01	H5509_015_0	9	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	015	0	1	04	01	H5509_015_0	9	1		0110111111111111111110011111000000111111111101111	1	20	20	2			2	
H5509	015	0	1	04	01	H5509_015_0	9	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	016	0	1	04	01	H5509_016_0	7	4	Health Education/Wellness	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5509	016	0	1	04	01	H5509_016_0	7	3	Home Health	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	016	0	1	04	01	H5509_016_0	7	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5509	016	0	1	04	01	H5509_016_0	7	1		0110111111111111111110011111000000111111111101111	1	25	25	2			2	
H5509	801	0	1	04	01	H5509_801_0	4	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H5509	801	0	1	04	01	H5509_801_0	4	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H5509	801	0	1	04	01	H5509_801_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	802	0	1	04	01	H5509_802_0	4	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H5509	802	0	1	04	01	H5509_802_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5509	802	0	1	04	01	H5509_802_0	4	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H5509	803	0	1	04	01	H5509_803_0	4	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H5509	803	0	1	04	01	H5509_803_0	4	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H5509	803	0	1	04	01	H5509_803_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	30.00	30.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H5516	001	0	1	04	01	H5516_001_0	5	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
H5516	001	0	1	04	01	H5516_001_0	5	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H5516	001	0	1	04	01	H5516_001_0	5	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5520	001	0	1	04	01	H5520_001_0	4	4	Group 20%	0000000000000011000000011010000000000000000100000	1	20	20	2			2	
H5520	001	0	1	04	01	H5520_001_0	4	5	Group 20% with $35 Deductible	0000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	001	0	1	04	01	H5520_001_0	4	6	Group $20 - $50	0000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	7	Group $100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	8	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	9	Group $200	0000000000000000010000000000000000000000000000000	2			1	200.00	200.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	3	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	10	Group $175	0000000000000000001000000000000000000000000000000	2			1	175.00	175.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	11	Group $0	0011000000000000000000000101000001111111111000010	2			1	0.00	0.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	12	Group 20% + $0	0000000000000100000000000000000000000000000000000	1	0	20	1	0.00	0.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	13	Group $15 - $20	0000000000100000000000000000000000000000000000000	2			1	15.00	20.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	14	Group $0 - $20	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	2	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	001	0	1	04	01	H5520_001_0	4	1	Group $20	0000100100000000100000000000000000000000000000001	2			1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	1	Group $20	0000100100000000100000000000000000000000000000001	2			1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	10	Group $0 - $20	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	11	Group $0	0011000000000000000000000101000001111111111000010	2			1	0.00	0.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	12	Group 18% + $20	0000000000000100000000000000000000000000000000000	1	0	18	1	20.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	13	Group $15 - $20	0000000000100000000000000000000000000000000000000	2			1	15.00	20.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	2	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	9	Group $200	0000000000000000010000000000000000000000000000000	2			1	200.00	200.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	4	Group 18%	0000000000000011000000011010000000000000000100000	1	18	18	2			2	
H5520	002	0	1	04	01	H5520_002_0	6	5	Group 20% with $35 Deductible	0000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	002	0	1	04	01	H5520_002_0	6	6	Group $20 - $50	0000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	7	Group $175	0000000000000000001001000000000000000000000000000	2			1	175.00	175.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	8	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	002	0	1	04	01	H5520_002_0	6	3	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	1	Group $20	0000100100000000100000000000000000000000000000001	2			1	20.00	20.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	10	Group $175	0000000000000000001000000000000000000000000000000	2			1	175.00	175.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	11	Group $0	0011000000000000000000000101000001111111111000010	2			1	0.00	0.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	12	Group 20% + $0	0000000000000100000000000000000000000000000000000	1	0	20	1	0.00	0.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	13	Group $15 - $20	0000000000100000000000000000000000000000000000000	2			1	15.00	20.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	14	Group $0 - $20	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	9	Group $200	0000000000000000010000000000000000000000000000000	2			1	200.00	200.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	3	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	4	Group 20%	0000000000000011000000011010000000000000000100000	1	20	20	2			2	
H5520	003	0	1	04	01	H5520_003_0	4	5	Group 20% with $35 Deductible	0000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	003	0	1	04	01	H5520_003_0	4	6	Group $20 - $50	0000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	7	Group $100	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	8	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	003	0	1	04	01	H5520_003_0	4	2	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	1	Group $20	0000100100000000100000000000000000000000000000001	2			1	20.00	20.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	10	Group $0 - $20	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	11	Group $0	0011000000000000000000000101000001111111111000010	2			1	0.00	0.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	12	Group 18% + $20	0000000000000100000000000000000000000000000000000	1	0	18	1	20.00	20.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	13	Group $15 - $20	0000000000100000000000000000000000000000000000000	2			1	15.00	20.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	2	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	9	Group $200	0000000000000000010000000000000000000000000000000	2			1	200.00	200.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	4	Group 18%	0000000000000011000000011010000000000000000100000	1	18	18	2			2	
H5520	004	0	1	04	01	H5520_004_0	6	5	Group 20% with $35 Deductible	0000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	004	0	1	04	01	H5520_004_0	6	6	Group $20 - $50	0000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	7	Group $175	0000000000000000001001000000000000000000000000000	2			1	175.00	175.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	8	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	004	0	1	04	01	H5520_004_0	6	3	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	1	Group $20	0000100100000000100000000000000000000000000000001	2			1	20.00	20.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	10	Group 15%	0000000000000000001000000000000000000000000000000	1	15	15	2			2	
H5520	005	0	1	04	01	H5520_005_0	6	11	Group $0	0011000000000000000000000101000001111111111000000	2			1	0.00	0.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	12	Group 20% + $20	0000000000000100000000000000000000000000000000000	1	0	20	1	20.00	20.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	13	Group $0 - $20	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	2	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	9	Group 17%	0000000000000000010000000000000000000000000000000	1	17	17	2			2	
H5520	005	0	1	04	01	H5520_005_0	6	4	Group 20%	0000000000000011000000011010000000000000000100010	1	20	20	2			2	
H5520	005	0	1	04	01	H5520_005_0	6	5	Group $15 - $20	0000000000100000000000000000000000000000000000000	2			1	15.00	20.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	6	Group $20 - $50	0000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	7	Group $250	0000000000000000000001000000000000000000000000000	2			1	250.00	250.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	8	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	005	0	1	04	01	H5520_005_0	6	3	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	11	Group $0	0011000000000000000000000101000001111111111000000	2			1	0.00	0.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	12	Group 20% + $20	0000000000000100000000000000000000000000000000000	1	0	20	1	20.00	20.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	13	Group $0 - $20	0000000000000000000000000000000000000000000000100	2			1	0.00	20.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	2	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	3	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	4	Group 20%	0000000000000011000000011010000000000000000100010	1	20	20	2			2	
H5520	006	0	1	04	01	H5520_006_0	6	5	Group $15 - $20	0000000000100000000000000000000000000000000000000	2			1	15.00	20.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	6	Group $20 - $50	0000000000000000000000000000000000000000000001000	2			1	20.00	50.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	7	Group $250	0000000000000000000001000000000000000000000000000	2			1	250.00	250.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	8	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	9	Group 17%	0000000000000000010000000000000000000000000000000	1	17	17	2			2	
H5520	006	0	1	04	01	H5520_006_0	6	1	Group $20	0000100100000000100000000000000000000000000000001	2			1	20.00	20.00	2	
H5520	006	0	1	04	01	H5520_006_0	6	10	Group 15%	0000000000000000001000000000000000000000000000000	1	15	15	2			2	
H5520	009	0	1	04	01	H5520_009_0	5	5	Group $50	0000000010010000001100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	6	Group $75	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	7	Group $100	0000000000000000010000000000000000000000000000000	2			1	100.00	100.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	8	Group 12%	0000000000000011000000011010000000000000000100000	1	12	12	2			2	
H5520	009	0	1	04	01	H5520_009_0	5	9	Group 20% + $35 Deductible	0000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	009	0	1	04	01	H5520_009_0	5	1	Group $0	1011000000000000100000000101000001111111111000010	2			1	0.00	0.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	4	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	11	Group $10 - $50	0000000000000000000000000000000000000000000001000	2			1	10.00	50.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	12	Group $10 - $15	0000000000100000000000000000000000000000000000000	2			1	10.00	15.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	13	Group $0 - $10	0000000000000000000000000000000000000000000000100	2			1	0.00	10.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	2	Group $10	0000100100000000000000000000000000000000000000001	2			1	10.00	10.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	3	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	009	0	1	04	01	H5520_009_0	5	10	Group 12% + $0	0000000000000100000000000000000000000000000000000	1	0	12	1	0.00	0.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	4	Group $35	0100001001001000000010000000000000000000000000000	2			1	35.00	35.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	5	Group $50	0000000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	6	Group $100	0000000000000000001001000000000000000000000000000	2			1	100.00	100.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	7	Group $125	0000000000000000010000000000000000000000000000000	2			1	125.00	125.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	8	Group 12%	0000000000000011000000011010000000000000000100000	1	12	12	2			2	
H5520	010	0	1	04	01	H5520_010_0	5	9	Group 20% + $35 Deductible	0000000000000000000000000000000000000000000010000	1	20	20	2			1	35.00
H5520	010	0	1	04	01	H5520_010_0	5	1	Group $0	1011000000000000100000000101000001111111111000010	2			1	0.00	0.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	10	Group 12% + $0	0000000000000100000000000000000000000000000000000	1	0	12	1	0.00	0.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	11	Group $10 - $50	0000000000000000000000000000000000000000000001000	2			1	10.00	50.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	12	Group $10 - $15	0000000000100000000000000000000000000000000000000	2			1	10.00	15.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	13	Group $0 - $10	0000000000000000000000000000000000000000000000100	2			1	0.00	10.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	2	Group $10	0000100100000000000000000000000000000000000000001	2			1	10.00	10.00	2	
H5520	010	0	1	04	01	H5520_010_0	5	3	Group $15	0000010000000000000000000000100000000000000000000	2			1	15.00	15.00	2	
H5520	807	0	1	04	01	H5520_807_0	1	3	Coinsurance 0% - 20%	0000000000000100000000000000000001000000000000000	1	0	20	2			2	
H5520	807	0	1	04	01	H5520_807_0	1	2	Coinsurance 20%	0110111101101011111111011111000000111111111101111	1	20	20	2			2	
H5520	807	0	1	04	01	H5520_807_0	1	1	Coinsurance 0%	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5520	807	0	1	04	01	H5520_807_0	1	4	Coinsurance 45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5520	808	0	1	04	01	H5520_808_0	1	4	Coinsurance 45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5520	808	0	1	04	01	H5520_808_0	1	1	Coinsurance 0%	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5520	808	0	1	04	01	H5520_808_0	1	2	Coinsurance 20%	0110111101101011111111011111000000111111111101111	1	20	20	2			2	
H5520	808	0	1	04	01	H5520_808_0	1	3	Coinsurance 0% - 20%	0000000000000100000000000000000001000000000000000	1	0	20	2			2	
H5520	809	0	1	04	01	H5520_809_0	1	4	Coinsurance 45%	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5520	809	0	1	04	01	H5520_809_0	1	3	Coinsurance 0% - 20%	0000000000000100000000000000000001000000000000000	1	0	20	2			2	
H5520	809	0	1	04	01	H5520_809_0	1	1	Coinsurance 0%	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5520	809	0	1	04	01	H5520_809_0	1	2	Coinsurance 20%	0110111101101011111111011111000000111111111101111	1	20	20	2			2	
H5521	012	0	1	04	01	H5521_012_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	20	20	2			2	
H5521	012	0	1	04	01	H5521_012_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	012	0	1	04	01	H5521_012_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	012	0	1	04	01	H5521_012_0	4	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	013	0	1	04	01	H5521_013_0	4	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	013	0	1	04	01	H5521_013_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	013	0	1	04	01	H5521_013_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	013	0	1	04	01	H5521_013_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	35	35	2			2	
H5521	015	0	1	04	01	H5521_015_0	4	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	015	0	1	04	01	H5521_015_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	015	0	1	04	01	H5521_015_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	015	0	1	04	01	H5521_015_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	30	30	2			2	
H5521	016	0	1	04	01	H5521_016_0	4	1	Tier 1	0111111111111111111110011101000001111111111101111	1	35	35	2			2	
H5521	016	0	1	04	01	H5521_016_0	4	4	Tier 4	1000000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	016	0	1	04	01	H5521_016_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	016	0	1	04	01	H5521_016_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	020	0	1	04	01	H5521_020_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	020	0	1	04	01	H5521_020_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	020	0	1	04	01	H5521_020_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	25	25	2			2	
H5521	020	0	1	04	01	H5521_020_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	022	0	1	04	01	H5521_022_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5521	022	0	1	04	01	H5521_022_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	022	0	1	04	01	H5521_022_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	022	0	1	04	01	H5521_022_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	35	35	2			2	
H5521	027	0	1	04	01	H5521_027_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	35	35	2			2	
H5521	027	0	1	04	01	H5521_027_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	027	0	1	04	01	H5521_027_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	027	0	1	04	01	H5521_027_0	4	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	028	0	1	04	01	H5521_028_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	30	30	2			2	
H5521	028	0	1	04	01	H5521_028_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5521	028	0	1	04	01	H5521_028_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	028	0	1	04	01	H5521_028_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	031	0	1	04	01	H5521_031_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H5521	031	0	1	04	01	H5521_031_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	031	0	1	04	01	H5521_031_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	031	0	1	04	01	H5521_031_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	30	30	2			2	
H5521	032	0	1	04	01	H5521_032_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	032	0	1	04	01	H5521_032_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	032	0	1	04	01	H5521_032_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H5521	032	0	1	04	01	H5521_032_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	30	30	2			2	
H5521	033	0	1	04	01	H5521_033_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	033	0	1	04	01	H5521_033_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H5521	033	0	1	04	01	H5521_033_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	30	30	2			2	
H5521	033	0	1	04	01	H5521_033_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	034	0	1	04	01	H5521_034_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	30	30	2			2	
H5521	034	0	1	04	01	H5521_034_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5521	034	0	1	04	01	H5521_034_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	034	0	1	04	01	H5521_034_0	4	4	Tier 4	1000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	036	0	1	04	01	H5521_036_0	4	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	036	0	1	04	01	H5521_036_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	036	0	1	04	01	H5521_036_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	35	35	2			2	
H5521	036	0	1	04	01	H5521_036_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	037	0	1	04	01	H5521_037_0	4	1	Tier 1	0111111111111111111110011101000001111111111101111	1	30	30	2			2	
H5521	037	0	1	04	01	H5521_037_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	037	0	1	04	01	H5521_037_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5521	038	0	1	04	01	H5521_038_0	4	1	Tier 1	0111111111111111111110011101000001111111111101111	1	35	35	2			2	
H5521	038	0	1	04	01	H5521_038_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5521	038	0	1	04	01	H5521_038_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	039	0	1	04	01	H5521_039_0	5	1	Tier 1	0111111111111111111110011101000001111111111101101	1	40	40	2			2	
H5521	039	0	1	04	01	H5521_039_0	5	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	20.00	20.00	2	
H5521	039	0	1	04	01	H5521_039_0	5	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
H5521	039	0	1	04	01	H5521_039_0	5	4	Tier 4	0000000000000000000000000000000000000000000000010	2			1	0.00	0.00	2	
H5521	040	0	1	04	01	H5521_040_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H5521	040	0	1	04	01	H5521_040_0	4	1	Tier 1	0111111111111111111110011101000001111111111101111	1	40	40	2			2	
H5521	040	0	1	04	01	H5521_040_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5521	801	0	1	04	01	H5521_801_0	3	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5521	801	0	1	04	01	H5521_801_0	3	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	801	0	1	04	01	H5521_801_0	3	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H5521	802	0	1	04	01	H5521_802_0	3	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H5521	802	0	1	04	01	H5521_802_0	3	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5521	802	0	1	04	01	H5521_802_0	3	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	805	0	2	04	01	H5521_805_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H5521	805	0	2	04	01	H5521_805_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5521	805	0	2	04	01	H5521_805_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5521	806	0	2	04	01	H5521_806_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H5521	806	0	2	04	01	H5521_806_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H5521	806	0	2	04	01	H5521_806_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5522	001	0	1	04	01	H5522_001_0	6	6	$50 Copay	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5522	001	0	1	04	01	H5522_001_0	6	5	50% Coinsurance OON	1000000000000000000000000000000000000000000000000	1	50	50	2			2	
H5522	001	0	1	04	01	H5522_001_0	6	4	Ambulance OON	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5522	001	0	1	04	01	H5522_001_0	6	3	0% Coinsurance OON	0001000000000000000000000000000000100000000010000	2			1	0.00	0.00	2	
H5522	001	0	1	04	01	H5522_001_0	6	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	001	0	1	04	01	H5522_001_0	6	1	20% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	20	20	2			2	
H5522	002	0	1	04	01	H5522_002_0	6	6	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5522	002	0	1	04	01	H5522_002_0	6	1	20% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	20	20	2			2	
H5522	002	0	1	04	01	H5522_002_0	6	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	002	0	1	04	01	H5522_002_0	6	5	50% Coinsurance OON	1000000000000000000000000000000000000000000000000	1	50	50	2			2	
H5522	002	0	1	04	01	H5522_002_0	6	4	Ambulance OON	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5522	002	0	1	04	01	H5522_002_0	6	3	0% Coinsurance OON	0001000000000000000000000000000000100000000010000	2			1	0.00	0.00	2	
H5522	004	0	1	04	01	H5522_004_0	6	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	004	0	1	04	01	H5522_004_0	6	1	20% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	20	20	2			2	
H5522	004	0	1	04	01	H5522_004_0	6	3	0% Coinsurance OON	0001000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H5522	004	0	1	04	01	H5522_004_0	6	4	Ambulance OON	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5522	004	0	1	04	01	H5522_004_0	6	5	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5522	005	0	1	04	01	H5522_005_0	8	5	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5522	005	0	1	04	01	H5522_005_0	8	4	Ambulance OON	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5522	005	0	1	04	01	H5522_005_0	8	3	0% Coinsurance OON	0001000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H5522	005	0	1	04	01	H5522_005_0	8	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	005	0	1	04	01	H5522_005_0	8	1	20% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	20	20	2			2	
H5522	008	0	1	04	01	H5522_008_0	7	4	25% Coinsurance OON	0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H5522	008	0	1	04	01	H5522_008_0	7	5	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5522	008	0	1	04	01	H5522_008_0	7	1	30% Coinsurance OON	0100111101101111111010000111000000011111111101111	1	30	30	2			2	
