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_maxplan_yn	pbp_c_oon_outpt_maxplan_amt	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	pbp_c_oon_outpt_cost_share	pbp_c_oon_outpt_cs_coins_yn	pbp_c_oon_outpt_cs_coins_min	pbp_c_oon_outpt_cs_coins_max	pbp_c_oon_outpt_cs_copay_yn	pbp_c_oon_outpt_cs_copay_min	pbp_c_oon_outpt_cs_copay_max
E5088	801	0	1	40	14	E5088_801_0	9	1	PCP  AHP services	000000100000100000000000000000000000000000000	2		2			1	10.00	30.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	9	Outpatient Hospital  ASC	000000000000000000011000000000000000000000000	2		2			1	0.00	100.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	11	Hearing  Eye Exams	000000000000000000000000000000000000000000101	2		2			1	0.00	25.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	12	Part B drugs	000000000000000000000000000000000000000100000	2		1	10	10	2			2		2						
E5088	801	0	1	40	14	E5088_801_0	9	13	Chiropractic services	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	14	Other 1	000000000000000000000000000000001000000000000	1	1000.00	1	20	20	2			2		2						
E5088	801	0	1	40	14	E5088_801_0	9	15	Prosthetics/Med Supps, Diab Supps  Svcs	000000000000000000000000001100000000000000000	2		1	0	15	2			2		2						
E5088	801	0	1	40	14	E5088_801_0	9	2	Specialty services	000000000101000000000000000000000000000001000	2		2			1	0.00	30.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	3	Therapy services	011100001000001001000000000000000000000000010	2		2			1	25.00	25.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	4	Psych/Mental Health Services	000000000010010000000000000000000000000000000	2		2			1	0.00	25.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	5	Partial Hospitalization, OP SA	000010000000000000000100000000000000000000000	2		1	20	20	2			2		2						
E5088	801	0	1	40	14	E5088_801_0	9	6	Zero cost sharing services	000001000000000100000010100010000111111000000	2		2			2			2		2						
E5088	801	0	1	40	14	E5088_801_0	9	7	Diagnostic Radiology	000000000000000010000000000000000000000000000	2		2			1	50.00	50.00	2		2						
E5088	801	0	1	40	14	E5088_801_0	9	8	OP x-rays, DME	000000000000000000100000010000000000000000000	2		1	15	15	2			2		2						
E5088	801	0	1	40	14	E5088_801_0	9	10	Ambulance	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	13	40% Coinsurance	000001000000000000000000000000000000000000000	2		1	40	40	2			2		2						
H0084	001	0	1	04	01	H0084_001_0	9	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
H0084	001	0	1	04	01	H0084_001_0	9	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	001	0	1	04	01	H0084_001_0	9	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H0084	001	0	1	04	01	H0084_001_0	9	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
H0084	003	0	1	04	01	H0084_003_0	7	4	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	003	0	1	04	01	H0084_003_0	7	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
H0084	003	0	1	04	01	H0084_003_0	7	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
H0084	003	0	1	04	01	H0084_003_0	7	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	003	0	1	04	01	H0084_003_0	7	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	004	0	1	04	01	H0084_004_0	6	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	13	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	12	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	11	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	10	40% Coinsurance	000001000000000000000000010000000000000000000	2		1	40	40	2			2		2						
H0084	004	0	1	04	01	H0084_004_0	6	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	5	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	9	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	004	0	1	04	01	H0084_004_0	6	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	7	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	004	0	1	04	01	H0084_004_0	6	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	005	0	1	04	01	H0084_005_0	6	1	$0 Copayment	000001000000000000000000000000000000000010000	2		2			1	0.00	0.00	2		2						
H0084	005	0	1	04	01	H0084_005_0	6	2	0% Coinsurance	000000000000000000000000100000000010111000000	2		1	0	0	2			2		2						
H0084	005	0	1	04	01	H0084_005_0	6	3	20% Coinsurance	011110111101101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	005	0	1	04	01	H0084_005_0	6	4	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	005	0	1	04	01	H0084_005_0	6	5	0% to 20% Coinsurance	000000000000000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	006	0	1	04	01	H0084_006_0	7	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
H0084	006	0	1	04	01	H0084_006_0	7	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
H0084	006	0	1	04	01	H0084_006_0	7	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	006	0	1	04	01	H0084_006_0	7	4	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	006	0	1	04	01	H0084_006_0	7	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	007	0	1	04	01	H0084_007_0	6	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	7	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	5	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	15	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	14	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	13	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	12	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	9	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	007	0	1	04	01	H0084_007_0	6	10	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	007	0	1	04	01	H0084_007_0	6	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
H0084	007	0	1	04	01	H0084_007_0	6	11	40% Coinsurance	000000000000000000000000010000000000000000000	2		1	40	40	2			2		2						