H5522	008	0	1	04	01	H5522_008_0	7	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	008	0	1	04	01	H5522_008_0	7	3	0% Coinsurance OON	0001000000000000000001000000000000100000000000000	2			1	0.00	0.00	2	
H5522	009	0	1	04	01	H5522_009_0	7	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	009	0	1	04	01	H5522_009_0	7	3	0% Coinsurance OON	0001000000000000000001000000000000100000000000000	2			1	0.00	0.00	2	
H5522	009	0	1	04	01	H5522_009_0	7	4	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H5522	009	0	1	04	01	H5522_009_0	7	1	30% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	30	30	2			2	
H5522	010	0	1	04	01	H5522_010_0	6	1	30% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	30	30	2			2	
H5522	010	0	1	04	01	H5522_010_0	6	4	Ambulance OON	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H5522	010	0	1	04	01	H5522_010_0	6	3	0% Coinsurance OON	0001000000000000000000000000000001100000000000000	2			1	0.00	0.00	2	
H5522	010	0	1	04	01	H5522_010_0	6	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5522	802	0	1	04	01	H5522_802_0	7	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H5522	802	0	1	04	01	H5522_802_0	7	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H5522	802	0	1	04	01	H5522_802_0	7	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5522	803	0	1	04	01	H5522_803_0	5	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5522	803	0	1	04	01	H5522_803_0	5	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H5522	803	0	1	04	01	H5522_803_0	5	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H5522	805	0	1	04	01	H5522_805_0	5	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H5522	805	0	1	04	01	H5522_805_0	5	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H5522	805	0	1	04	01	H5522_805_0	5	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H5525	004	0	1	04	01	H5525_004_0	6	4		0000001010001110100110000001000000000011111000000	1	30	30	1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	6	5		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5525	004	0	1	04	01	H5525_004_0	6	6		0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H5525	004	0	1	04	01	H5525_004_0	6	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H5525	004	0	1	04	01	H5525_004_0	6	3		0000000000000000000000000000000001000000000000100	2			1	0.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	6	9		0000000000000001000000000000000000000000000000000	1	20	20	2			2	
H5525	004	0	1	04	01	H5525_004_0	6	1		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H5525	004	0	1	04	01	H5525_004_0	6	10		1000000000000000000000000000000000000000000010000	1	50	50	2			2	
H5525	004	0	1	04	01	H5525_004_0	6	2		0000110101110000000000000000000000011100000001001	2			1	35.00	35.00	2	
H5525	004	0	1	04	01	H5525_004_0	6	8		0000000000000000000000000000001000100000000000010	2			1	0.00	0.00	2	
H5526	002	0	1	04	01	H5526_002_0	5	4	Mental health Psychiatric	0000000000010000000000000000000000000000000000000	1	50	50	2			2	
H5526	002	0	1	04	01	H5526_002_0	5	3	Mental Health/Substance Abuse	0010000010000000000100000000000000000000000000000	1	50	50	2			2	
H5526	002	0	1	04	01	H5526_002_0	5	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5526	002	0	1	04	01	H5526_002_0	5	1	Part B Drugs/Outpatient Surgery	0000000000000000011000000000000000000000000100000	1	20	20	2			2	
H5526	002	0	1	04	01	H5526_002_0	5	7	DME/Prosthetics	0000000000000000000000011100000000000000000000000	1	35	35	2			2	
H5526	002	0	1	04	01	H5526_002_0	5	5	Primary Care/Specialist Services	0101111101101111100010100011000000111111111001111	2			1	30.00	30.00	2	
H5526	002	0	1	04	01	H5526_002_0	5	6	Health Education	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	003	0	1	04	01	H5526_003_0	8	6	Health Education and Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	003	0	1	04	01	H5526_003_0	8	7	DME/Prosthetics	0000000000000000000000011100000000000000000000000	1	50	50	2			2	
H5526	003	0	1	04	01	H5526_003_0	8	8	Outpatient/ASC Services	0000000000000000011000000000000000000000000000000	1	20	20	2			2	
H5526	003	0	1	04	01	H5526_003_0	8	9	Primary Care	0001100000000000000000000010000000110000000000000	2			1	25.00	25.00	2	
H5526	003	0	1	04	01	H5526_003_0	8	3	Mental Health/Substance Abuse	0010000010000000000100000000000000000000000000000	1	50	50	2			2	
H5526	003	0	1	04	01	H5526_003_0	8	5	Specialist Services	0100011101101111100010100001000000001111111001111	1	20	20	2			2	
H5526	003	0	1	04	01	H5526_003_0	8	4	Mental Health Psychiatric	0000000000010000000000000000000000000000000000000	1	50	50	2			2	
H5526	003	0	1	04	01	H5526_003_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5526	003	0	1	04	01	H5526_003_0	8	1	Part B Drugs	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	004	0	1	04	01	H5526_004_0	8	4	Mental Health Psychiatric	0000000000010000000000000000000000000000000000000	1	50	50	2			2	
H5526	004	0	1	04	01	H5526_004_0	8	3	Mental Health/Substance Abuse	0010000010000000000100000000000000000000000000000	1	50	50	2			2	
H5526	004	0	1	04	01	H5526_004_0	8	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5526	004	0	1	04	01	H5526_004_0	8	1	Part B Drugs	0000000000000000000000000000000000000000000100000	1	20	20	2			2	
H5526	004	0	1	04	01	H5526_004_0	8	5	Primary Care/Specialist Services	0001100000000000000000100011000000111111100001010	2			1	25.00	25.00	2	
H5526	004	0	1	04	01	H5526_004_0	8	8	Outpatient/ASC Services	0000000000000000011000000000000000000000000000000	1	20	20	2			2	
H5526	004	0	1	04	01	H5526_004_0	8	7	DME/Prosthetics	0000000000000000000000011100000000000000000000000	1	35	35	2			2	
H5526	004	0	1	04	01	H5526_004_0	8	6	Health Education and Wellness	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	004	0	1	04	01	H5526_004_0	8	9		0100011101101111100010000000000000000000011000101	2			1	40.00	40.00	2	
H5526	806	0	1	04	01	H5526_806_0	2	1	Part B Drugs	0000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5526	806	0	1	04	01	H5526_806_0	2	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5526	806	0	1	04	01	H5526_806_0	2	8	Primary, Home Health and Dialysis	0000100000000000000000000010000000110000000000000	2			1	30.00	30.00	2	
H5526	806	0	1	04	01	H5526_806_0	2	9		0001000000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H5526	806	0	1	04	01	H5526_806_0	2	7	DME/Prosthetics	0000000000000000000000011100000000000000000000000	1	50	50	2			2	
H5526	806	0	1	04	01	H5526_806_0	2	6	Health Education	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	806	0	1	04	01	H5526_806_0	2	5	Specialist Services	0100011101101111100010100001000000001111111001111	2			1	45.00	45.00	2	
H5526	806	0	1	04	01	H5526_806_0	2	3	Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H5526	806	0	1	04	01	H5526_806_0	2	4	Outpatient Surgery	0000000000000000011000000000000000000000000000000	1	25	25	2			2	
H5526	808	0	1	04	01	H5526_808_0	2	9		0001000000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H5526	808	0	1	04	01	H5526_808_0	2	8	Primary, Home Health and Dialysis	0000100000000000000000000010000000110000000000000	2			1	30.00	30.00	2	
H5526	808	0	1	04	01	H5526_808_0	2	6	Health Education	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	808	0	1	04	01	H5526_808_0	2	7	DME/Prosthetics	0000000000000000000000011100000000000000000000000	1	50	50	2			2	
H5526	808	0	1	04	01	H5526_808_0	2	5	Specialist Services	0100011101101111100010100001000000001111111001111	2			1	45.00	45.00	2	
H5526	808	0	1	04	01	H5526_808_0	2	4	Outpatient Surgery	0000000000000000011000000000000000000000000000000	1	25	25	2			2	
H5526	808	0	1	04	01	H5526_808_0	2	3	Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H5526	808	0	1	04	01	H5526_808_0	2	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5526	808	0	1	04	01	H5526_808_0	2	1	Part B Drugs	0000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5526	810	0	1	04	01	H5526_810_0	2	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5526	810	0	1	04	01	H5526_810_0	2	1	Part B Drugs	0000000000000000000000000000000000000000000100000	1	30	30	2			2	
H5526	810	0	1	04	01	H5526_810_0	2	3	Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	1	50	50	2			2	
H5526	810	0	1	04	01	H5526_810_0	2	4	Outpatient Surgery	0000000000000000011000000000000000000000000000000	1	25	25	2			2	
H5526	810	0	1	04	01	H5526_810_0	2	9		0001000000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H5526	810	0	1	04	01	H5526_810_0	2	6	Health Education	0000000000000000000000000000000001000000000000000	2			1	0.00	50.00	2	
H5526	810	0	1	04	01	H5526_810_0	2	7	DME/Prosthetics	0000000000000000000000011100000000000000000000000	1	50	50	2			2	
H5526	810	0	1	04	01	H5526_810_0	2	8	Primary, Home Health and Dialysis	0000100000000000000000000010000000110000000000000	2			1	30.00	30.00	2	
H5526	810	0	1	04	01	H5526_810_0	2	5	Specialist Services	0100011101101111100010100001000000001111111001111	2			1	45.00	45.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	1	25% Cost Sharing	0010100110110111111100000001000000011111111001001	1	25	25	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	4	$75 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5528	001	0	1	04	01	H5528_001_0	4	5	50% Cost Sharing	0100001000001000000010000000000000000000000110010	1	50	50	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	6	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	001	0	1	04	01	H5528_001_0	4	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	002	0	1	04	01	H5528_002_0	6	1	25% Cost Sharing	0010100110110111111100000001000000011111111001001	1	25	25	2			2	
H5528	002	0	1	04	01	H5528_002_0	6	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	002	0	1	04	01	H5528_002_0	6	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	002	0	1	04	01	H5528_002_0	6	4	50% Cost Sharing	0100001000001000000010000000000000000000000110010	1	50	50	2			2	
H5528	002	0	1	04	01	H5528_002_0	6	5	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	002	0	1	04	01	H5528_002_0	6	6	$100 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5528	002	0	1	04	01	H5528_002_0	6	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	003	0	1	04	01	H5528_003_0	6	5	$75 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5528	003	0	1	04	01	H5528_003_0	6	4	50% Cost Sharing	0000000000000000000000000000000000000000000110010	1	50	50	2			2	
H5528	003	0	1	04	01	H5528_003_0	6	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	003	0	1	04	01	H5528_003_0	6	6	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	003	0	1	04	01	H5528_003_0	6	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	003	0	1	04	01	H5528_003_0	6	1	25% Cost Sharing	0110101110111111111110000001000000011111111001001	1	25	25	2			2	
H5528	003	0	1	04	01	H5528_003_0	6	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	004	0	1	04	01	H5528_004_0	4	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	004	0	1	04	01	H5528_004_0	4	1	25% Cost Sharing	0010100110110111111100000001000000011111111001001	1	25	25	2			2	
H5528	004	0	1	04	01	H5528_004_0	4	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	004	0	1	04	01	H5528_004_0	4	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	004	0	1	04	01	H5528_004_0	4	6	$75 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5528	004	0	1	04	01	H5528_004_0	4	5	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	004	0	1	04	01	H5528_004_0	4	4	50% Cost Sharing	0100001000001000000010000000000000000000000110010	1	50	50	2			2	
H5528	005	0	1	04	01	H5528_005_0	8	4	50% Cost Sharing	0100001000001000000010000000000000000000000110010	1	50	50	2			2	
H5528	005	0	1	04	01	H5528_005_0	8	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	005	0	1	04	01	H5528_005_0	8	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	005	0	1	04	01	H5528_005_0	8	1	25% Cost Sharing	0010100110110111111100000001000000011111111001001	1	25	25	2			2	
H5528	005	0	1	04	01	H5528_005_0	8	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	005	0	1	04	01	H5528_005_0	8	5	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	005	0	1	04	01	H5528_005_0	8	6	$100 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5528	008	0	1	04	01	H5528_008_0	6	1	25% Cost Sharing	0110101110111111111110000001000000011111111001001	1	25	25	2			2	
H5528	008	0	1	04	01	H5528_008_0	6	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	008	0	1	04	01	H5528_008_0	6	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	008	0	1	04	01	H5528_008_0	6	4	50% Cost Sharing	0000000000000000000000000000000000000000000110010	1	50	50	2			2	
H5528	008	0	1	04	01	H5528_008_0	6	5	$75 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5528	008	0	1	04	01	H5528_008_0	6	6	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	008	0	1	04	01	H5528_008_0	6	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	009	0	1	04	01	H5528_009_0	5	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	009	0	1	04	01	H5528_009_0	5	6	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	009	0	1	04	01	H5528_009_0	5	5	50% Cost Sharing	0100001000001000000010000000000000000000000110010	1	50	50	2			2	
H5528	009	0	1	04	01	H5528_009_0	5	4	$75 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5528	009	0	1	04	01	H5528_009_0	5	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	009	0	1	04	01	H5528_009_0	5	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	009	0	1	04	01	H5528_009_0	5	1	25% Cost Sharing	0010100110110111111100000001000000011111111001001	1	25	25	2			2	
H5528	010	0	1	04	01	H5528_010_0	6	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	010	0	1	04	01	H5528_010_0	6	6	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	010	0	1	04	01	H5528_010_0	6	5	50% Cost Sharing	0100001000001000000010000000000000000000000110010	1	50	50	2			2	
H5528	010	0	1	04	01	H5528_010_0	6	4	$100 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5528	010	0	1	04	01	H5528_010_0	6	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	010	0	1	04	01	H5528_010_0	6	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	010	0	1	04	01	H5528_010_0	6	1	25% Cost Sharing	0010100110110111111100000001000000011111111001001	1	25	25	2			2	
H5528	011	0	1	04	01	H5528_011_0	6	6	$75 Cost Sharing	0000000000000000000001000000000000000000000000000	2			1	75.00	75.00	2	
H5528	011	0	1	04	01	H5528_011_0	6	3	$0 Cost Sharing	0001000000000000000000000010000001100000000000000	2			1	0.00	0.00	2	
H5528	011	0	1	04	01	H5528_011_0	6	1	25% Cost Sharing	0110101110111111111110000001000000011111111001001	1	25	25	2			2	
H5528	011	0	1	04	01	H5528_011_0	6	7	30% Cost Sharing	0000000000000000000000011100000000000000000000000	1	30	30	2			2	
H5528	011	0	1	04	01	H5528_011_0	6	2	$40 Cost Sharing	0000010001000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H5528	011	0	1	04	01	H5528_011_0	6	5	50% Cost Sharing	0000000000000000000000000000000000000000000110010	1	50	50	2			2	
H5528	011	0	1	04	01	H5528_011_0	6	4	25% - 50% Cost Sharing	0000000000000000000000000000000000000000000000100	1	25	50	2			2	
H5528	018	0	1	04	01	H5528_018_0	6	1	$0 Cost Sharing	0111111111111111111111011111000001111111111111111	2			1	0.00	0.00	2	
H5528	018	0	1	04	01	H5528_018_0	6	2	$125 Maximum Benefit	0000000000000000000000000000010000000000000000000	2			1	125.00	125.00	2	
H5528	019	0	1	04	01	H5528_019_0	5	1	35% Cost Sharing	0110111111111111111110011101000000011111111111111	1	35	35	2			2	
H5528	019	0	1	04	01	H5528_019_0	5	2	$0 Cost Sharing	0001000000000000000001000010000001100000000000000	2			1	0.00	0.00	2	
H5528	020	0	1	04	01	H5528_020_0	4	2	$0 Cost Sharing	0001000000000000000001000010000001100000000000000	2			1	0.00	0.00	2	
H5528	020	0	1	04	01	H5528_020_0	4	1	35% Cost Sharing	0110111111111111111110011101000000011111111111111	1	35	35	2			2	
H5528	021	0	1	04	01	H5528_021_0	4	1	35% Cost Sharing	0110111111111111111110011101000000011111111111111	1	35	35	2			2	
H5528	021	0	1	04	01	H5528_021_0	4	2	$0 Cost Sharing	0001000000000000000001000010000001100000000000000	2			1	0.00	0.00	2	
H5528	804	0	1	04	01	H5528_804_0	4	2	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5528	804	0	1	04	01	H5528_804_0	4	1	20% Coinsurance	0100111101101011111011011110000001010111111101111	1	20	20	2			2	
H5528	804	0	1	04	01	H5528_804_0	4	3	0% Coinsurance	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5528	804	0	1	04	01	H5528_804_0	4	4	0%- 20% Cost Sharing	0000000000000100000000000001000000101000000000000	1	0	20	2			2	
H5528	807	0	1	04	01	H5528_807_0	4	3	0% Coinsurance	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
H5528	807	0	1	04	01	H5528_807_0	4	4	0%- 20% Cost Sharing	0000000000000100000000000001000000001000000000000	1	0	20	2			2	
H5528	807	0	1	04	01	H5528_807_0	4	2	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H5528	807	0	1	04	01	H5528_807_0	4	1	20% Coinsurance	0100111101101011111011011110000001110111111101111	1	20	20	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	12	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	30.00	45.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	11	OON Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	10	OON $0 Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	1	20% OON Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	13	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	275.00	275.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	2	30% OON Coinsurance	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	45.00	45.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H5529	001	0	1	04	01	H5529_001_0	7	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	45.00	275.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5529	001	0	1	04	01	H5529_001_0	7	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	45.00	90.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	25.00	225.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	2	25% OON Coinsurance	0000000000000010100000011100000000000000000000000	1	25	25	2			2	
H5529	004	0	1	04	01	H5529_004_0	7	13	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	12	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	15.00	25.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	11	OON Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	25.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	10	OON $0 Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	1	20% OON Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H5529	004	0	1	04	01	H5529_004_0	7	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	25.00	50.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	25.00	25.00	2	
H5529	004	0	1	04	01	H5529_004_0	7	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	25	2			2	
H5529	804	0	1	04	01	H5529_804_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5529	804	0	1	04	01	H5529_804_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5529	805	0	1	04	01	H5529_805_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5529	805	0	1	04	01	H5529_805_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5529	806	0	1	04	01	H5529_806_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5529	806	0	1	04	01	H5529_806_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5529	807	0	1	04	01	H5529_807_0	5	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5529	807	0	1	04	01	H5529_807_0	5	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	1	20% Coinsurance	0000000000000001000000000010000000000000011100000	1	20	20	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	9	$100 Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	8	$50 Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	7	$40 - $80  PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	40.00	80.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	6	$40 Specialist	0100010101000000000000000000000000000000000000101	2			1	40.00	40.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	5	$20 PCP	0000100000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	4	$275 Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	275.00	275.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	3	0% - 30% Coinsurance Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	2	30% Coinsurance	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
H5530	001	0	1	04	01	H5530_001_0	9	13	$40 - $275 Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	40.00	275.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	12	$0 - $40 Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
H5530	001	0	1	04	01	H5530_001_0	9	11	$20 - $40 Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	20.00	40.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	9	$100 Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	3	0% - 25% Coinsurance Labs	0000000000000100000000000000000000000000000000000	1	0	25	2			2	
H5530	004	0	1	04	01	H5530_004_0	8	2	25% Coinsurance	0000000000000010100000011100000000000000000000000	1	25	25	2			2	
H5530	004	0	1	04	01	H5530_004_0	8	13	$25 - $225 Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	25.00	225.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	12	$0 - $25 Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	25.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	11	$15 - $25 Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	15.00	25.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	4	$225 Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	1	20% Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
H5530	004	0	1	04	01	H5530_004_0	8	5	$15 PCP	0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	6	$25 Specialist	0100010101000000000000000000000000000000000000101	2			1	25.00	25.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	7	$25 - $50  PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	25.00	50.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	8	$50 Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
H5530	004	0	1	04	01	H5530_004_0	8	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
H5530	804	0	1	04	01	H5530_804_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5530	804	0	1	04	01	H5530_804_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5530	805	0	1	04	01	H5530_805_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5530	805	0	1	04	01	H5530_805_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5530	806	0	1	04	01	H5530_806_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5530	806	0	1	04	01	H5530_806_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5530	807	0	1	04	01	H5530_807_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
H5530	807	0	1	04	01	H5530_807_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	10	Group 10	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	2	Group 2	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	1	Group 1	0100101101101000000010000000000000010000000011101	2			1	40.00	40.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	9	Group 9	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	8	Group 8	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H5532	001	0	1	04	01	H5532_001_0	5	7	Group 7	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	6	Group 6	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H5532	001	0	1	04	01	H5532_001_0	5	5	Group 5	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
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H5532	001	0	1	04	01	H5532_001_0	5	3	Group 3	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
H5533	003	0	1	04	01	H5533_003_0	7	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5533	003	0	1	04	01	H5533_003_0	7	3	$50 Copay	0000010111110000000100000000000000000000000001101	2			1	50.00	50.00	2	
H5533	003	0	1	04	01	H5533_003_0	7	4	30% Cost-Sharing	0111001000001111111011000111000000011111111100000	1	30	30	2			2	
H5533	003	0	1	04	01	H5533_003_0	7	5	50% Cost Sharing	0000000000000000000000011000000001000000000000000	1	50	50	2			2	
H5533	003	0	1	04	01	H5533_003_0	7	2	$30 Copay	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H5533	004	0	1	04	01	H5533_004_0	7	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5533	004	0	1	04	01	H5533_004_0	7	3	$45 Copay	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H5533	004	0	1	04	01	H5533_004_0	7	4	30% Cost Sharing	0111000000000111111011000011000000011111111000000	1	30	30	2			2	
H5533	004	0	1	04	01	H5533_004_0	7	5	50% Cost Sharing	0000000000000000000000011100000001000000000100000	1	50	50	2			2	
H5533	004	0	1	04	01	H5533_004_0	7	2	$25 Copay	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H5533	801	0	1	04	01	H5533_801_0	4	3	50% Cost Sharing	1000000000000000000000011100000001000000000011000	1	50	50	2			2	
H5533	801	0	1	04	01	H5533_801_0	4	2	20% Cost Sharing	0111111111111111111111000011000000011111111100101	1	20	20	2			2	
H5533	801	0	1	04	01	H5533_801_0	4	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5533	802	0	1	04	01	H5533_802_0	5	3	50% Cost Sharing	1000000000000000000000011100000001000000000011000	1	50	50	2			2	
H5533	802	0	1	04	01	H5533_802_0	5	2	20% Cost Sharing	0111111111111111111111000011000000011111111100101	1	20	20	2			2	
H5533	802	0	1	04	01	H5533_802_0	5	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5533	803	0	1	04	01	H5533_803_0	4	3	50% Cost Sharing	1000000000000000000000011100000001000000000011000	1	50	50	2			2	
H5533	803	0	1	04	01	H5533_803_0	4	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H5533	803	0	1	04	01	H5533_803_0	4	2	20% Cost Sharing	0111111111111111111111000011000000011111111100101	1	20	20	2			2	
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H6328	001	0	1	04	01	H6328_001_0	12	8	$200 Copay	0000000000000000010000000000000000000000000000000	2			1	200.00	200.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	7	$150 copay	0000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	6	$100 copay	0010000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	5	$50 copay	0000000010010000000100000010000000000000000000000	2			1	50.00	50.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	4	$40 Copay	0001000000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	3	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	1	$20 Copay	0000111000001000000010000000000000000000000000000	2			1	20.00	20.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	14	50% Coinsurance	1000000000000000000000000000000000000000000010010	1	50	50	2			2	
H6328	001	0	1	04	01	H6328_001_0	12	13	30% to 40% Coinsurance	0000000000000000000000011000000000000000000000000	1	30	40	2			2	
H6328	001	0	1	04	01	H6328_001_0	12	12	30% Coinsurance	0000000000000001000000000001000000000000000100000	1	30	30	2			2	
H6328	001	0	1	04	01	H6328_001_0	12	11	20% Coinsurance	0000000000000000000000000100000000000000011000000	1	20	20	2			2	
H6328	001	0	1	04	01	H6328_001_0	12	10	$75 to $200 Copay	0000000000000010000000000000000000000000000000000	2			1	75.00	200.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	9	$10 to $25 Copay	0000000000000100100000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	001	0	1	04	01	H6328_001_0	12	2	$30 Copay	0000000101100000000000000000000001111111100001101	2			1	30.00	30.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	9	$225 Copay	0000000000000000010000000000000000000000000000000	2			1	225.00	225.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	8	$175 Copay	0000000000000000001000000000000000000000000000000	2			1	175.00	175.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	7	$125 copay	0010000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	6	$55 Copay	0000000010010000000100000010000000000000000000000	2			1	55.00	55.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	5	$40 copay	0101000000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	4	$35 Copay	0000000101100000000000000000000000000000000001101	2			1	35.00	35.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	3	$30 Copay	0000000000000000000000000000000001111111100000000	2			1	30.00	30.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	2	$25 Copay	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	15	50% Coinsurance	0000000000000000000000000000000000000000000000010	1	50	50	2			2	
H6328	002	0	1	04	01	H6328_002_0	11	14	30% to 40% Coinsurance	0000000000000000000000011000000000000000000000000	1	30	40	2			2	
H6328	002	0	1	04	01	H6328_002_0	11	13	30% Coinsurance	0000000000000001000000000001000000000000000100000	1	30	30	2			2	
H6328	002	0	1	04	01	H6328_002_0	11	11	$75 to $200 Coinsurance	0000000000000010000000000000000000000000000000000	2			1	75.00	200.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	12	20% Coinsurance	0000000000000000000000000100000000000000011000000	1	20	20	2			2	
H6328	002	0	1	04	01	H6328_002_0	11	10	$10 to $25 Copay	0000000000000100100000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	002	0	1	04	01	H6328_002_0	11	1	$20 Copay	0000011000001000000010000000000000000000000000000	2			1	20.00	20.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	1	$20 Copay	0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	9	$250 Copay	0000000000000000010000000000000000000000000000000	2			1	250.00	250.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	11	$75 to $250 Copay	0000000000000010000000000000000000000000000000000	2			1	75.00	250.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	12	20% Coinsurance	0000000000000000000000000100000000000000011000000	1	20	20	2			2	
H6328	003	0	1	04	01	H6328_003_0	11	13	30% Coinsurance	0000000000000001000000000001000000000000000100000	1	30	30	2			2	
H6328	003	0	1	04	01	H6328_003_0	11	14	30% to 40% Coinsurance	0000000000000000000000011000000000000000000000000	1	30	40	2			2	
H6328	003	0	1	04	01	H6328_003_0	11	15	50% Coinsurance	0000000000000000000000000000000000000000000000010	1	50	50	2			2	
H6328	003	0	1	04	01	H6328_003_0	11	2	$25 Copay	0000001000001000000010000000000000000000000000000	2			1	25.00	25.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	3	$30 Copay	0000000000000000000000000000000001111111100000000	2			1	30.00	30.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	4	$35 Copay	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	5	$45 Copay	0101000101100000000000000000000000000000000001101	2			1	45.00	45.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	6	$60 Copay	0000000010010000000100000010000000000000000000000	2			1	60.00	60.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	8	$175	0000000000000000001000000000000000000000000000000	2			1	175.00	175.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	7	$150 Copay	0010000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H6328	003	0	1	04	01	H6328_003_0	11	10	$10 to $25 Copay	0000000000000100100000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	4	$40 Copay	0001000000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	5	$50 copay	0000000010010000000100000010000000000000000000000	2			1	50.00	50.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	6	$100 copay	0010000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	7	$150 copay	0000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	8	$200 Copay	0000000000000000010000000000000000000000000000000	2			1	200.00	200.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	9	$10 to $25 Copay	0000000000000100100000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	1	$20 Copay	0000111000001000000010000000000000000000000000000	2			1	20.00	20.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	10	$75 to $200 Copay	0000000000000010000000000000000000000000000000000	2			1	75.00	200.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	11	20% Coinsurance	0000000000000000000000000100000000000000011000000	1	20	20	2			2	
H6328	005	0	1	04	01	H6328_005_0	8	12	30% Coinsurance	0000000000000001000000000001000000000000000100000	1	30	30	2			2	
H6328	005	0	1	04	01	H6328_005_0	8	13	30% to 40% Coinsurance	0000000000000000000000011000000000000000000000000	1	30	40	2			2	
H6328	005	0	1	04	01	H6328_005_0	8	14	50% Coinsurance	1000000000000000000000000000000000000000000010010	1	50	50	2			2	
H6328	005	0	1	04	01	H6328_005_0	8	2	$30 Copay	0000000101100000000000000000000001111111100001101	2			1	30.00	30.00	2	
H6328	005	0	1	04	01	H6328_005_0	8	3	$35 Copay	0100000000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	1	$20 Copay	0000011000001000000010000000000000000000000000000	2			1	20.00	20.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	6	$55 Copay	0000000010010000000100000010000000000000000000000	2			1	55.00	55.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	11	$75 to $200 Coinsurance	0000000000000010000000000000000000000000000000000	2			1	75.00	200.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	12	20% Coinsurance	0000000000000000000000000100000000000000011000000	1	20	20	2			2	
H6328	006	0	1	04	01	H6328_006_0	9	13	30% Coinsurance	0000000000000001000000000001000000000000000100000	1	30	30	2			2	
H6328	006	0	1	04	01	H6328_006_0	9	14	30% to 40% Coinsurance	0000000000000000000000011000000000000000000000000	1	30	40	2			2	
H6328	006	0	1	04	01	H6328_006_0	9	15	50% Coinsurance	0000000000000000000000000000000000000000000000010	1	50	50	2			2	
H6328	006	0	1	04	01	H6328_006_0	9	2	$25 Copay	0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	3	$30 Copay	0000000000000000000000000000000001111111100000000	2			1	30.00	30.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	4	$35 Copay	0000000101100000000000000000000000000000000001101	2			1	35.00	35.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	5	$40 copay	0101000000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	9	$225 Copay	0000000000000000010000000000000000000000000000000	2			1	225.00	225.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	8	$175 Copay	0000000000000000001000000000000000000000000000000	2			1	175.00	175.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	7	$125 copay	0010000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H6328	006	0	1	04	01	H6328_006_0	9	10	$10 to $25 Copay	0000000000000100100000000000000000000000000000000	2			1	10.00	25.00	2	
H6328	801	0	1	04	01	H6328_801_0	2	1	20% Coinsurance	0111111101101111111111011111000001111111111111111	1	20	20	2			2	
H6328	801	0	1	04	01	H6328_801_0	2	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H6328	802	0	1	04	01	H6328_802_0	2	1	20% Coinsurance	0111111101101111111111011111000001111111111111111	1	20	20	2			2	
H6328	802	0	1	04	01	H6328_802_0	2	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H6328	803	0	1	04	01	H6328_803_0	2	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H6328	803	0	1	04	01	H6328_803_0	2	1	20% Coinsurance	0111111101101111111111011111000001111111111111111	1	20	20	2			2	
H6328	804	0	1	04	01	H6328_804_0	2	1	20% Coinsurance	0111111101101111111111011111000001111111111111111	1	20	20	2			2	
H6328	804	0	1	04	01	H6328_804_0	2	2	45% Coinsurance	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H6411	002	0	1	04	01	H6411_002_0	4	6		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
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H6609	013	0	1	04	01	H6609_013_0	4	1	Group 1	0100000000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	10	Group 10	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H6609	013	0	1	04	01	H6609_013_0	4	11	Group 11	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H6609	013	0	1	04	01	H6609_013_0	4	12	Group 12	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	13	Group 13	0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H6609	013	0	1	04	01	H6609_013_0	4	2	Group 2	0010000000000000001000000000000000000000000000000	2			1	50.00	50.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	9	Group 9	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	4	Group 4	0000110111110000000010000000000000000000000001101	2			1	15.00	15.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	5	Group 5	0000001000001000100100000000000000000000000000000	2			1	15.00	50.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	6	Group 6	0000000000000100000000000000000000000000000000000	1	30	30	1	15.00	50.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	7	Group 7	0000000000000010000000000000000000000000000000000	2			1	15.00	125.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	8	Group 8	0000000000000001010000000000000000000000000000000	1	20	20	1	15.00	125.00	2	
H6609	013	0	1	04	01	H6609_013_0	4	3	Group 3	0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H6609	014	0	1	04	01	H6609_014_0	4	1	Group 1	0100000000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	9	Group 9	0000000000000000001000000000000000000000000000000	2			1	125.00	125.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	11	Group 11	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	12	Group 12	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H6609	014	0	1	04	01	H6609_014_0	4	13	Group 13	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H6609	014	0	1	04	01	H6609_014_0	4	14	Group 14	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	15	Group 15	0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H6609	014	0	1	04	01	H6609_014_0	4	2	Group 2	0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H6609	014	0	1	04	01	H6609_014_0	4	3	Group 3	0000110111110000000000000000000000000000000001101	2			1	25.00	25.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	4	Group 4	0010001000001000100100000000000000000000000000000	2			1	25.00	50.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	5	Group 5	0000000000000100000000000000000000000000000000000	1	30	30	1	25.00	50.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	6	Group 6	0000000000000010000000000000000000000000000000000	2			1	25.00	125.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	7	Group 7	0000000000000001000000000000000000000000000000000	1	20	20	1	25.00	25.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	8	Group 8	0000000000000000010000000000000000000000000000000	1	20	20	1	15.00	125.00	2	
H6609	014	0	1	04	01	H6609_014_0	4	10	Group 10	0000000000000000000010000000000000000000000000000	2			1	15.00	25.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	1	Group 1	0110000000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	10	Group 10	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	11	Group 11	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H6609	015	0	1	04	01	H6609_015_0	4	12	Group 12	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H6609	015	0	1	04	01	H6609_015_0	4	13	Group 13	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	14	Group 14	0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H6609	015	0	1	04	01	H6609_015_0	4	9	Group 9	0000000000000000000010000000000000000000000000000	2			1	15.00	20.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	3	Group 3	0000110111110000000000000000000000000000000001101	2			1	20.00	20.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	4	Group 4	0000001000001000000000000000000000000000000000000	2			1	20.00	25.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	5	Group 5	0000000000000101000000000000000000000000000000000	1	20	20	1	20.00	50.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	6	Group 6	0000000000000010100100000000000000000000000000000	2			1	20.00	50.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	7	Group 7	0000000000000000010000000000000000000000000000000	1	20	20	1	15.00	75.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	8	Group 8	0000000000000000001000000000000000000000000000000	2			1	75.00	75.00	2	
H6609	015	0	1	04	01	H6609_015_0	4	2	Group 2	0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H6609	016	0	1	04	01	H6609_016_0	4	6	Group 6	0000000000000010000000000000000000000000000000000	2			1	25.00	125.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	5	Group 5	0000000000000100000000000000000000000000000000000	1	30	30	1	25.00	50.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	8	Group 8	0000000000000000010000000000000000000000000000000	1	20	20	1	15.00	125.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	9	Group 9	0000000000000000001000000000000000000000000000000	2			1	125.00	125.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	1	Group 1	0100000000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	10	Group 10	0000000000000000000010000000000000000000000000000	2			1	15.00	25.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	11	Group 11	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	12	Group 12	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H6609	016	0	1	04	01	H6609_016_0	4	13	Group 13	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H6609	016	0	1	04	01	H6609_016_0	4	14	Group 14	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	15	Group 15	0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H6609	016	0	1	04	01	H6609_016_0	4	2	Group 2	0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H6609	016	0	1	04	01	H6609_016_0	4	3	Group 3	0000110111110000000000000000000000000000000001101	2			1	25.00	25.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	4	Group 4	0010001000001000100100000000000000000000000000000	2			1	25.00	50.00	2	
H6609	016	0	1	04	01	H6609_016_0	4	7	Group 7	0000000000000001000000000000000000000000000000000	1	20	20	1	25.00	25.00	2	
H6609	017	0	1	04	01	H6609_017_0	3	1		0000110111110000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	017	0	1	04	01	H6609_017_0	3	2		0000001000001111100110000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	017	0	1	04	01	H6609_017_0	3	3		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H6609	017	0	1	04	01	H6609_017_0	3	4		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H6609	017	0	1	04	01	H6609_017_0	3	9		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H6609	017	0	1	04	01	H6609_017_0	3	6		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H6609	017	0	1	04	01	H6609_017_0	3	7		0000000000000000000000000000000001000000000000000	1	50	50	2			2	
H6609	017	0	1	04	01	H6609_017_0	3	8		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	017	0	1	04	01	H6609_017_0	3	5		0111000000000000011000011000000000000000000000000	1	30	30	2			2	
H6609	018	0	1	04	01	H6609_018_0	5	1		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H6609	018	0	1	04	01	H6609_018_0	5	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H6609	018	0	1	04	01	H6609_018_0	5	2		0001000000000000000000000001000001111111111000000	1	0	0	2			2	
H6609	019	0	1	04	01	H6609_019_0	5	1		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H6609	019	0	1	04	01	H6609_019_0	5	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
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H6609	021	0	1	04	01	H6609_021_0	3	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	021	0	1	04	01	H6609_021_0	3	2		0101000000000000011000011000000000000000000000000	1	30	30	2			2	
H6609	021	0	1	04	01	H6609_021_0	3	1		0010110111110000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	021	0	1	04	01	H6609_021_0	3	9		0000000000000000000000000000000001000000000000000	1	50	50	2			2	
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H6609	021	0	1	04	01	H6609_021_0	3	3		0000001000001111100110000000000000000011111000000	1	30	30	1	35.00	35.00	2	
H6609	021	0	1	04	01	H6609_021_0	3	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H6609	022	0	1	04	01	H6609_022_0	8	2		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
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H6609	022	0	1	04	01	H6609_022_0	8	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H6609	023	0	1	04	01	H6609_023_0	8	2		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H6609	023	0	1	04	01	H6609_023_0	8	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
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H6609	024	0	1	04	01	H6609_024_0	2	10		0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H6609	024	0	1	04	01	H6609_024_0	2	1		0000110111110000000000000000000000011100000001101	2			1	35.00	35.00	2	
H6609	024	0	1	04	01	H6609_024_0	2	9		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H6609	024	0	1	04	01	H6609_024_0	2	8		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H6609	024	0	1	04	01	H6609_024_0	2	3		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H6609	024	0	1	04	01	H6609_024_0	2	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H6609	024	0	1	04	01	H6609_024_0	2	6		0000000000000000000000000100000000000000000000000	1	20	25	2			2	
H6609	024	0	1	04	01	H6609_024_0	2	5		0111000000000000011000000000000000000000000000000	1	30	30	2			2	
H6609	024	0	1	04	01	H6609_024_0	2	4		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H6609	028	0	1	04	01	H6609_028_0	6	1		0001000000000000000000000001000101111111111000000	1	0	0	2			2	
H6609	028	0	1	04	01	H6609_028_0	6	3		0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H6609	028	0	1	04	01	H6609_028_0	6	2		0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H6609	029	0	1	04	01	H6609_029_0	4	12	Group 12	0000000000000000000001011110000000000000000000000	1	20	20	2			2	
H6609	029	0	1	04	01	H6609_029_0	4	13	Group 13	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	9	Group 9	0000000000000000010000000000000000000000000000000	1	20	20	1	30.00	150.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	2	Group 2	0010000000000000000000000000000000000000000000000	2			1	50.00	50.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H6609	029	0	1	04	01	H6609_029_0	4	4	Group 4	0000110111110000000000000000000000000000000001101	2			1	25.00	25.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	8	Group 8	0000000000000001000000000000000000000000000000000	1	20	20	1	25.00	25.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	7	Group 7	0000000000000010000000000000000000000000000000000	2			1	125.00	150.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	6	Group 6	0000000000000100000000000000000000000000000000000	1	30	30	1	25.00	50.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	5	Group 5	0000001000001000100100000000000000000000000000000	2			1	25.00	50.00	2	
H6609	029	0	1	04	01	H6609_029_0	4	11	Group 11	0000000000000000000010000000000000000000000000000	2			1	25.00	30.00	2	
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H6609	029	0	1	04	01	H6609_029_0	4	1	Group 1	0100000000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
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H6609	036	0	1	04	01	H6609_036_0	3	3	Group 3	0000000000000001000001000010000000000000000000000	1	20	20	2			2	
H6609	036	0	1	04	01	H6609_036_0	3	2	Group 2	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H6609	036	0	1	04	01	H6609_036_0	3	1	Group 1	0110111111111110101110000000000001011111111001101	1	30	30	2			2	
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H6609	038	0	1	04	01	H6609_038_0	4	7	Group 7	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H6609	038	0	1	04	01	H6609_038_0	4	6	Group 6	0000000000000000000000011000000000000000000000000	1	40	40	2			2	
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H6609	038	0	1	04	01	H6609_038_0	4	4	Group 4	0000000000000000010000000000000000000000000000000	1	20	30	2			2	
H6609	038	0	1	04	01	H6609_038_0	4	3	Group 3	0000000000000001000000000010000000000000000000000	1	20	20	2			2	
H6609	038	0	1	04	01	H6609_038_0	4	2	Group 2	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
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H6609	038	0	1	04	01	H6609_038_0	4	1	Group 1	0110111111111110101110000000000001011111111001101	1	30	30	2			2	
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H6609	041	0	1	04	01	H6609_041_0	4	2	Group 2	0010000000000000001000000000000000000000000000000	2			1	50.00	50.00	2	
H6609	041	0	1	04	01	H6609_041_0	4	3	Group 3	0001000000000000000000011000000000000000000000000	1	25	25	2			2	
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H6609	041	0	1	04	01	H6609_041_0	4	5	Group 5	0000001000001000100100000000000000000000000000000	2			1	15.00	50.00	2	
H6609	041	0	1	04	01	H6609_041_0	4	6	Group 6	0000000000000100000000000000000000000000000000000	1	30	30	1	15.00	15.00	2	
H6609	041	0	1	04	01	H6609_041_0	4	7	Group 7	0000000000000010000000000000000000000000000000000	2			1	15.00	125.00	2	
H6609	041	0	1	04	01	H6609_041_0	4	8	Group 8	0000000000000001010000000000000000000000000000000	1	20	20	1	15.00	125.00	2	