H0084	009	0	1	04	01	H0084_009_0	5	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	009	0	1	04	01	H0084_009_0	5	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	009	0	1	04	01	H0084_009_0	5	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
H0084	009	0	1	04	01	H0084_009_0	5	13	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	009	0	1	04	01	H0084_009_0	5	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	010	0	1	04	01	H0084_010_0	7	6	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	010	0	1	04	01	H0084_010_0	7	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	010	0	1	04	01	H0084_010_0	7	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
H0084	010	0	1	04	01	H0084_010_0	7	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
H0084	010	0	1	04	01	H0084_010_0	7	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	010	0	1	04	01	H0084_010_0	7	4	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	011	0	1	04	01	H0084_011_0	6	14	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	13	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	12	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	11	40% Coinsurance	000000000000000000000000010000000000000000000	2		1	40	40	2			2		2						
H0084	011	0	1	04	01	H0084_011_0	6	10	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	011	0	1	04	01	H0084_011_0	6	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	15	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	9	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	011	0	1	04	01	H0084_011_0	6	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	7	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H0084	011	0	1	04	01	H0084_011_0	6	5	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
H0084	012	0	1	04	01	H0084_012_0	6	4	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	012	0	1	04	01	H0084_012_0	6	3	20% Coinsurance	011110111101101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	012	0	1	04	01	H0084_012_0	6	2	0% Coninsurance	000000000000000000000000100000000010111000000	2		1	0	0	2			2		2						
H0084	012	0	1	04	01	H0084_012_0	6	1	$0 Copayment	000001000000000000000000000000000000000010000	2		2			1	0.00	0.00	2		2						
H0084	012	0	1	04	01	H0084_012_0	6	5	0% to 20% Coinsurance	000000000000000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	013	0	1	04	01	H0084_013_0	5	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
H0084	013	0	1	04	01	H0084_013_0	5	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	013	0	1	04	01	H0084_013_0	5	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	13	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	013	0	1	04	01	H0084_013_0	5	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	013	0	1	04	01	H0084_013_0	5	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	014	0	1	04	01	H0084_014_0	7	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
H0084	014	0	1	04	01	H0084_014_0	7	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
H0084	014	0	1	04	01	H0084_014_0	7	6	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	014	0	1	04	01	H0084_014_0	7	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	014	0	1	04	01	H0084_014_0	7	4	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	014	0	1	04	01	H0084_014_0	7	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	015	0	1	04	01	H0084_015_0	6	7	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	5	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	15	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	14	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	9	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	015	0	1	04	01	H0084_015_0	6	12	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	11	40% Coinsurance	000000000000000000000000010000000000000000000	2		1	40	40	2			2		2						
H0084	015	0	1	04	01	H0084_015_0	6	10	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	015	0	1	04	01	H0084_015_0	6	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
H0084	015	0	1	04	01	H0084_015_0	6	13	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	016	0	1	04	01	H0084_016_0	6	4	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	016	0	1	04	01	H0084_016_0	6	5	0% to 20% Coinsurance	000000000000000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	016	0	1	04	01	H0084_016_0	6	1	$0 Copayment	000001000000000000000000000000000000000010000	2		2			1	0.00	0.00	2		2						
H0084	016	0	1	04	01	H0084_016_0	6	2	0% Coinsurance	000000000000000000000000100000000010111000000	2		1	0	0	2			2		2						
H0084	016	0	1	04	01	H0084_016_0	6	3	20% Coinsurance	011110111101101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	017	0	1	04	01	H0084_017_0	5	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	017	0	1	04	01	H0084_017_0	5	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
H0084	017	0	1	04	01	H0084_017_0	5	13	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	017	0	1	04	01	H0084_017_0	5	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	017	0	1	04	01	H0084_017_0	5	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H0084	018	0	1	04	01	H0084_018_0	7	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	018	0	1	04	01	H0084_018_0	7	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
H0084	018	0	1	04	01	H0084_018_0	7	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
H0084	018	0	1	04	01	H0084_018_0	7	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	018	0	1	04	01	H0084_018_0	7	4	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	018	0	1	04	01	H0084_018_0	7	6	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	019	0	1	04	01	H0084_019_0	6	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	10	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	019	0	1	04	01	H0084_019_0	6	11	40% Coinsurance	000000000000000000000000010000000000000000000	2		1	40	40	2			2		2						