H6609	041	0	1	04	01	H6609_041_0	4	9	Group 9	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
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H6609	042	0	1	04	01	H6609_042_0	4	1	Group 1	0100000000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
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H6900	005	0	1	04	01	H6900_005_0	5	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H6900	005	0	1	04	01	H6900_005_0	5	7		0001000000000000000000011110000000000000000000000	1	20	20	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H7002	002	0	1	04	01	H7002_002_0	4	3		0000000000000000000000000000000000000000000100000	1	20	30	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	4		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7002	002	0	1	04	01	H7002_002_0	4	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	6		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	7		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
H7002	002	0	1	04	01	H7002_002_0	4	8		0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H7006	001	0	1	04	01	H7006_001_0	11	8	Supplemental	0000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H7006	001	0	1	04	01	H7006_001_0	11	7	Transportation	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7006	001	0	1	04	01	H7006_001_0	11	6	Outpatient  Surgery	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H7006	001	0	1	04	01	H7006_001_0	11	5	Lab  Imaging	0000000000000111100000000000000000000000000000000	1	0	20	2			2	
H7006	001	0	1	04	01	H7006_001_0	11	4	Drugs  Supplies	0000000000000000000000011000000000000000000100000	1	20	20	2			2	
H7006	001	0	1	04	01	H7006_001_0	11	3	Rehab	0101011000001000000010000000000000000000000000000	2			1	30.00	30.00	2	
H7006	001	0	1	04	01	H7006_001_0	11	1	Office Visits	0010100111110000000100000000000000000000000001101	2			1	30.00	30.00	2	
H7006	001	0	1	04	01	H7006_001_0	11	2	Preventive	0000000000000000000000000111000001111111111000000	2			1	0.00	0.00	2	
H7006	002	0	1	04	01	H7006_002_0	7	7	Transportation	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7006	002	0	1	04	01	H7006_002_0	7	6	Outpatient  Surgery	0000000000000000011000000000000000000000000000000	2			1	200.00	200.00	2	
H7006	002	0	1	04	01	H7006_002_0	7	5	Lab  Imaging	0000000000000111100000000000000000000000000000000	1	0	20	2			2	
H7006	002	0	1	04	01	H7006_002_0	7	4	Drugs  Supplies	0000000000000000000000011000000000000000000100000	1	20	20	2			2	
H7006	002	0	1	04	01	H7006_002_0	7	3	Rehab	0101011000001000000010000000000000000000000000000	2			1	30.00	30.00	2	
H7006	002	0	1	04	01	H7006_002_0	7	2	Preventive	0000000000000000000000000111000001111111111000000	2			1	0.00	0.00	2	
H7006	002	0	1	04	01	H7006_002_0	7	1	Office Visits	0010100111110000000100000000000000000000000001101	2			1	30.00	30.00	2	
H7006	002	0	1	04	01	H7006_002_0	7	8	Supplemental	0000000000000000000000000000000000000000000010010	2			1	0.00	0.00	2	
H7188	003	0	1	04	01	H7188_003_0	8	1		0111111111111111111110011000000000011111111001101	1	30	30	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	2		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7188	003	0	1	04	01	H7188_003_0	8	3		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	4		0000000000000000000000000001000000100000000000110	2			1	0.00	0.00	2	
H7188	003	0	1	04	01	H7188_003_0	8	5		0000000000000000000000000000011001000000000011000	1	50	50	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H7188	003	0	1	04	01	H7188_003_0	8	7		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H7188	005	0	1	04	01	H7188_005_0	3	1		0111111111111111111110000000000000011111111001101	1	30	30	2			2	
H7188	005	0	1	04	01	H7188_005_0	3	2		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7188	005	0	1	04	01	H7188_005_0	3	3		0000000000000000000000011000000000000000000000000	1	25	25	2			2	
H7188	005	0	1	04	01	H7188_005_0	3	4		0000000000000000000001000001000000100000000000010	2			1	0.00	0.00	2	
H7188	005	0	1	04	01	H7188_005_0	3	5		0000000000000000000000000000011001000000000000000	1	50	50	2			2	
H7188	005	0	1	04	01	H7188_005_0	3	6		0000000000000000000000000100000000000000000000000	1	20	25	2			2	
H7188	005	0	1	04	01	H7188_005_0	3	7		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H7301	002	0	1	04	01	H7301_002_0	13	1	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7301	002	0	1	04	01	H7301_002_0	13	2	OON Covered Benefits	0111111111111111111110011111000000011111111101111	1	30	30	2			2	
H7301	002	0	1	04	01	H7301_002_0	13	4	Immunizations - Hepatitis B	0000000000000000000000000000000000100000000000000	1	30	30	1	0.00	0.00	2	
H7301	002	0	1	04	01	H7301_002_0	13	3	Health Education/Wellness - Smoking Cess	0000000000000000000000000000000001000000000000000	1	0	0	1	0.00	0.00	2	
H7301	801	0	1	04	01	H7301_801_0	14	3	Immunizations - Hep B	0000000000000000000000000000000000100000000000000	1	20	20	2			2	
H7301	801	0	1	04	01	H7301_801_0	14	1	Covered Benefits	0111111101101111111111011111000001011111111101111	1	20	20	2			2	
H7301	801	0	1	04	01	H7301_801_0	14	2	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H7301	801	0	1	04	01	H7301_801_0	14	4	Health Education/Wellness - Smoking Cess	0000000000000000000000000000000001000000000000000	1	0	0	1	0.00	0.00	2	
H7301	802	0	1	04	01	H7301_802_0	12	4	Health Education/Wellness - Smoking Cess	0000000000000000000000000000000001000000000000000	1	0	0	1	0.00	0.00	2	
H7301	802	0	1	04	01	H7301_802_0	12	3	Immunizations - Hep B	0000000000000000000000000000000000100000000000000	1	20	20	2			2	
H7301	802	0	1	04	01	H7301_802_0	12	2	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H7301	802	0	1	04	01	H7301_802_0	12	1	Covered Benefits	0111111101101111111111011111000001011111111101111	1	20	20	2			2	
H7301	803	0	1	04	01	H7301_803_0	5	2	Mental Health	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H7301	803	0	1	04	01	H7301_803_0	5	3	Immunizations - Hep B	0000000000000000000000000000000000100000000000000	1	20	20	2			2	
H7301	803	0	1	04	01	H7301_803_0	5	4	Health Education/Wellness - Smoking Cess	0000000000000000000000000000000001000000000000000	1	0	0	1	0.00	0.00	2	
H7301	803	0	1	04	01	H7301_803_0	5	1	Covered Benefits	0111111101101111111111011111000001011111111101111	1	20	20	2			2	
H7306	001	0	1	04	01	H7306_001_0	10	2	Group 2	0000000000000000000000000000000001000000000000000	1	30	30	1	50.00	50.00	2	
H7306	001	0	1	04	01	H7306_001_0	10	1	Group 1	0111111111111111111111011111000000111111111101111	1	30	30	2			2	
H7306	801	0	1	04	01	H7306_801_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H7306	801	0	1	04	01	H7306_801_0	4	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H7306	801	0	1	04	01	H7306_801_0	4	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H7306	803	0	1	04	01	H7306_803_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H7306	803	0	1	04	01	H7306_803_0	4	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H7306	803	0	1	04	01	H7306_803_0	4	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H7306	804	0	1	04	01	H7306_804_0	5	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H7306	804	0	1	04	01	H7306_804_0	5	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H7306	804	0	1	04	01	H7306_804_0	5	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H7341	001	1	1	09	04	H7341_001_1	6	8		0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H7341	001	1	1	09	04	H7341_001_1	6	9		0000000000000100000000000000000000000000000000000	2			1	0.00	30.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	7		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	4		0000000000000000000000000001000001101111111001010	2			2			2	
H7341	001	1	1	09	04	H7341_001_1	6	5		0000000001000000000000000000000000000000000000101	2			1	0.00	35.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	6		0001000000000000000000000000000000000000000000000	2			1	21.00	21.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	1		0110000000000011100010011010000000000000000100000	1	20	20	2			2	
H7341	001	1	1	09	04	H7341_001_1	6	10		0000000000001000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	11		0000000000000000010000000000000000000000000000000	1	20	20	1	350.00	350.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	12		0000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	13		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	14		0000000000000000000000000100000000000000000000000	1	10	10	2			2	
H7341	001	1	1	09	04	H7341_001_1	6	15		0000000000000000000000000000000000010000000000000	2			1	0.00	15.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	2		0000001100100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H7341	001	1	1	09	04	H7341_001_1	6	3		0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H7341	001	2	1	09	04	H7341_001_2	5	10		0000000000001000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	12		0000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	9		0000000000000100000000000000000000000000000000000	2			1	0.00	30.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	8		0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H7341	001	2	1	09	04	H7341_001_2	5	7		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	11		0000000000000000010000000000000000000000000000000	1	20	20	1	350.00	350.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	6		0001000000000000000000000000000000000000000000000	2			1	21.00	21.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	5		0000000001000000000000000000000000000000000000101	2			1	0.00	35.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	4		0000000000000000000000000001000001101111111001010	2			2			2	
H7341	001	2	1	09	04	H7341_001_2	5	3		0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H7341	001	2	1	09	04	H7341_001_2	5	2		0000001100100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	15		0000000000000000000000000000000000010000000000000	2			1	0.00	15.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	14		0000000000000000000000000100000000000000000000000	1	10	10	2			2	
H7341	001	2	1	09	04	H7341_001_2	5	13		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7341	001	2	1	09	04	H7341_001_2	5	1		0110000000000011100010011010000000000000000100000	1	20	20	2			2	
H7341	002	1	1	09	04	H7341_002_1	3	1		0110000000000011100010011010000000000000000100000	1	20	20	2			2	
H7341	002	1	1	09	04	H7341_002_1	3	10		0000000000001000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	11		0000000000000000010000000000000000000000000000000	1	20	20	1	350.00	350.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	12		0000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	13		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	14		0000000000000000000000000100000000000000000000000	1	10	10	2			2	
H7341	002	1	1	09	04	H7341_002_1	3	15		0000000000000000000000000000000000010000000000000	2			1	0.00	15.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	2		0000001100100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	3		0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H7341	002	1	1	09	04	H7341_002_1	3	4		0000000000000000000000000001000001101111111001010	2			2			2	
H7341	002	1	1	09	04	H7341_002_1	3	5		0000000001000000000000000000000000000000000000101	2			1	0.00	35.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	6		0001000000000000000000000000000000000000000000000	2			1	21.00	21.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	7		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7341	002	1	1	09	04	H7341_002_1	3	8		0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H7341	002	1	1	09	04	H7341_002_1	3	9		0000000000000100000000000000000000000000000000000	2			1	0.00	30.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	1		0110000000000011100010011010000000000000000100000	1	20	20	2			2	
H7341	002	2	1	09	04	H7341_002_2	3	9		0000000000000100000000000000000000000000000000000	2			1	0.00	30.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	11		0000000000000000010000000000000000000000000000000	1	20	20	1	350.00	350.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	12		0000000000000000001000000000000000000000000000000	2			1	150.00	150.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	13		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	14		0000000000000000000000000100000000000000000000000	1	10	10	2			2	
H7341	002	2	1	09	04	H7341_002_2	3	15		0000000000000000000000000000000000010000000000000	2			1	0.00	15.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	2		0000001100100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	3		0000000010010000000100000000000000000000000000000	1	45	45	2			2	
H7341	002	2	1	09	04	H7341_002_2	3	4		0000000000000000000000000001000001101111111001010	2			2			2	
H7341	002	2	1	09	04	H7341_002_2	3	5		0000000001000000000000000000000000000000000000101	2			1	0.00	35.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	6		0001000000000000000000000000000000000000000000000	2			1	21.00	21.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	7		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7341	002	2	1	09	04	H7341_002_2	3	8		0000010000000000000000000000000000000000000000000	1	50	50	2			2	
H7341	002	2	1	09	04	H7341_002_2	3	10		0000000000001000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7787	001	0	1	04	01	H7787_001_0	6	2	$30 - $60copay	0000000000000000000000000000000000000000000000100	2			1	30.00	60.00	2	
H7787	001	0	1	04	01	H7787_001_0	6	1	30% coinsurance	0110000010110111111110011111100000000011100101010	1	30	30	2			2	
H7787	001	0	1	04	01	H7787_001_0	6	3	$40 copay	0001100000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7787	001	0	1	04	01	H7787_001_0	6	4	$60 Copay	0000011101001000000000000000000000000000000000000	2			1	60.00	60.00	2	
H7787	001	0	1	04	01	H7787_001_0	6	5	$50 copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H7787	001	0	1	04	01	H7787_001_0	6	6	$0-60 Preventative copay	0000000000000000000000000000000001111100011000001	2			1	0.00	60.00	2	
H7787	001	0	1	04	01	H7787_001_0	6	7	50% preventive dental	0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H7787	002	0	1	04	01	H7787_002_0	5	2	$40	0001100000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7787	002	0	1	04	01	H7787_002_0	5	1	30% coinsurance	0110000010110111111110011111000000000011100101010	1	30	30	2			2	
H7787	002	0	1	04	01	H7787_002_0	5	3	$60 copay	0000011101001000000000000000000000000000000000100	2			1	60.00	60.00	2	
H7787	002	0	1	04	01	H7787_002_0	5	5	$40-$60 copay	0000000000000000000000000000000001111100011000001	2			1	40.00	60.00	2	
H7787	002	0	1	04	01	H7787_002_0	5	4	$50 copay	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H7787	004	0	1	04	01	H7787_004_0	7	1	30% coinsurance	0110000010110111111110011111000000000011100100010	1	30	30	2			2	
H7787	004	0	1	04	01	H7787_004_0	7	2	$35-$60 copay	0000000000000000000000000000000000000000000000100	2			1	35.00	60.00	2	
H7787	004	0	1	04	01	H7787_004_0	7	3	$40 copay	0001100000000000000000000000000000000000000000000	2			1	40.00	40.00	2	
H7787	004	0	1	04	01	H7787_004_0	7	4	Dental 50%	0000000000000000000000000000000000000000000011000	1	50	50	2			2	
H7787	004	0	1	04	01	H7787_004_0	7	6	$0-60 copay	0000000000000000000000000000000001111100011000001	2			1	0.00	60.00	2	
H7787	004	0	1	04	01	H7787_004_0	7	5	$60 copay	0000011101001000000000000000000000000000000000000	2			1	60.00	60.00	2	
H7787	004	0	1	04	01	H7787_004_0	7	7	$50 copay (Ambulance)	0000000000000000000001000000000000000000000000000	2			1	50.00	50.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	9	Not Covered	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	008	0	1	04	01	H7917_008_0	7	8		0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	7		0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	008	0	1	04	01	H7917_008_0	7	6		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	1	Zero Cost Share Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	3		0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	2		0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	008	0	1	04	01	H7917_008_0	7	10		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	008	0	1	04	01	H7917_008_0	7	5	$30  copay group	0000000000000000000000000000000000000000000000101	2			1	30.00	30.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	8		0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	9	Not Covered	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	009	0	1	04	01	H7917_009_0	7	7		0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	009	0	1	04	01	H7917_009_0	7	6		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	5	$30  copay group	0000000000000000000000000000000000000000000000101	2			1	30.00	30.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	3		0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	2		0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	009	0	1	04	01	H7917_009_0	7	10		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	009	0	1	04	01	H7917_009_0	7	1	Zero Cost Share Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	8		0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	7		0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	010	0	1	04	01	H7917_010_0	7	6		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	5	$30  copay group	0000000000000000000000000000000000000000000000101	2			1	30.00	30.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	9	Not Covered	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	010	0	1	04	01	H7917_010_0	7	3		0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	2		0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	10		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	010	0	1	04	01	H7917_010_0	7	1	Zero Cost Share Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	010	0	1	04	01	H7917_010_0	7	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	9	Not Covered	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	011	0	1	04	01	H7917_011_0	6	8		0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	7		0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	011	0	1	04	01	H7917_011_0	6	6		0000100000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	5	$30  copay group	0000000000000000000000000000000000000000000000101	2			1	30.00	30.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	3		0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	2		0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	1	Zero Cost Share Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	011	0	1	04	01	H7917_011_0	6	10		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	012	0	1	04	01	H7917_012_0	7	1	$35 cost share	0000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H7917	012	0	1	04	01	H7917_012_0	7	10	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	012	0	1	04	01	H7917_012_0	7	2	Zero Cost Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	012	0	1	04	01	H7917_012_0	7	3	$30 Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H7917	012	0	1	04	01	H7917_012_0	7	9	Advanced Imaging	0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	012	0	1	04	01	H7917_012_0	7	5	$400 copayment	0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	012	0	1	04	01	H7917_012_0	7	6	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	012	0	1	04	01	H7917_012_0	7	7	30% Cost Group	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	012	0	1	04	01	H7917_012_0	7	8	Lab	0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	012	0	1	04	01	H7917_012_0	7	4	$45 Group	0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	10	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	013	0	1	04	01	H7917_013_0	7	2	Zero Cost Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	3	$30 Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	4	$45 Group	0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	5	$400 copayment	0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	6	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	7	30% Cost Group	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	013	0	1	04	01	H7917_013_0	7	8	Lab	0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	013	0	1	04	01	H7917_013_0	7	9	Advanced Imaging	0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	013	0	1	04	01	H7917_013_0	7	1	$35 cost share	0000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	4	$45 Group	0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	3	$30 Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	2	Zero Cost Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	10	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	014	0	1	04	01	H7917_014_0	7	9	Advanced Imaging	0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	014	0	1	04	01	H7917_014_0	7	5	$400 copayment	0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	6	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	7	30% Cost Group	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	014	0	1	04	01	H7917_014_0	7	8	Lab	0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	014	0	1	04	01	H7917_014_0	7	1	$35 cost share	0000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	4	$45 Group	0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	3	$30 Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	2	Zero Cost Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	10	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	015	0	1	04	01	H7917_015_0	7	1	$35 cost share	0000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	8	Lab	0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	9	Advanced Imaging	0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	015	0	1	04	01	H7917_015_0	7	7	30% Cost Group	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	015	0	1	04	01	H7917_015_0	7	6	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	015	0	1	04	01	H7917_015_0	7	5	$400 copayment	0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	5	$400 copayment	0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	1	$35 cost share	0000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	7	30% Cost Group	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	026	0	1	04	01	H7917_026_0	5	8	Lab	0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	9	Advanced Imaging	0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	026	0	1	04	01	H7917_026_0	5	6	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	10	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	026	0	1	04	01	H7917_026_0	5	2	Zero Cost Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	3	$30 Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H7917	026	0	1	04	01	H7917_026_0	5	4	$45 Group	0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	1	$35 cost share	0000000000000000000000000000000000000000000000101	2			1	35.00	35.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	10	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H7917	027	0	1	04	01	H7917_027_0	5	2	Zero Cost Group	0001000000100000000000000101000101111111111011010	2			1	0.00	0.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	3	$30 Group	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	9	Advanced Imaging	0000000000000011000000000000000000000000000100000	1	25	25	2			2	
H7917	027	0	1	04	01	H7917_027_0	5	5	$400 copayment	0000000000000000011000000000000000000000000000000	2			1	400.00	400.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	6	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	7	30% Cost Group	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H7917	027	0	1	04	01	H7917_027_0	5	8	Lab	0000000000000100100000000000000000000000000000000	2			1	10.00	10.00	2	
H7917	027	0	1	04	01	H7917_027_0	5	4	$45 Group	0110011111011000000110000000000000000000000000000	2			1	45.00	45.00	2	
H7917	801	0	1	04	01	H7917_801_0	3	3	Partial Hospitalization	0010000010000000000000000000000000000000000000000	1	50	50	2			2	
H7917	801	0	1	04	01	H7917_801_0	3	2	All Others	0101111101101111111111011111000001111111111101111	1	0	20	2			2	
H7917	801	0	1	04	01	H7917_801_0	3	1	MH-Psych	0000000000010000000000000000000000000000000000000	1	45	45	2			2	
H7917	801	0	1	04	01	H7917_801_0	3	4	Not Covered	1000000000000000000000100000111110000000000010000	1	50	50	2			2	
H7917	802	0	1	04	01	H7917_802_0	3	2	All Others	0101111101101111111111011111000001111111111101111	1	0	20	2			2	
H7917	802	0	1	04	01	H7917_802_0	3	3	Partial Hospitalization	0010000010000000000000000000000000000000000000000	1	50	50	2			2	
H7917	802	0	1	04	01	H7917_802_0	3	4	Not Covered	1000000000000000000000100000111110000000000010000	1	50	50	2			2	
H7917	802	0	1	04	01	H7917_802_0	3	1	MH-Psych	0000000000010000000000000000000000000000000000000	1	45	45	2			2	
H7917	803	0	1	04	01	H7917_803_0	3	1	MH-Psych	0000000000010000000000000000000000000000000000000	1	45	45	2			2	
H7917	803	0	1	04	01	H7917_803_0	3	2	All Others	0101111101101111111111011111000001111111111101111	1	0	20	2			2	
H7917	803	0	1	04	01	H7917_803_0	3	3	Partial Hospitalization	0010000010000000000000000000000000000000000000000	1	50	50	2			2	
H7917	803	0	1	04	01	H7917_803_0	3	4	Not Covered	1000000000000000000000100000111110000000000010000	1	50	50	2			2	
H8091	001	0	1	04	01	H8091_001_0	5	1	All Other	0111111111111111111110011111000000011111111101111	1	30	30	2			2	
H8091	001	0	1	04	01	H8091_001_0	5	2	Immunizations	0000000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H8091	001	0	1	04	01	H8091_001_0	5	3	Health and Wellness	0000000000000000000000000000000001000000000000000	1	30	50	2			1	250.00
H8091	001	0	1	04	01	H8091_001_0	5	4	Ambulance	0000000000000000000001000000000000000000000000000	2			1	250.00	500.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	9		0000000000000001000000011010000000000000000000000	1	20	20	2			2	
H8098	001	0	1	09	04	H8098_001_0	12	8		0000000000000000001000000000000000000000000000000	1	10	10	2			2	
H8098	001	0	1	09	04	H8098_001_0	12	7		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	5		0000000000000010100000000000000000000000000000000	1	0	25	1	0.00	50.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	6		0000000000000000000000000000000000000000000010000	2			1	0.00	75.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	4		0100001000001000000010000000000000000000000000000	1	25	25	1	40.00	40.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	3		0000000111110000000100000000000000000000001000001	2			1	40.00	40.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	2		0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	15		0000000000000000000000000000000000000000000001000	1	30	30	2			2	
H8098	001	0	1	09	04	H8098_001_0	12	14		0010000000000000000000000000000000000000000000000	2			1	269.00	269.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	13		0001000000000000000000000001000001111111110000100	2			1	0.00	0.00	2	
H8098	001	0	1	09	04	H8098_001_0	12	12		0000000000000100000000000100000000000000000000010	1	0	25	2			2	
H8098	001	0	1	09	04	H8098_001_0	12	11		0000000000000000010000000000000000000000000000000	1	25	25	2			2	
H8098	001	0	1	09	04	H8098_001_0	12	10		0000000000000000000000000000000000000000000100000	1	23	23	2			2	
H8098	001	0	1	09	04	H8098_001_0	12	1		0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	13		0001000000000000000000000001000001111111110000100	2			1	0.00	0.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	12		0000000000000100000000000100000000000000000000010	1	0	25	2			2	
H8098	003	0	1	09	04	H8098_003_0	10	15		0000000000000000000000000000000000000000000001000	1	30	30	2			2	
H8098	003	0	1	09	04	H8098_003_0	10	2		0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	3		0000000111110000000100000000000000000000001000101	2			1	40.00	40.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	4		0100001000001000000010000000000000000000000000000	1	25	25	1	40.00	40.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	5		0000000000000010100000000000000000000000000000000	1	0	25	1	0.00	50.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	6		0000000000000000000000000000000000000000000010000	2			1	0.00	75.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	7		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	8		0000000000000000001000000000000000000000000000000	1	10	10	2			2	
H8098	003	0	1	09	04	H8098_003_0	10	1		0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8098	003	0	1	09	04	H8098_003_0	10	10		0000000000000000000000000000000000000000000100000	1	23	23	2			2	
H8098	003	0	1	09	04	H8098_003_0	10	11		0000000000000000010000000000000000000000000000000	1	25	25	2			2	
H8098	003	0	1	09	04	H8098_003_0	10	9		0000000000000001000000011010000000000000000000000	1	20	20	2			2	
H8098	003	0	1	09	04	H8098_003_0	10	14		0010000000000000000000000000000000000000000000000	2			1	269.00	269.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	12		0000000000000000000000000100000000000000000000000	1	0	20	2			2	
H8098	005	0	1	09	04	H8098_005_0	11	11		0000000000000000010000000000000000000000000001000	1	30	30	2			2	
H8098	005	0	1	09	04	H8098_005_0	11	10		0000000000000000000000011000000000000000000100000	1	20	20	2			2	
H8098	005	0	1	09	04	H8098_005_0	11	1		0000100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	9		0000000000000001000000000010000000000000000000000	1	20	20	2			2	
H8098	005	0	1	09	04	H8098_005_0	11	8		0000000000000000001000000000000000000000000000000	1	15	15	2			2	
H8098	005	0	1	09	04	H8098_005_0	11	7		0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	6		0000000000000100000000000000000000000000000000000	1	5	5	2			2	
H8098	005	0	1	09	04	H8098_005_0	11	5		0000000000000010100000000000000000000000000000000	1	0	25	1	0.00	50.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	4		0100001000001000000010000000000000000000000000000	1	25	25	1	40.00	40.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	3		0000000111110000000100000000000000000000001000001	2			1	40.00	40.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	2		0000010000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	15		0000000000000000000000000000000000000000000000010	2			1	10.00	10.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	14		0010000000000000000000000000000000000000000000000	2			1	269.00	269.00	2	
H8098	005	0	1	09	04	H8098_005_0	11	13		0001000000000000000000000001000001111111110000100	2			1	0.00	0.00	2	
H8098	009	0	1	09	04	H8098_009_0	9	1		0000100000000000000000000000000000000000000000000	2			1	10.00	10.00	2	
H8098	009	0	1	09	04	H8098_009_0	9	10		0000000000000000000000000000000000000000000100000	1	23	23	2			2	
H8098	009	0	1	09	04	H8098_009_0	9	11		0000000000000000010000000000000000000000000000000	1	25	25	2			2	
H8098	009	0	1	09	04	H8098_009_0	9	12		0000000000000100000000000000000000000000000000010	1	0	25	2			2	
H8098	009	0	1	09	04	H8098_009_0	9	13		0001000000000000000000000001000001111111110000100	2			1	0.00	0.00	2	
H8098	009	0	1	09	04	H8098_009_0	9	14		0010000000000000000000000000000000000000000000000	2			1	269.00	269.00	2	
H8098	009	0	1	09	04	H8098_009_0	9	15		0000000000000000000000000000000000000000000001000	1	30	30	2			2	
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H8145	087	0	1	09	04	H8145_087_0	6	7		0000001000001000000010000000000000000000000000000	1	25	25	1	15.00	15.00	2	
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H8145	087	0	1	09	04	H8145_087_0	6	5		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H8145	087	0	1	09	04	H8145_087_0	6	12		0000000000000100000000000000000000000000000000000	1	0	25	1	0.00	35.00	2	
H8145	087	0	1	09	04	H8145_087_0	6	3		0100100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	087	0	1	09	04	H8145_087_0	6	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	087	0	1	09	04	H8145_087_0	6	13		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	087	0	1	09	04	H8145_087_0	6	1		0010000000100000001001011110000000000000000000000	1	20	20	2			2	
H8145	087	0	1	09	04	H8145_087_0	6	10		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H8145	087	0	1	09	04	H8145_087_0	6	4		0000010011010000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	12		0000000000000000000000000000000000000000000000010	2			1	25.00	25.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	13		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	2		0001000000000000000000000001000001111111111000000	2			1	0.00	0.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	3		0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	4		0010000111110000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	5		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	6		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H8145	089	0	1	09	04	H8145_089_0	6	7		0000001000001000000000000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	8		0000000010010000000110000000000000000000000000000	1	25	25	1	35.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	9		0000000000000000010000000000000000000000000000000	1	20	25	2			2	
H8145	089	0	1	09	04	H8145_089_0	6	11		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	10		0000000000000100000000000000000000000000000000000	1	20	25	1	0.00	35.00	2	
H8145	089	0	1	09	04	H8145_089_0	6	1		0100000000000000001001011110000000000000000000000	1	20	20	2			2	
H8145	091	0	1	09	04	H8145_091_0	4	7		0000001000001000000010000000000000000000000000000	1	25	25	1	15.00	15.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	6		0000000000000000000100000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	5		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	4		0000010011010000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	3		0100100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	9		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	12		0000000000000100000000000000000000000000000000000	1	0	25	1	0.00	35.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	11		0000000100000000000000000000000000000000000000000	2			1	15.00	35.00	2	
H8145	091	0	1	09	04	H8145_091_0	4	10		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H8145	091	0	1	09	04	H8145_091_0	4	1		0010000000100000001001011110000000000000000000000	1	20	20	2			2	
H8145	091	0	1	09	04	H8145_091_0	4	8		0000000000000000010000000000000000000000000000000	1	20	25	2			2	
H8145	091	0	1	09	04	H8145_091_0	4	13		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	11	Group 11	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	9	Group 9	0000000000000000010000000000000000000000000000000	1	20	20	1	100.00	125.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	8	Group 8	0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	7	Group 7	0000000000000010100000000000000000000000000000000	2			1	15.00	125.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	6	Group 6	0000000000000100000000000000000000000000000000000	1	20	20	1	0.00	125.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	5	Group 5	0000000111110000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	4	Group 4	0000001000001000000110000000000000000000000000000	2			1	35.00	125.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	3	Group 3	0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	2	Group 2	0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H8145	093	0	1	09	04	H8145_093_0	4	15	Group 15	0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	14	Group 14	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	13	Group 13	0000000000000000000000000010000000000000000100000	1	20	20	2			2	
H8145	093	0	1	09	04	H8145_093_0	4	12	Group 12	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H8145	093	0	1	09	04	H8145_093_0	4	10	Group 10	0000000000000000001000000000000000000000000000000	2			1	75.00	75.00	2	
H8145	093	0	1	09	04	H8145_093_0	4	1	Group 1	0110000000000000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	3		0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	8		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	15		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	14		0000000000000000000000000000000000000000000100000	1	20	20	1	0.00	0.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	13		0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	12		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
H8145	095	0	1	09	04	H8145_095_0	3	4		0000001000001000000110000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	5		0000000111110000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	1		0110000000000000000001000010000000000000000000000	1	20	20	2			2	
H8145	095	0	1	09	04	H8145_095_0	3	6		0000000000000100000000000000000000000000000000000	1	20	30	1	0.00	100.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	10		0000000000000000001000000000000000000000000000000	2			1	125.00	125.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	11		0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8145	095	0	1	09	04	H8145_095_0	3	7		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H8145	095	0	1	09	04	H8145_095_0	3	2		0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H8145	095	0	1	09	04	H8145_095_0	3	9		0000000000000000010000000000000000000000000000000	1	20	25	1	100.00	100.00	2	
H8145	096	0	1	09	04	H8145_096_0	4	3	Group 3	0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H8145	096	0	1	09	04	H8145_096_0	4	2	Group 2	0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H8145	096	0	1	09	04	H8145_096_0	4	1	Group 1	0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H8145	097	0	1	09	04	H8145_097_0	2	1	Group 1	0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H8145	097	0	1	09	04	H8145_097_0	2	2	Group 2	0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H8145	097	0	1	09	04	H8145_097_0	2	3	Group 3	0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	1	Group 1	0110111111111110101110000000000001011111111001101	1	30	30	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	2	Group 2	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	3	Group 3	0000000000000001000001000010000000000000000000000	1	20	20	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	4	Group 4	0000000000000000010000000000000000000000000000000	1	20	30	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	5	Group 5	0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	6	Group 6	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H8145	099	0	1	09	04	H8145_099_0	4	7	Group 7	0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H8145	099	0	1	09	04	H8145_099_0	4	8	Group 8	0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H8145	100	0	1	09	04	H8145_100_0	4	3	Group 3	0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H8145	100	0	1	09	04	H8145_100_0	4	1	Group 1	0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H8145	100	0	1	09	04	H8145_100_0	4	2	Group 2	0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H8145	103	0	1	09	04	H8145_103_0	5	5		0110111111111010101110000000000000000000000001011	1	25	25	2			2	
H8145	103	0	1	09	04	H8145_103_0	5	2		0000000000000000000000011000000000000000000000000	1	35	35	2			2	
H8145	103	0	1	09	04	H8145_103_0	5	4		0001000000000000000000000001001000111111111000000	2			1	0.00	0.00	2	
H8145	103	0	1	09	04	H8145_103_0	5	3		0000000000000000000000000100000000000000000000000	1	20	35	2			2	
H8145	103	0	1	09	04	H8145_103_0	5	1		0000000000000000000001000010000000000000000000000	1	20	20	2			2	
H8145	103	0	1	09	04	H8145_103_0	5	6		0000000000000100000000000000000001000000000000100	1	0	25	2			2	
H8145	103	0	1	09	04	H8145_103_0	5	7		0000000000000001010000000000000000000000000000000	1	20	25	2			2	
H8145	103	0	1	09	04	H8145_103_0	5	8		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	3	Group 3	0000000000000001000001000010000000000000000000000	1	20	20	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	2	Group 2	0001000000000000000000000000000000000000000000000	1	25	25	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	1	Group 1	0110111111111110101110000000000001011111111001101	1	30	30	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	8	Group 8	0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	6	Group 6	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	7	Group 7	0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H8145	104	0	1	09	04	H8145_104_0	4	5	Group 5	0000000000000000000000011000000000000000000000000	1	40	40	2			2	
H8145	104	0	1	09	04	H8145_104_0	4	4	Group 4	0000000000000000010000000000000000000000000000000	1	20	30	2			2	
H8145	107	0	1	09	04	H8145_107_0	4	2	Group 2	0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H8145	107	0	1	09	04	H8145_107_0	4	3	Group 3	0000000000000100000000000000000000000000000100100	1	0	20	2			2	
H8145	107	0	1	09	04	H8145_107_0	4	1	Group 1	0110111111111011111111011110000000000000000001011	1	20	20	2			2	
H8145	108	0	1	09	04	H8145_108_0	1	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	3		0100100000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	4		0000010011010000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	5		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	6		0000000000000000000100000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	7		0000001000001000000010000000000000000000000000000	1	25	25	1	15.00	15.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	8		0000000000000000010000000000000000000000000000000	1	20	25	2			2	
H8145	108	0	1	09	04	H8145_108_0	1	9		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	1		0010000000100000001001011110000000000000000000000	1	20	20	2			2	
H8145	108	0	1	09	04	H8145_108_0	1	13		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	12		0000000000000100000000000000000000000000000000000	1	0	25	1	0.00	35.00	2	
H8145	108	0	1	09	04	H8145_108_0	1	10		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
H8145	108	0	1	09	04	H8145_108_0	1	11		0000000100000000000000000000000000000000000000000	2			1	15.00	35.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	1	Group 1	0110000000000000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	10	Group 10	0000000000000000001000000000000000000000000000000	2			1	75.00	75.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	11	Group 11	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	12	Group 12	0000000000000000000000000100000000000000000000000	1	20	40	2			2	
H8145	109	0	1	09	04	H8145_109_0	4	13	Group 13	0000000000000000000000000010000000000000000100000	1	20	20	2			2	
H8145	109	0	1	09	04	H8145_109_0	4	14	Group 14	0000000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	15	Group 15	0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	2	Group 2	0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H8145	109	0	1	09	04	H8145_109_0	4	3	Group 3	0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	4	Group 4	0000001000001000000110000000000000000000000000000	2			1	35.00	125.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	5	Group 5	0000000111110000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	6	Group 6	0000000000000100000000000000000000000000000000000	1	20	20	1	0.00	125.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	7	Group 7	0000000000000010100000000000000000000000000000000	2			1	15.00	125.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	8	Group 8	0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	109	0	1	09	04	H8145_109_0	4	9	Group 9	0000000000000000010000000000000000000000000000000	1	20	20	1	100.00	125.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	8		0000000000000000000010000000000000000000000000000	1	25	25	1	35.00	35.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	11		0000000000000001000000000000000000000000000000000	1	20	20	1	35.00	35.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	6		0000000000000010100000000000000000000000000000000	1	20	25	1	15.00	35.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	5		0000000000000000000100000000000000000000000000000	1	25	25	2			2	
H8145	110	0	1	09	04	H8145_110_0	6	9		0000000000000000010000000000000000000000000000000	1	20	25	2			2	
H8145	110	0	1	09	04	H8145_110_0	6	1		0110000000000000001001011110000000000000000100000	1	20	20	2			2	
H8145	110	0	1	09	04	H8145_110_0	6	10		0000000000000100000000000000000000000000000000000	1	20	25	1	0.00	35.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	7		0000001000001000000000000000000000000000000000000	1	20	25	1	35.00	35.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	12		0000000000000000000000000000000000000000000000010	2			1	25.00	25.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	13		0000000000000000000000000000000000000000000000100	2			1	0.00	35.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	2		0001000000000000000000000001001001111111111000000	2			1	0.00	0.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	3		0000110000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
H8145	110	0	1	09	04	H8145_110_0	6	4		0000000111110000000000000000000000000000000001001	2			1	35.00	35.00	2	
H8145	111	0	1	09	04	H8145_111_0	1	1		0110111111111011111111011110000000000000000101001	1	20	20	2			2	
H8145	111	0	1	09	04	H8145_111_0	1	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	111	0	1	09	04	H8145_111_0	1	3		0000000000000100000000000000000000000000000000100	1	0	20	2			2	
H8145	112	0	1	09	04	H8145_112_0	3	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	112	0	1	09	04	H8145_112_0	3	3		0000000000000100000000000000000000000000000000100	1	0	20	2			2	
H8145	112	0	1	09	04	H8145_112_0	3	1		0110111111111011111111011110000000000000000101001	1	20	20	2			2	
H8145	113	0	1	09	04	H8145_113_0	1	1		0110111111111011111111011110000000000000000101001	1	20	20	2			2	
H8145	113	0	1	09	04	H8145_113_0	1	3		0000000000000100000000000000000000000000000000100	1	0	20	2			2	
H8145	113	0	1	09	04	H8145_113_0	1	2		0001000000000000000000000001001001111111111000010	2			1	0.00	0.00	2	
H8145	114	0	1	09	04	H8145_114_0	2	3		0000000000000100000000000000000000000000000000100	1	0	20	2			2	
H8145	114	0	1	09	04	H8145_114_0	2	1		0110111111111011111111011110000000000000000111001	1	20	20	2			2	
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H8558	005	0	1	04	01	H8558_005_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	005	0	1	04	01	H8558_005_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	005	0	1	04	01	H8558_005_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	005	0	1	04	01	H8558_005_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	005	0	1	04	01	H8558_005_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	006	0	1	04	01	H8558_006_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	006	0	1	04	01	H8558_006_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	006	0	1	04	01	H8558_006_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	006	0	1	04	01	H8558_006_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	006	0	1	04	01	H8558_006_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	006	0	1	04	01	H8558_006_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	006	0	1	04	01	H8558_006_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	006	0	1	04	01	H8558_006_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	006	0	1	04	01	H8558_006_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	006	0	1	04	01	H8558_006_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	007	0	1	04	01	H8558_007_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	007	0	1	04	01	H8558_007_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	007	0	1	04	01	H8558_007_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	007	0	1	04	01	H8558_007_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	007	0	1	04	01	H8558_007_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	007	0	1	04	01	H8558_007_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	007	0	1	04	01	H8558_007_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	007	0	1	04	01	H8558_007_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	007	0	1	04	01	H8558_007_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	007	0	1	04	01	H8558_007_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	008	0	1	04	01	H8558_008_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	008	0	1	04	01	H8558_008_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	008	0	1	04	01	H8558_008_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	008	0	1	04	01	H8558_008_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	008	0	1	04	01	H8558_008_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	008	0	1	04	01	H8558_008_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	008	0	1	04	01	H8558_008_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	008	0	1	04	01	H8558_008_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	008	0	1	04	01	H8558_008_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	008	0	1	04	01	H8558_008_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	009	0	1	04	01	H8558_009_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	009	0	1	04	01	H8558_009_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	009	0	1	04	01	H8558_009_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	009	0	1	04	01	H8558_009_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	010	0	1	04	01	H8558_010_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	010	0	1	04	01	H8558_010_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	010	0	1	04	01	H8558_010_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	010	0	1	04	01	H8558_010_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	010	0	1	04	01	H8558_010_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	010	0	1	04	01	H8558_010_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	010	0	1	04	01	H8558_010_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	010	0	1	04	01	H8558_010_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	010	0	1	04	01	H8558_010_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	010	0	1	04	01	H8558_010_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	011	0	1	04	01	H8558_011_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	011	0	1	04	01	H8558_011_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	011	0	1	04	01	H8558_011_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	011	0	1	04	01	H8558_011_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	011	0	1	04	01	H8558_011_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	011	0	1	04	01	H8558_011_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	011	0	1	04	01	H8558_011_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	011	0	1	04	01	H8558_011_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	011	0	1	04	01	H8558_011_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	011	0	1	04	01	H8558_011_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	012	0	1	04	01	H8558_012_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	012	0	1	04	01	H8558_012_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	012	0	1	04	01	H8558_012_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	012	0	1	04	01	H8558_012_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	012	0	1	04	01	H8558_012_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	012	0	1	04	01	H8558_012_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	012	0	1	04	01	H8558_012_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	012	0	1	04	01	H8558_012_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	012	0	1	04	01	H8558_012_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	012	0	1	04	01	H8558_012_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	801	0	1	04	01	H8558_801_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8558	801	0	1	04	01	H8558_801_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	801	0	1	04	01	H8558_801_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	801	0	1	04	01	H8558_801_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	801	0	1	04	01	H8558_801_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	801	0	1	04	01	H8558_801_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	801	0	1	04	01	H8558_801_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	801	0	1	04	01	H8558_801_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	801	0	1	04	01	H8558_801_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	801	0	1	04	01	H8558_801_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	802	0	1	04	01	H8558_802_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H8558	802	0	1	04	01	H8558_802_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H8558	802	0	1	04	01	H8558_802_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H8558	802	0	1	04	01	H8558_802_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H8558	802	0	1	04	01	H8558_802_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H8558	802	0	1	04	01	H8558_802_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8558	802	0	1	04	01	H8558_802_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H8558	802	0	1	04	01	H8558_802_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H8558	802	0	1	04	01	H8558_802_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H8558	802	0	1	04	01	H8558_802_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H8604	001	0	1	04	01	H8604_001_0	5	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	001	0	1	04	01	H8604_001_0	5	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	001	0	1	04	01	H8604_001_0	5	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	001	0	1	04	01	H8604_001_0	5	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	001	0	1	04	01	H8604_001_0	5	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	002	0	1	04	01	H8604_002_0	5	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	002	0	1	04	01	H8604_002_0	5	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	002	0	1	04	01	H8604_002_0	5	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	002	0	1	04	01	H8604_002_0	5	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	002	0	1	04	01	H8604_002_0	5	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	003	0	1	04	01	H8604_003_0	5	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	003	0	1	04	01	H8604_003_0	5	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	003	0	1	04	01	H8604_003_0	5	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	003	0	1	04	01	H8604_003_0	5	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	003	0	1	04	01	H8604_003_0	5	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	004	0	1	04	01	H8604_004_0	5	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	004	0	1	04	01	H8604_004_0	5	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	004	0	1	04	01	H8604_004_0	5	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	004	0	1	04	01	H8604_004_0	5	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	004	0	1	04	01	H8604_004_0	5	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	005	0	1	04	01	H8604_005_0	6	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	005	0	1	04	01	H8604_005_0	6	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	005	0	1	04	01	H8604_005_0	6	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	005	0	1	04	01	H8604_005_0	6	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	005	0	1	04	01	H8604_005_0	6	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	006	0	1	04	01	H8604_006_0	6	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	006	0	1	04	01	H8604_006_0	6	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	006	0	1	04	01	H8604_006_0	6	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	006	0	1	04	01	H8604_006_0	6	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	006	0	1	04	01	H8604_006_0	6	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	801	0	1	04	01	H8604_801_0	5	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	801	0	1	04	01	H8604_801_0	5	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	801	0	1	04	01	H8604_801_0	5	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	801	0	1	04	01	H8604_801_0	5	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	801	0	1	04	01	H8604_801_0	5	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
H8604	802	0	1	04	01	H8604_802_0	5	1	20% Coinsurance	0111000000000111111010000111000001101111111100010	1	20	20	2			2	
H8604	802	0	1	04	01	H8604_802_0	5	3	$20 PCP/Routine Physical	0000100000000000000000000000000000010000000000000	2			1	20.00	20.00	2	
H8604	802	0	1	04	01	H8604_802_0	5	2	DME	0000000000000000000000011000000000000000000000000	1	30	30	2			2	
H8604	802	0	1	04	01	H8604_802_0	5	4	SCP	0000011111111000000100000000000000000000000001101	2			1	45.00	45.00	2	
H8604	802	0	1	04	01	H8604_802_0	5	5	Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
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H8644	003	0	1	04	01	H8644_003_0	6	3		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H8644	003	0	1	04	01	H8644_003_0	6	5		0000000000000000000000000000011001000000000011000	1	50	50	2			2	
H8644	003	0	1	04	01	H8644_003_0	6	4		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H8644	003	0	1	04	01	H8644_003_0	6	6		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H8644	003	0	1	04	01	H8644_003_0	6	7		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
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H8684	001	0	1	04	01	H8684_001_0	4	3	Tier 3	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
H8684	001	0	1	04	01	H8684_001_0	4	2	Tier 2	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H8684	001	0	1	04	01	H8684_001_0	4	1	Tier 1	0111111111111111111110011101000001111111111101101	1	20	20	2			2	
H8684	801	0	1	04	01	H8684_801_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H8684	801	0	1	04	01	H8684_801_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H8684	801	0	1	04	01	H8684_801_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H8684	802	0	1	04	01	H8684_802_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H8684	802	0	1	04	01	H8684_802_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
H8684	802	0	1	04	01	H8684_802_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H8684	805	0	2	04	01	H8684_805_0	2	1	Tier 1	0111111101101111111111011111000001111111111101111	1	20	20	2			2	
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H8684	805	0	2	04	01	H8684_805_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
H8684	806	0	2	04	01	H8684_806_0	2	3	Tier 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
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H8684	806	0	2	04	01	H8684_806_0	2	2	Tier 2	0000000010010000000000000000000000000000000000000	1	45	45	2			2	
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H8707	005	0	1	04	01	H8707_005_0	4	6		0000000000000000000000000100000000000000000000000	1	20	30	2			2	
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H8707	005	0	1	04	01	H8707_005_0	4	1		0111111111111111111110011000000000011111111001101	1	30	30	2			2	
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H8707	006	0	1	04	01	H8707_006_0	5	5		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
H8707	006	0	1	04	01	H8707_006_0	5	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H8707	006	0	1	04	01	H8707_006_0	5	3		0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H8707	006	0	1	04	01	H8707_006_0	5	2		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
H8707	007	0	1	04	01	H8707_007_0	5	1		0111111111111111111110011000001001011111111001101	1	30	30	2			2	
H8707	007	0	1	04	01	H8707_007_0	5	2		0000000000000000000001000001000000100000000000010	2			1	0.00	0.00	2	
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H8707	007	0	1	04	01	H8707_007_0	5	4		0000000000000000000000000100000000000000000100000	1	20	30	2			2	
H8980	002	0	1	04	01	H8980_002_0	12	1	20% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	20	20	2			2	
H8980	002	0	1	04	01	H8980_002_0	12	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H8980	002	0	1	04	01	H8980_002_0	12	3	0% Coinsurance OON	0001000000000000000000000000000000100000000000000	2			1	0.00	0.00	2	
H8980	002	0	1	04	01	H8980_002_0	12	4	Ambulance OON	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H8980	002	0	1	04	01	H8980_002_0	12	5	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H8980	003	0	1	04	01	H8980_003_0	6	4	$50 Copay OON	0000000000000000000000000000000001000000000000000	2			1	50.00	50.00	2	
H8980	003	0	1	04	01	H8980_003_0	6	3	0% Coinsurance OON	0001000000000000000001000000000000100000000000000	2			1	0.00	0.00	2	
H8980	003	0	1	04	01	H8980_003_0	6	1	30% Coinsurance OON	0100111101101111111010011111000000011111111101111	1	30	30	2			2	
H8980	003	0	1	04	01	H8980_003_0	6	2	45% Coinsurance OON	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
H8980	801	0	1	04	01	H8980_801_0	4	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H8980	801	0	1	04	01	H8980_801_0	4	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H8980	801	0	1	04	01	H8980_801_0	4	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H8980	802	0	1	04	01	H8980_802_0	5	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H8980	802	0	1	04	01	H8980_802_0	5	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
H8980	802	0	1	04	01	H8980_802_0	5	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H8980	803	0	1	04	01	H8980_803_0	5	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H8980	803	0	1	04	01	H8980_803_0	5	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
H8980	803	0	1	04	01	H8980_803_0	5	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
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H9184	002	0	1	04	01	H9184_002_0	4	2	Group 2	0001111101101111111001000011000000010000000100011	1	20	20	2			2	
H9503	001	0	1	04	01	H9503_001_0	3	1		0111111111111110101110011000000001011111111001101	1	30	30	2			2	
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H9503	001	0	1	04	01	H9503_001_0	3	7		0000000000000000000000000000000000000000000010000	1	50	50	2			2	
H9503	001	0	1	04	01	H9503_001_0	3	4		0000000000000000010000000000000000000000000100000	1	0	30	2			2	
H9503	001	0	1	04	01	H9503_001_0	3	3		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H9503	001	0	1	04	01	H9503_001_0	3	2		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H9503	003	0	1	04	01	H9503_003_0	3	1		0110111111111110101110000000000001011111111001101	1	30	30	2			2	
H9503	003	0	1	04	01	H9503_003_0	3	2		0001000000000000000000011000000000000000000000000	1	40	40	2			2	
H9503	003	0	1	04	01	H9503_003_0	3	3		0000000000000000000000000100000000000000000000000	1	20	40	2			2	
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H9503	003	0	1	04	01	H9503_003_0	3	5		0000000000000000000000000000000000000000000100000	1	0	30	2			2	
H9503	003	0	1	04	01	H9503_003_0	3	6		0000000000000000000000000001001000100000000000010	2			1	0.00	0.00	2	
H9503	003	0	1	04	01	H9503_003_0	3	7		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
H9503	003	0	1	04	01	H9503_003_0	3	8		0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
H9572	001	1	1	04	01	H9572_001_1	12	1		0111111111111111100111000010000000111111100001000	1	40	40	2			2	
H9572	001	1	1	04	01	H9572_001_1	12	2		0000000000000000011000011000000001000000000000000	1	40	40	2			2	
H9572	001	1	1	04	01	H9572_001_1	12	7		0000000000000000000000000101000000000000011000000	1	0	0	2			2	
H9572	001	1	1	04	01	H9572_001_1	12	6		0000000000000000000000000000000000000000000000110	2			1	0.00	10.00	2	
H9572	001	1	1	04	01	H9572_001_1	12	5		0000000000000000000000000000000000000000000100000	1	0	15	2			2	
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H9572	001	2	1	04	01	H9572_001_2	13	1		0111111111111111100111000010000000111111100001000	1	40	40	2			2	
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H9572	001	2	1	04	01	H9572_001_2	13	3		1000000000000000000000000000000000000000000000001	1	50	50	2			2	
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H9572	001	3	1	04	01	H9572_001_3	12	1		0111111111111111100111000010000000111111100001000	1	40	40	2			2	
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H9615	804	0	1	04	01	H9615_804_0	5	2	$25 Copay	0010101111011000100110000000000000010000000001101	2			1	25.00	25.00	2	
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H9670	003	0	1	04	01	H9670_003_0	6	3	$50 Copay	0000010111110000000100000000000000000000000001101	2			1	50.00	50.00	2	
H9670	003	0	1	04	01	H9670_003_0	6	2	$30 Copay	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
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H9670	003	0	1	04	01	H9670_003_0	6	4	30% Cost-Sharing	0111001000001111111011000111000000011111111100000	1	30	30	2			2	
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H9670	004	0	1	04	01	H9670_004_0	6	5	50% Cost Sharing	0000000000000000000000011000000001000000000000000	1	50	50	2			2	
H9670	004	0	1	04	01	H9670_004_0	6	3	$50 Copay	0000010111110000000100000000000000000000000001101	2			1	50.00	50.00	2	
H9670	004	0	1	04	01	H9670_004_0	6	2	$30 Copay	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9670	004	0	1	04	01	H9670_004_0	6	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H9670	801	0	1	04	01	H9670_801_0	5	2	20% Cost Sharing	0111111111111111111111000011000000011111111100101	1	20	20	2			2	
H9670	801	0	1	04	01	H9670_801_0	5	1	$0 Copay	0000000000000000000000000000000000100000000000010	2			1	0.00	0.00	2	
H9670	801	0	1	04	01	H9670_801_0	5	3	50% Cost Sharing	1000000000000000000000011100000001000000000011000	1	50	50	2			2	
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H9670	802	0	1	04	01	H9670_802_0	5	2	20% Cost Sharing	0111111111111111111111000011000000011111111100101	1	20	20	2			2	
H9670	802	0	1	04	01	H9670_802_0	5	3	50% Cost Sharing	1000000000000000000000011100000001000000000011000	1	50	50	2			2	
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H9847	802	0	1	04	01	H9847_802_0	2	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H9847	802	0	1	04	01	H9847_802_0	2	1	Group 1	0100111101101111111111011111000001111111111101111	1	20	20	2			2	
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H9847	803	0	1	04	01	H9847_803_0	2	2	Group 2	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
H9847	803	0	1	04	01	H9847_803_0	2	3	Group 3	0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
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H9988	001	0	1	04	01	H9988_001_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	001	0	1	04	01	H9988_001_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	001	0	1	04	01	H9988_001_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	001	0	1	04	01	H9988_001_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	001	0	1	04	01	H9988_001_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	001	0	1	04	01	H9988_001_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	001	0	1	04	01	H9988_001_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	002	0	1	04	01	H9988_002_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	002	0	1	04	01	H9988_002_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	002	0	1	04	01	H9988_002_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	002	0	1	04	01	H9988_002_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	002	0	1	04	01	H9988_002_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	002	0	1	04	01	H9988_002_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	002	0	1	04	01	H9988_002_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	002	0	1	04	01	H9988_002_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	002	0	1	04	01	H9988_002_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	002	0	1	04	01	H9988_002_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	003	0	1	04	01	H9988_003_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	003	0	1	04	01	H9988_003_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	003	0	1	04	01	H9988_003_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	003	0	1	04	01	H9988_003_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	004	0	1	04	01	H9988_004_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	004	0	1	04	01	H9988_004_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	004	0	1	04	01	H9988_004_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	004	0	1	04	01	H9988_004_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	004	0	1	04	01	H9988_004_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	004	0	1	04	01	H9988_004_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	004	0	1	04	01	H9988_004_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	004	0	1	04	01	H9988_004_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	004	0	1	04	01	H9988_004_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	004	0	1	04	01	H9988_004_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	005	0	1	04	01	H9988_005_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H9988	005	0	1	04	01	H9988_005_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H9988	005	0	1	04	01	H9988_005_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H9988	005	0	1	04	01	H9988_005_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H9988	005	0	1	04	01	H9988_005_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	005	0	1	04	01	H9988_005_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	005	0	1	04	01	H9988_005_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	005	0	1	04	01	H9988_005_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	005	0	1	04	01	H9988_005_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H9988	005	0	1	04	01	H9988_005_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	006	0	1	04	01	H9988_006_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H9988	006	0	1	04	01	H9988_006_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H9988	006	0	1	04	01	H9988_006_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H9988	006	0	1	04	01	H9988_006_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	006	0	1	04	01	H9988_006_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H9988	006	0	1	04	01	H9988_006_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	006	0	1	04	01	H9988_006_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	006	0	1	04	01	H9988_006_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	006	0	1	04	01	H9988_006_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	006	0	1	04	01	H9988_006_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	007	0	1	04	01	H9988_007_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	40.00	40.00	2	
H9988	007	0	1	04	01	H9988_007_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	20.00	20.00	2	
H9988	007	0	1	04	01	H9988_007_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	10	20	1	20.00	40.00	2	
H9988	007	0	1	04	01	H9988_007_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H9988	007	0	1	04	01	H9988_007_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	007	0	1	04	01	H9988_007_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
H9988	007	0	1	04	01	H9988_007_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	007	0	1	04	01	H9988_007_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	007	0	1	04	01	H9988_007_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	007	0	1	04	01	H9988_007_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	008	0	1	04	01	H9988_008_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	45.00	45.00	2	
H9988	008	0	1	04	01	H9988_008_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	25.00	25.00	2	
H9988	008	0	1	04	01	H9988_008_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	20	20	2			2	
H9988	008	0	1	04	01	H9988_008_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	15	20	1	25.00	45.00	2	
H9988	009	0	1	04	01	H9988_009_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	009	0	1	04	01	H9988_009_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	009	0	1	04	01	H9988_009_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	009	0	1	04	01	H9988_009_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	009	0	1	04	01	H9988_009_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	009	0	1	04	01	H9988_009_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	009	0	1	04	01	H9988_009_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	009	0	1	04	01	H9988_009_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	009	0	1	04	01	H9988_009_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	009	0	1	04	01	H9988_009_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	010	0	1	04	01	H9988_010_0	5	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	010	0	1	04	01	H9988_010_0	5	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	010	0	1	04	01	H9988_010_0	5	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	010	0	1	04	01	H9988_010_0	5	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	010	0	1	04	01	H9988_010_0	5	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	010	0	1	04	01	H9988_010_0	5	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	010	0	1	04	01	H9988_010_0	5	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	010	0	1	04	01	H9988_010_0	5	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	010	0	1	04	01	H9988_010_0	5	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	010	0	1	04	01	H9988_010_0	5	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	801	0	1	04	01	H9988_801_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	801	0	1	04	01	H9988_801_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	801	0	1	04	01	H9988_801_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	801	0	1	04	01	H9988_801_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	802	0	1	04	01	H9988_802_0	3	1	Outpatient Services	0100001000001011111010000011000000000000000100000	1	25	25	2			2	
H9988	802	0	1	04	01	H9988_802_0	3	8	Ambulance	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
H9988	802	0	1	04	01	H9988_802_0	3	7	Outpatient Substance Abuse	0000000000000000000100000000000000000000000000000	1	50	50	2			2	
H9988	802	0	1	04	01	H9988_802_0	3	6	Mental Health/Psychiatric Services	0000000010010000000000000000000000000000000000000	1	50	50	2			2	
H9988	802	0	1	04	01	H9988_802_0	3	9	No Cost Sharing	0001000000000100000000000000000101010000000011111	1	0	0	2			2	
H9988	802	0	1	04	01	H9988_802_0	3	4	DME	0000000000000000000000011100000000000000000000000	1	25	25	2			2	
H9988	802	0	1	04	01	H9988_802_0	3	3	Physician Specialist	0000000101100000000000000000000000000000000000000	2			1	50.00	50.00	2	
H9988	802	0	1	04	01	H9988_802_0	3	2	Primary Care Physician	0000110000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
H9988	802	0	1	04	01	H9988_802_0	3	10	Preventive Services	0000000000000000000000000000000000101111111000000	1	25	25	1	30.00	50.00	2	
H9988	802	0	1	04	01	H9988_802_0	3	5	Partial Hospitalization	0010000000000000000000000000000000000000000000000	1	50	50	2			2	
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R3175	001	0	1	31	11	R3175_001_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	11	Group 11	0000000000000000000000000000000000000000000000010	1	0	30	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	3	Group 3	0001000000000011011000011100000000001111111100000	1	30	30	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	12	Group 12	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R3175	001	0	1	31	11	R3175_001_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R3175	001	0	1	31	11	R3175_001_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	30.00	30.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	11	Group 11	0000000000000000000000000000000000000000000000010	1	0	30	2			2	
R3175	002	0	1	31	11	R3175_002_0	2	12	Group 12	0000010000000000000000000000100000000000000000000	1	50	50	2			2	
R3175	002	0	1	31	11	R3175_002_0	2	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	45.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R3175	002	0	1	31	11	R3175_002_0	2	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R3175	002	0	1	31	11	R3175_002_0	2	3	Group 3	0001000000000011011000011100000000001111111100000	1	30	30	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
R3175	003	0	1	31	11	R3175_003_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
R3175	003	0	1	31	11	R3175_003_0	4	3	Group 3	0000000000000000000000000000000000000000000010000	1	50	50	2			2	
R3175	801	0	1	31	11	R3175_801_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R3175	801	0	1	31	11	R3175_801_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R3175	801	0	1	31	11	R3175_801_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R3175	801	0	1	31	11	R3175_801_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R3175	802	0	1	31	11	R3175_802_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R3175	802	0	1	31	11	R3175_802_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R3175	802	0	1	31	11	R3175_802_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R3175	802	0	1	31	11	R3175_802_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R3175	803	0	1	31	11	R3175_803_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R3175	803	0	1	31	11	R3175_803_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R3175	803	0	1	31	11	R3175_803_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R3175	803	0	1	31	11	R3175_803_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R3332	001	0	1	31	11	R3332_001_0	10	2	Ambulance	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R3332	001	0	1	31	11	R3332_001_0	10	3	Renal Dialysis	0000000000000000000000000010000000000000000000000	2			1	25.00	25.00	2	
R3332	001	0	1	31	11	R3332_001_0	10	4	No copayment	0001000000000000000000000000000001000000000000000	2			1	0.00	0.00	2	
R3332	001	0	1	31	11	R3332_001_0	10	1	30% coinsurance	0110111111111111111110011101000000111111111101111	1	30	30	2			2	
R3444	008	0	1	31	11	R3444_008_0	6	2	$15 Copay	0000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R3444	008	0	1	31	11	R3444_008_0	6	3	0% Coinsurance	0001000001000000000000000000000000000000000000000	1	0	0	2			2	
R3444	008	0	1	31	11	R3444_008_0	6	4	20% Coinsurance	0100111101101111111011011111000000000000000101111	1	20	20	2			2	
R3444	008	0	1	31	11	R3444_008_0	6	5	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
R3444	008	0	1	31	11	R3444_008_0	6	1	$0 Copay	0000000000000100000000100000010001111111111000110	2			1	0.00	0.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	10	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
R3444	009	0	1	31	11	R3444_009_0	6	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	11	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
R3444	009	0	1	31	11	R3444_009_0	6	12	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
R3444	009	0	1	31	11	R3444_009_0	6	2	$10 Copay	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	9	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
R3444	009	0	1	31	11	R3444_009_0	6	4	$30 Copay	0000000000000000000000000000000000000000000000100	2			1	30.00	30.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	5	$40 Copay	0010010000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	6	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	7	$150 Copay	0000000000000000011001000000000000000000000000000	2			1	150.00	150.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	8	$35 Copay	0000100000000000000100000000000000000000000000000	2			1	35.00	35.00	2	
R3444	009	0	1	31	11	R3444_009_0	6	3	$35 - $40 Copay	0000000010010000000000000000000000000000000000000	2			1	35.00	40.00	2	
R3444	011	0	1	31	11	R3444_011_0	4	2	0% Coinsurance	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
R3444	011	0	1	31	11	R3444_011_0	4	1	$0 Copay	0000000000000100000000100000000001111111111010110	2			1	0.00	0.00	2	
R3444	011	0	1	31	11	R3444_011_0	4	3	20% Coinsurance	0100111101101111111011011111000000000000000101111	1	20	20	2			2	
R3444	011	0	1	31	11	R3444_011_0	4	4	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
R3444	012	0	1	31	11	R3444_012_0	5	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	10	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
R3444	012	0	1	31	11	R3444_012_0	5	11	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
R3444	012	0	1	31	11	R3444_012_0	5	12	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
R3444	012	0	1	31	11	R3444_012_0	5	13	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
R3444	012	0	1	31	11	R3444_012_0	5	14	$35-$40 Copay	0000000010010000000000000000000000000000000000000	2			1	35.00	40.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	9	$175 Copay	0000000000000000011000000000000000000000000000000	2			1	175.00	175.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	3	$15 Copay	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	4	$30 Copay	0000000000000000000000000000000000000000000000100	2			1	30.00	30.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	5	$35 Copay	0000100000000000000100000000000000000000000000000	2			1	35.00	35.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	6	$40 Copay	0010000000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	7	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	8	$150 Copay	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R3444	012	0	1	31	11	R3444_012_0	5	2	$10 Copay	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	10	Group 10	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	1	Group 1	0100101101101000000010000000000000010000000011101	2			1	40.00	40.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	9	Group 9	0000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	8	Group 8	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5287	001	0	1	31	11	R5287_001_0	6	7	Group 7	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	6	Group 6	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	5	Group 5	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	4	Group 4	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	3	Group 3	0000000000000100000000000000000000000000000000000	1	30	30	1	20.00	20.00	2	
R5287	001	0	1	31	11	R5287_001_0	6	2	Group 2	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
R5287	002	0	1	31	11	R5287_002_0	4	3	Group 3	0000000000000100000000000000000000000000000000000	1	30	30	1	18.00	18.00	2	
R5287	002	0	1	31	11	R5287_002_0	4	2	Group 2	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
R5287	002	0	1	31	11	R5287_002_0	4	10	Group 10	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
R5287	002	0	1	31	11	R5287_002_0	4	1	Group 1	0100101101101000000010000000000000010000000011101	2			1	40.00	40.00	2	
R5287	002	0	1	31	11	R5287_002_0	4	6	Group 6	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R5287	002	0	1	31	11	R5287_002_0	4	4	Group 4	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R5287	002	0	1	31	11	R5287_002_0	4	7	Group 7	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R5287	002	0	1	31	11	R5287_002_0	4	8	Group 8	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5287	002	0	1	31	11	R5287_002_0	4	9	Group 9	0000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R5287	002	0	1	31	11	R5287_002_0	4	5	Group 5	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5287	003	0	1	31	11	R5287_003_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
R5287	003	0	1	31	11	R5287_003_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
R5287	003	0	1	31	11	R5287_003_0	4	6	Group 6	0000000000000000000000000000000000000000000010000	2			1	40.00	40.00	2	
R5287	003	0	1	31	11	R5287_003_0	4	3	Group 3	0000000000000000000000100000000000000000000000000	1	50	50	2			2	
R5287	003	0	1	31	11	R5287_003_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
R5287	003	0	1	31	11	R5287_003_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5287	801	0	1	31	11	R5287_801_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5287	801	0	1	31	11	R5287_801_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5287	801	0	1	31	11	R5287_801_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5287	801	0	1	31	11	R5287_801_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5287	802	0	1	31	11	R5287_802_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5287	802	0	1	31	11	R5287_802_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5287	802	0	1	31	11	R5287_802_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5287	802	0	1	31	11	R5287_802_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5287	805	0	1	31	11	R5287_805_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5287	805	0	1	31	11	R5287_805_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5287	805	0	1	31	11	R5287_805_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5287	805	0	1	31	11	R5287_805_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5342	001	0	1	31	11	R5342_001_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	20.00	20.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
R5342	001	0	1	31	11	R5342_001_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5342	001	0	1	31	11	R5342_001_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	40.00	40.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
R5342	001	0	1	31	11	R5342_001_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5342	001	0	1	31	11	R5342_001_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5342	002	0	1	31	11	R5342_002_0	2	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
R5342	002	0	1	31	11	R5342_002_0	2	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	40.00	40.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
R5342	002	0	1	31	11	R5342_002_0	2	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R5342	002	0	1	31	11	R5342_002_0	2	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	20.00	20.00	2	
R5342	003	0	1	31	11	R5342_003_0	4	2	Group 2	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	1	Group 1	0111111111111011111111011101000001011111111101101	1	30	30	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	5	Group 5	0000000000000000000000000000010000100000000000010	2			1	0.00	0.00	2	
R5342	003	0	1	31	11	R5342_003_0	4	3	Group 3	0000000000000000000000100000000000000000000010000	1	50	50	2			2	
R5342	003	0	1	31	11	R5342_003_0	4	4	Group 4	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5342	801	0	1	31	11	R5342_801_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5342	801	0	1	31	11	R5342_801_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5342	801	0	1	31	11	R5342_801_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5342	801	0	1	31	11	R5342_801_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5342	802	0	1	31	11	R5342_802_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5342	802	0	1	31	11	R5342_802_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5342	802	0	1	31	11	R5342_802_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5342	802	0	1	31	11	R5342_802_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5342	803	0	1	31	11	R5342_803_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5342	803	0	1	31	11	R5342_803_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5342	803	0	1	31	11	R5342_803_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5342	803	0	1	31	11	R5342_803_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5566	005	0	1	31	11	R5566_005_0	9	1	Group 1	0111111111111111111111011101000001011111111101111	1	40	40	2			2	
R5566	005	0	1	31	11	R5566_005_0	9	2	Group 2	0000000000000000000000000010000000100000000000000	1	0	40	2			2	
R5566	805	0	1	31	11	R5566_805_0	7	1	Group 1	0000000000000000000000000010000000100000000000000	1	0	50	2			2	
R5566	805	0	1	31	11	R5566_805_0	7	2	Group 2	0111111111111111111111011101000001011111111101111	1	50	50	2			2	
R5674	001	0	1	31	11	R5674_001_0	3	9	Group 9	0000000000000000000001000000000000000000000000000	1	30	30	1	150.00	150.00	2	
R5674	001	0	1	31	11	R5674_001_0	3	8	Group 8	0000000000000000000000000000000001000000000000000	1	0	30	2			2	
R5674	001	0	1	31	11	R5674_001_0	3	7	Group 7	0110000000000000000000000001000000100000000000000	2			1	0.00	0.00	2	
R5674	001	0	1	31	11	R5674_001_0	3	6	Group 6	0001000000000000000000000000000000000000000000010	1	40	40	2			2	
R5674	001	0	1	31	11	R5674_001_0	3	5	Group 5	0000000000100000000000000000000000000000000000000	2			1	40.00	45.00	2	
R5674	001	0	1	31	11	R5674_001_0	3	2	Group 2	0000001111011000000110000000000000000000000001101	2			1	45.00	45.00	2	
R5674	001	0	1	31	11	R5674_001_0	3	3	Group 3	0000000000000111100000011100000000001111111000000	1	30	30	2			2	
R5674	001	0	1	31	11	R5674_001_0	3	4	Group 4	0000000000000000011000000010000000000000000100000	1	20	20	2			2	
R5674	001	0	1	31	11	R5674_001_0	3	1	Group 1	0000110000000000000000000000000000010000000000000	2			1	40.00	40.00	2	
R5674	801	0	1	31	11	R5674_801_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5674	801	0	1	31	11	R5674_801_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5674	801	0	1	31	11	R5674_801_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5674	801	0	1	31	11	R5674_801_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5674	802	0	1	31	11	R5674_802_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5674	802	0	1	31	11	R5674_802_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5674	802	0	1	31	11	R5674_802_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5674	802	0	1	31	11	R5674_802_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5674	803	0	1	31	11	R5674_803_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R5674	803	0	1	31	11	R5674_803_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R5674	803	0	1	31	11	R5674_803_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R5674	803	0	1	31	11	R5674_803_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R5826	001	0	1	31	11	R5826_001_0	7	3	Ambulance	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
R5826	001	0	1	31	11	R5826_001_0	7	2	Part B Drugs	0000000000000000000000000100000000000000000100000	1	20	30	2			2	
R5826	001	0	1	31	11	R5826_001_0	7	5		0000000000000000000000000001000000100000000000010	2			1	0.00	0.00	2	
R5826	001	0	1	31	11	R5826_001_0	7	1	PCP/SPC	0111111111111111111110011000000000011111111001101	1	30	30	2			2	
R5826	001	0	1	31	11	R5826_001_0	7	6		0000000000000000000000000000001001000000000000000	1	50	50	2			2	
R5826	001	0	1	31	11	R5826_001_0	7	4	ESRD	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R5826	002	0	1	31	11	R5826_002_0	7	3		0000000000000000000000000000000000000000000100000	1	0	20	2			2	
R5826	002	0	1	31	11	R5826_002_0	7	6		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
R5826	002	0	1	31	11	R5826_002_0	7	4		0000000000000000000000000001001100100000000000010	2			1	0.00	0.00	2	
R5826	002	0	1	31	11	R5826_002_0	7	2		0000000000000000000000000010000000000000000000000	1	0	20	2			2	
R5826	002	0	1	31	11	R5826_002_0	7	1		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R5826	002	0	1	31	11	R5826_002_0	7	5		0111111111111111111110011100000001011111111001101	1	20	20	2			2	
R5826	003	0	1	31	11	R5826_003_0	7	3		0000000100000000000000000000000000000000000000000	2			1	15.00	35.00	2	
R5826	003	0	1	31	11	R5826_003_0	7	2		0010010011010000000000000000000000000000000001001	2			1	35.00	35.00	2	
R5826	003	0	1	31	11	R5826_003_0	7	4		0001000000100000000000000001001001111111111000010	2			1	0.00	0.00	2	
R5826	003	0	1	31	11	R5826_003_0	7	5		0000000000000000000000000000000000000000000011000	1	50	50	2			2	
R5826	003	0	1	31	11	R5826_003_0	7	6		0000000000000000000000011010000000000000000100000	1	20	20	2			2	
R5826	003	0	1	31	11	R5826_003_0	7	7		0000000000000000000000000100000000000000000000000	1	20	25	2			2	
R5826	003	0	1	31	11	R5826_003_0	7	8		0000000000000000010000000000000000000000000000000	1	20	20	1	15.00	250.00	2	
R5826	003	0	1	31	11	R5826_003_0	7	9		0000000000000000001000000000000000000000000000000	2			1	225.00	225.00	2	
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R5826	814	0	1	31	11	R5826_814_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	814	0	1	31	11	R5826_814_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	814	0	1	31	11	R5826_814_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	815	0	1	31	11	R5826_815_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	815	0	1	31	11	R5826_815_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	815	0	1	31	11	R5826_815_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	816	0	1	31	11	R5826_816_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	816	0	1	31	11	R5826_816_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	816	0	1	31	11	R5826_816_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	817	0	1	31	11	R5826_817_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	817	0	1	31	11	R5826_817_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	817	0	1	31	11	R5826_817_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	818	0	1	31	11	R5826_818_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	818	0	1	31	11	R5826_818_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	818	0	1	31	11	R5826_818_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	819	0	1	31	11	R5826_819_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	819	0	1	31	11	R5826_819_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	819	0	1	31	11	R5826_819_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	820	0	1	31	11	R5826_820_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	820	0	1	31	11	R5826_820_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	820	0	1	31	11	R5826_820_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	821	0	1	31	11	R5826_821_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	821	0	1	31	11	R5826_821_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	821	0	1	31	11	R5826_821_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	822	0	1	31	11	R5826_822_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	822	0	1	31	11	R5826_822_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	822	0	1	31	11	R5826_822_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	823	0	1	31	11	R5826_823_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	823	0	1	31	11	R5826_823_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	823	0	1	31	11	R5826_823_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	824	0	1	31	11	R5826_824_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	824	0	1	31	11	R5826_824_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	824	0	1	31	11	R5826_824_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	825	0	1	31	11	R5826_825_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	825	0	1	31	11	R5826_825_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	825	0	1	31	11	R5826_825_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	826	0	1	31	11	R5826_826_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	826	0	1	31	11	R5826_826_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	826	0	1	31	11	R5826_826_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	827	0	1	31	11	R5826_827_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	827	0	1	31	11	R5826_827_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	827	0	1	31	11	R5826_827_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	828	0	1	31	11	R5826_828_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	828	0	1	31	11	R5826_828_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	828	0	1	31	11	R5826_828_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	831	0	1	31	11	R5826_831_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	831	0	1	31	11	R5826_831_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	831	0	1	31	11	R5826_831_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	832	0	1	31	11	R5826_832_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	832	0	1	31	11	R5826_832_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	832	0	1	31	11	R5826_832_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	833	0	1	31	11	R5826_833_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	833	0	1	31	11	R5826_833_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	833	0	1	31	11	R5826_833_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	834	0	1	31	11	R5826_834_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	834	0	1	31	11	R5826_834_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	834	0	1	31	11	R5826_834_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	835	0	1	31	11	R5826_835_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	835	0	1	31	11	R5826_835_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	835	0	1	31	11	R5826_835_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	836	0	1	31	11	R5826_836_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	836	0	1	31	11	R5826_836_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	836	0	1	31	11	R5826_836_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	837	0	1	31	11	R5826_837_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	837	0	1	31	11	R5826_837_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	837	0	1	31	11	R5826_837_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	838	0	1	31	11	R5826_838_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	838	0	1	31	11	R5826_838_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	838	0	1	31	11	R5826_838_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	839	0	1	31	11	R5826_839_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	839	0	1	31	11	R5826_839_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	839	0	1	31	11	R5826_839_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	840	0	1	31	11	R5826_840_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	840	0	1	31	11	R5826_840_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	840	0	1	31	11	R5826_840_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	841	0	1	31	11	R5826_841_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	841	0	1	31	11	R5826_841_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	841	0	1	31	11	R5826_841_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	842	0	1	31	11	R5826_842_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	842	0	1	31	11	R5826_842_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	842	0	1	31	11	R5826_842_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	843	0	1	31	11	R5826_843_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5826	843	0	1	31	11	R5826_843_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	843	0	1	31	11	R5826_843_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	844	0	1	31	11	R5826_844_0	5	3	#3	0001000000000100000000000000000000101000000000000	1	0	20	2			2	
R5826	844	0	1	31	11	R5826_844_0	5	2	#2	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5826	844	0	1	31	11	R5826_844_0	5	1	#1	0110111101101011111011011111000001010111111101111	1	20	20	2			2	
R5941	003	0	1	31	11	R5941_003_0	12	1	20% Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
R5941	003	0	1	31	11	R5941_003_0	12	10	No Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	11	Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	30.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	12	Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	13	Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	40.00	275.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	2	25% Coinsurance	0000000000000010100000011100000000000000000000000	1	25	25	2			2	
R5941	003	0	1	31	11	R5941_003_0	12	4	Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	275.00	275.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	9	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	8	Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	7	PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	40.00	80.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	6	Specialist	0100010101000000000000000000000000000000000000101	2			1	40.00	40.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	5	PCP	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	003	0	1	31	11	R5941_003_0	12	3	Labs 0% - 25%	0000000000000100000000000000000000000000000000000	1	0	25	2			2	
R5941	007	0	1	31	11	R5941_007_0	4	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	45.00	90.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	45.00	45.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	45.00	300.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	2	30% OON Coinsurance	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
R5941	007	0	1	31	11	R5941_007_0	4	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
R5941	007	0	1	31	11	R5941_007_0	4	13	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	300.00	300.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	12	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	30.00	45.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	11	OON Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	10	OON $0 Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
R5941	007	0	1	31	11	R5941_007_0	4	1	20% OON Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
R5941	008	0	1	31	11	R5941_008_0	7	8	OON Mental Health/Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	7	OON Therapies	0000001000001000000000000000000000000000000000000	2			1	45.00	90.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	6	OON Specialist	0100010101000000000000000000000000000000000000101	2			1	45.00	45.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	1	20% OON Coinsurance	0000000000000001000000000010000000000000011110000	1	20	20	2			2	
R5941	008	0	1	31	11	R5941_008_0	7	10	OON $0 Copayment	0001000000000000000010000001000001111111100001000	2			1	0.00	0.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	11	OON Eye Wear	0000000000000000000000000000000000000000000000010	2			1	0.00	45.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	12	Other Health Care Professional Services	0000000000100000000000000000000000000000000000000	2			1	30.00	45.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	2	30% OON Coinsurance	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
R5941	008	0	1	31	11	R5941_008_0	7	3	OON Labs	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
R5941	008	0	1	31	11	R5941_008_0	7	4	OON Outpatient Hospital Services	0000000000000000010000000000000000000000000000000	2			1	45.00	300.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	5	OON PCP	0000100000000000000000000000000000000000000000000	2			1	30.00	30.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	13	OON ASC Services	0000000000000000001000000000000000000000000000000	2			1	300.00	300.00	2	
R5941	008	0	1	31	11	R5941_008_0	7	9	OON Ambulance	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	9	Ambulance Services	0000000000000000000001000000000000000000000000000	2			1	125.00	125.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	8	Mental Health / Substance Abuse	0010000010010000000100000000000000000000000000000	2			1	50.00	50.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	7	PT, OT, ST	0000001000001000000000000000000000000000000000000	2			1	45.00	100.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	6	Specialist	0100010101000000000000000000000000000000000000101	2			1	45.00	45.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	5	PCP	0000100000000000000000000000000000000000000000000	2			1	35.00	35.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	3	Labs 0% - 30%	0000000000000100000000000000000000000000000000000	1	0	30	2			2	
R5941	009	0	1	31	11	R5941_009_0	10	4	Outpatient Surgery	0000000000000000001000000000000000000000000000000	2			1	350.00	350.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	1	20% Coinsurance	0000000000000001000000000010000000000000011100000	1	20	20	2			2	
R5941	009	0	1	31	11	R5941_009_0	10	10	No Copayment	0001000000000000000010000001000001111111100001010	2			1	0.00	0.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	11	Other Healthcare	0000000000100000000000000000000000000000000000000	2			1	35.00	45.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	12	Outpatient Hospital	0000000000000000010000000000000000000000000000000	2			1	45.00	350.00	2	
R5941	009	0	1	31	11	R5941_009_0	10	2	30% Coinsurance	0000000000000010100000011100000000000000000000000	1	30	30	2			2	
R5941	801	0	1	31	11	R5941_801_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
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R5941	802	0	1	31	11	R5941_802_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5941	802	0	1	31	11	R5941_802_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
R5941	805	0	1	31	11	R5941_805_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
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R5941	806	0	1	31	11	R5941_806_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
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R5941	807	0	1	31	11	R5941_807_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5941	807	0	1	31	11	R5941_807_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
R5941	808	0	1	31	11	R5941_808_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R5941	808	0	1	31	11	R5941_808_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
R6801	008	0	1	31	11	R6801_008_0	6	3	0% Coinsurance	0001000001000000000000000000000000000000000000000	1	0	0	2			2	
R6801	008	0	1	31	11	R6801_008_0	6	4	20% Coinsurance	0100111101101111111011011111000000000000000101111	1	20	20	2			2	
R6801	008	0	1	31	11	R6801_008_0	6	1	$0 Copay	0000000000000100000000100000010001111111111000110	2			1	0.00	0.00	2	
R6801	008	0	1	31	11	R6801_008_0	6	2	$15 Copay	0000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R6801	008	0	1	31	11	R6801_008_0	6	5	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
R6801	009	0	1	31	11	R6801_009_0	6	7	$150 Copay	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	6	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	5	$40 Copay	0010010000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	4	$25 Copay	0000100000000000000100000000000000000000000000000	2			1	25.00	25.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	3	$25 - $40 Copay	0000000010010000000000000000000000000000000000000	2			1	25.00	40.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	8	$175 Copay	0000000000000000011000000000000000000000000000000	2			1	175.00	175.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	12	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
R6801	009	0	1	31	11	R6801_009_0	6	11	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
R6801	009	0	1	31	11	R6801_009_0	6	10	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
R6801	009	0	1	31	11	R6801_009_0	6	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
R6801	009	0	1	31	11	R6801_009_0	6	9	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
R6801	009	0	1	31	11	R6801_009_0	6	2	$10 Copay	0000000000000000000000000000000000000000000010100	2			1	10.00	10.00	2	
R6801	011	0	1	31	11	R6801_011_0	4	4	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
R6801	011	0	1	31	11	R6801_011_0	4	3	20% Coinsurance	0100111101101111111011011111000000000000000101111	1	20	20	2			2	
R6801	011	0	1	31	11	R6801_011_0	4	2	0% Coinsurance	0001000000000000000000000000000000000000000000000	1	0	0	2			2	
R6801	011	0	1	31	11	R6801_011_0	4	1	$0 Copay	0000000000000100000000100000000001111111111010110	2			1	0.00	0.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	8	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
R6801	012	0	1	31	11	R6801_012_0	5	7	$150 Copay	0000000000000000011001000000000000000000000000000	2			1	150.00	150.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	6	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	5	$40 Copay	0010000000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	4	$35 Copay	0000100000000000000100000000000000000000000000000	2			1	35.00	35.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	9	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
R6801	012	0	1	31	11	R6801_012_0	5	2	$10 Copay	0000000000000000000000000000000000000000000010100	2			1	10.00	10.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	12	$35 - $40 Copays	0000000010010000000000000000000000000000000000000	2			1	35.00	40.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	11	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
R6801	012	0	1	31	11	R6801_012_0	5	10	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
R6801	012	0	1	31	11	R6801_012_0	5	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
R6801	012	0	1	31	11	R6801_012_0	5	3	$15 Copay	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R7439	001	0	1	31	11	R7439_001_0	10	5		0000000000000000100000000000000000000000000000000	2			1	21.00	37.00	2	
R7439	001	0	1	31	11	R7439_001_0	10	1		0001000000000000000000011100000000000000001100010	1	30	30	2			2	
R7439	001	0	1	31	11	R7439_001_0	10	2		0100111101101000000010000000000000000000000001000	2			1	37.00	37.00	2	
R7439	001	0	1	31	11	R7439_001_0	10	3		0010000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R7439	001	0	1	31	11	R7439_001_0	10	6		0000000000000100000000000001000001110000000000101	2			1	0.00	37.00	2	
R7439	001	0	1	31	11	R7439_001_0	10	7		0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R7439	001	0	1	31	11	R7439_001_0	10	4		0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R7439	001	0	1	31	11	R7439_001_0	10	8		0000000000000011011000000000000000001111110000000	1	30	30	2			2	
R7439	003	0	1	31	11	R7439_003_0	10	2		0000000000000001000000011111000001111111111000111	2			1	0.00	30.00	2	
R7439	003	0	1	31	11	R7439_003_0	10	3		0000000000000000000001000000000000000000000100000	2			1	0.00	0.00	2	
R7439	003	0	1	31	11	R7439_003_0	10	4		0000000000000010111000000000000000000000000000000	2			1	30.00	60.00	2	
R7439	003	0	1	31	11	R7439_003_0	10	5		0000000000000100000000000000000000000000000000000	2			1	0.00	60.00	2	
R7439	003	0	1	31	11	R7439_003_0	10	1		0111111111111000000110000000000000000000000001000	2			1	30.00	30.00	2	
R7439	006	0	1	31	11	R7439_006_0	10	4		0000000000000010111000000000000000000000000000000	2			1	30.00	60.00	2	
R7439	006	0	1	31	11	R7439_006_0	10	3		0000000000000000000001000000000000000000000100000	2			1	0.00	0.00	2	
R7439	006	0	1	31	11	R7439_006_0	10	2		0000000000000001000000011111000001111111111000111	2			1	0.00	30.00	2	
R7439	006	0	1	31	11	R7439_006_0	10	1		0111111111111000000110000000000000000000000001000	2			1	30.00	30.00	2	
R7439	006	0	1	31	11	R7439_006_0	10	5		0000000000000100000000000000000000000000000000000	2			1	0.00	60.00	2	
R7439	801	0	1	31	11	R7439_801_0	5	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
R7439	801	0	1	31	11	R7439_801_0	5	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7439	801	0	1	31	11	R7439_801_0	5	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R7439	801	0	1	31	11	R7439_801_0	5	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
R7439	802	0	1	31	11	R7439_802_0	5	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
R7439	802	0	1	31	11	R7439_802_0	5	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
R7439	802	0	1	31	11	R7439_802_0	5	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7439	802	0	1	31	11	R7439_802_0	5	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R7439	805	0	1	31	11	R7439_805_0	5	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7439	805	0	1	31	11	R7439_805_0	5	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R7439	805	0	1	31	11	R7439_805_0	5	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
R7439	805	0	1	31	11	R7439_805_0	5	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
R7439	806	0	1	31	11	R7439_806_0	5	1		0100111101101111111111011111000001010111111101111	1	20	20	2			2	
R7439	806	0	1	31	11	R7439_806_0	5	2		0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R7439	806	0	1	31	11	R7439_806_0	5	3		0001000000000000000000000000000000000000000000000	2			1	0.00	0.00	2	
R7439	806	0	1	31	11	R7439_806_0	5	4		0000000000000000000000000000000000101000000000000	1	0	20	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	8	Group 8	0000000010010000000100000000000000000000000000000	2			1	35.00	45.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	9	Group 9	0000000000000000000000000010000000000000000000000	1	20	20	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	7	Group 7	0000000000000000000001000000000000000000000000000	2			1	200.00	200.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	6	Group 6	0010000000000000000000000000000000000000000000000	2			1	75.00	75.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	5	Group 5	0000000000000000100000000000000000000000000000000	2			1	21.00	21.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	4	Group 4	0000000000000100000000000000000000000000000000000	1	30	30	1	10.00	10.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	3	Group 3	0001000000000011011000011100000000001111111100010	1	30	30	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	2	Group 2	0100001101001000000010000000000000000000000001101	2			1	50.00	50.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	11	Group 11	0000010000000000000000000000000000000000000000000	1	50	50	2			2	
R7444	001	0	1	31	11	R7444_001_0	4	10	Group 10	1000000000000000000000000001000001100000000000000	2			1	0.00	0.00	2	
R7444	001	0	1	31	11	R7444_001_0	4	1	Group 1	0000100000100000000000000000000000010000000000000	2			1	30.00	30.00	2	
R7444	801	0	1	31	11	R7444_801_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R7444	801	0	1	31	11	R7444_801_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R7444	801	0	1	31	11	R7444_801_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R7444	801	0	1	31	11	R7444_801_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R7444	802	0	1	31	11	R7444_802_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R7444	802	0	1	31	11	R7444_802_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R7444	802	0	1	31	11	R7444_802_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R7444	802	0	1	31	11	R7444_802_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R7444	803	0	1	31	11	R7444_803_0	2	1	Group 1	0100111101101011111111011111000000000000000101111	1	20	20	2			2	
R7444	803	0	1	31	11	R7444_803_0	2	3	Group 3	0000000000000100000000000000000000000000000000000	1	0	20	2			2	
R7444	803	0	1	31	11	R7444_803_0	2	2	Group 2	0001000000000000000000000000000001111111111000000	2			1	0.00	0.00	2	
R7444	803	0	1	31	11	R7444_803_0	2	4	Group 4	0010000010010000000000000000000000000000000000000	1	45	45	2			2	
R9896	008	0	1	31	11	R9896_008_0	6	1	$0 Copay	0000000000000100000000100000010001111111111000110	2			1	0.00	0.00	2	
R9896	008	0	1	31	11	R9896_008_0	6	3	0% Coinsurance	0001000001000000000000000000000000000000000000000	1	0	0	2			2	
R9896	008	0	1	31	11	R9896_008_0	6	4	20% Coinsurance	0100111101101111111011011111000000000000000101111	1	20	20	2			2	
R9896	008	0	1	31	11	R9896_008_0	6	5	45% Coinsurance	0010000010010000000100000000000000000000000000000	1	45	45	2			2	
R9896	008	0	1	31	11	R9896_008_0	6	2	$15 Copay	0000000000000000000000000000000000000000000010000	2			1	15.00	15.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	9	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
R9896	009	0	1	31	11	R9896_009_0	6	8	$175 Copay	0000000000000000011000000000000000000000000000000	2			1	175.00	175.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	7	$150 Copay	0000000000000000000001000000000000000000000000000	2			1	150.00	150.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	6	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	5	$40 Copay	0010000000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	4	$25 Copay	0000000000000000000000000000000000000000000000100	2			1	25.00	25.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	3	$15 Copay	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	2	$10 Copay	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	10	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
R9896	009	0	1	31	11	R9896_009_0	6	11	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
R9896	009	0	1	31	11	R9896_009_0	6	12	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
R9896	009	0	1	31	11	R9896_009_0	6	14	$30 Copay	0000100000000000000100000000000000000000000000000	2			1	30.00	30.00	2	
R9896	009	0	1	31	11	R9896_009_0	6	13	$30 - $40 Copay	0000000010010000000000000000000000000000000000000	2			1	30.00	40.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	9	$150 Copay	0000000000000000011000000000000000000000000000000	2			1	150.00	150.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	14	$35-$40 Copay	0000000010010000000000000000000000000000000000000	2			1	35.00	40.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	2	$10 Copay	0000000000000000000000000000000000000000000010000	2			1	10.00	10.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	3	$15 Copay	0000010000000000000000000000000000000000000000000	2			1	15.00	15.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	4	$25 Copay	0000000000000000000000000000000000000000000000100	2			1	25.00	25.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	5	$35 Copay	0000100000000000000100000000000000000000000000000	2			1	35.00	35.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	6	$40 Copay	0010000000000000000100000000000000000000000000000	2			1	40.00	40.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	13	40% Coinsurance	0000000000000000000000010000000000000000000000000	1	40	40	2			2	
R9896	012	0	1	31	11	R9896_012_0	5	8	$100 Copay	0000000000000000000001000000000000000000000000000	2			1	100.00	100.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	7	$50 Copay	0100001101101000000010000000000000000000000000111	2			1	50.00	50.00	2	
R9896	012	0	1	31	11	R9896_012_0	5	12	35% Coinsurance	0000000000000000000000001000000000000000000000000	1	35	35	2			2	
R9896	012	0	1	31	11	R9896_012_0	5	11	30% Coinsurance	0001000000000000000000000000000000000000000000000	1	30	30	2			2	
R9896	012	0	1	31	11	R9896_012_0	5	10	20% Coinsurance	0000000000000111100000000010000000000000000100000	1	20	20	2			2	
R9896	012	0	1	31	11	R9896_012_0	5	1	$0 Copay	0000000001000100000000100101000001111111111001110	2			1	0.00	0.00	2	
R9943	001	0	1	31	11	R9943_001_0	10	3	$40 OON Copayment Group	0000010101000000000000000000000000000000000000000	2			1	40.00	40.00	2	
R9943	001	0	1	31	11	R9943_001_0	10	2	$30 OON Copayment Group	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
R9943	001	0	1	31	11	R9943_001_0	10	1	30% OON Coinsurance Group	0111001010011111111110001101000000001111111000001	1	30	30	2			2	
R9943	001	0	1	31	11	R9943_001_0	10	4	$175 OON Copayment Group	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
R9943	001	0	1	31	11	R9943_001_0	10	5	$30 - $40 OON Copayment Group	0000000000100000000000000000000000000000000000000	2			1	30.00	40.00	2	
R9943	001	0	1	31	11	R9943_001_0	10	6	10% OON Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
R9943	001	0	1	31	11	R9943_001_0	10	7	$0 OON Copayment Group	0000000000000000000000000000000001100000000001110	2			1	0.00	0.00	2	
R9943	001	0	1	31	11	R9943_001_0	10	8	25% OON Coinsurance Group	0000000000000000000000010000000000000000000100000	1	25	25	2			2	
R9943	004	0	1	31	11	R9943_004_0	8	9	20% OON Coinsurance Group	0000000000000000000000000000000000000000000010000	1	20	20	2			2	
R9943	004	0	1	31	11	R9943_004_0	8	8	25% OON Coinsurance Group	0000000000000000000000010000000000000000000100000	1	25	25	2			2	
R9943	004	0	1	31	11	R9943_004_0	8	7	$0 OON Copayment Group	1000000000000000000000000000000001100000000001110	2			1	0.00	0.00	2	
R9943	004	0	1	31	11	R9943_004_0	8	6	10% OON Coinsurance Group	0000000000000000000000000010000000000000000000000	1	10	10	2			2	
R9943	004	0	1	31	11	R9943_004_0	8	5	$30 - $45 OON Copayment Group	0000000000100000000000000000000000000000000000000	2			1	30.00	45.00	2	
R9943	004	0	1	31	11	R9943_004_0	8	4	$175 OON Copayment Group	0000000000000000000001000000000000000000000000000	2			1	175.00	175.00	2	
R9943	004	0	1	31	11	R9943_004_0	8	3	$45 OON Copayment Group	0000010101000000000000000000100000000000000000000	2			1	45.00	45.00	2	
R9943	004	0	1	31	11	R9943_004_0	8	1	30% OON Coinsurance Group	0111001010011111111110001101000000001111111000001	1	30	30	2			2	
R9943	004	0	1	31	11	R9943_004_0	8	2	$30 OON Copayment Group	0000100000000000000000000000000000010000000000000	2			1	30.00	30.00	2	
R9943	805	0	1	31	11	R9943_805_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
R9943	805	0	1	31	11	R9943_805_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R9943	806	0	1	31	11	R9943_806_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
R9943	806	0	1	31	11	R9943_806_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
R9943	807	0	1	31	11	R9943_807_0	6	1	Non-Mental Health Services	0111111101101111111011011111000001111111111101111	1	20	20	2			2	
R9943	807	0	1	31	11	R9943_807_0	6	2	Mental Health Services	0000000010010000000100000000000000000000000000000	1	45	45	2			2	