H0084	019	0	1	04	01	H0084_019_0	6	12	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	13	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	14	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	15	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	5	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	7	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	019	0	1	04	01	H0084_019_0	6	9	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	021	0	1	04	01	H0084_021_0	5	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
H0084	021	0	1	04	01	H0084_021_0	5	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	021	0	1	04	01	H0084_021_0	5	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	13	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	021	0	1	04	01	H0084_021_0	5	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	021	0	1	04	01	H0084_021_0	5	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H0084	022	0	1	04	01	H0084_022_0	7	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	022	0	1	04	01	H0084_022_0	7	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
H0084	022	0	1	04	01	H0084_022_0	7	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
H0084	022	0	1	04	01	H0084_022_0	7	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
H0084	022	0	1	04	01	H0084_022_0	7	4	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
H0084	022	0	1	04	01	H0084_022_0	7	6	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H0084	023	0	1	04	01	H0084_023_0	8	12	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	11	40% Coinsurance	000000000000000000000000010000000000000000000	2		1	40	40	2			2		2						
H0084	023	0	1	04	01	H0084_023_0	8	10	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	023	0	1	04	01	H0084_023_0	8	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	13	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	9	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	023	0	1	04	01	H0084_023_0	8	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	7	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	5	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	15	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	023	0	1	04	01	H0084_023_0	8	14	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
H0084	025	0	1	04	01	H0084_025_0	5	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
H0084	025	0	1	04	01	H0084_025_0	5	13	35% Coinsurance	000001000000000000000000000000000000000000000	2		1	35	35	2			2		2						
H0084	025	0	1	04	01	H0084_025_0	5	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
H0084	025	0	1	04	01	H0084_025_0	5	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
H0104	010	1	1	04	01	H0104_010_1	8	1	Part B - General	011111111111111111111110011110000010111111111	2		1	30	30	2			2		2						
H0104	010	1	1	04	01	H0104_010_1	8	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	010	2	1	04	01	H0104_010_2	7	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	010	2	1	04	01	H0104_010_2	7	1	Part B - General	011111111111111111111110011110000010111111111	2		1	30	30	2			2		2						
H0104	010	3	1	04	01	H0104_010_3	7	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	010	3	1	04	01	H0104_010_3	7	1	Part B - General	011111111111111111111110011110000010111111111	2		1	30	30	2			2		2						
H0104	010	4	1	04	01	H0104_010_4	7	1	Part B - General	011111111111111111111110011110000010111111111	2		1	30	30	2			2		2						
H0104	010	4	1	04	01	H0104_010_4	7	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	010	5	1	04	01	H0104_010_5	7	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	010	5	1	04	01	H0104_010_5	7	1	Part B - General	011111111111111111111110011110000010111111111	2		1	30	30	2			2		2						
H0104	011	1	1	04	01	H0104_011_1	5	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	011	1	1	04	01	H0104_011_1	5	1	Part B - General	011111111111111111111110011110000010111101111	2		1	30	30	2			2		2						
H0104	011	2	1	04	01	H0104_011_2	5	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	011	2	1	04	01	H0104_011_2	5	1	Part B - General	011111111111111111111110011110000010111101111	2		1	30	30	2			2		2						
H0104	011	3	1	04	01	H0104_011_3	5	1	Part B - General	011111111111111111111110011110000010111101111	2		1	30	30	2			2		2						
H0104	011	3	1	04	01	H0104_011_3	5	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	011	4	1	04	01	H0104_011_4	5	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	011	4	1	04	01	H0104_011_4	5	1	Part B - General	011111111111111111111110011110000010111101111	2		1	30	30	2			2		2						
H0104	011	5	1	04	01	H0104_011_5	5	2	Ambulance Services	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H0104	011	5	1	04	01	H0104_011_5	5	1	Part B - General	011111111111111111111110011110000010111101111	2		1	30	30	2			2		2						
H0104	011	6	1	04	01	H0104_011_6	5	1	Part B - General	011111111111111111111110011110000010111101111	2		1	30	30	2			2		2						
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H1509	007	0	1	04	01	H1509_007_0	4	3	Group 3	000001000000000011011000001100001000011100010	2		1	30	30	2			2		2						
H1509	007	0	1	04	01	H1509_007_0	4	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
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H1509	009	0	1	04	01	H1509_009_0	4	11	Group 11	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
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H1537	801	0	1	04	01	H1537_801_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
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H2997	003	0	1	04	01	H2997_003_0	11	3	10% Coinsurance Group	000001000000000000000000000000000000000000000	2		1	10	10	2			2		2						
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H2997	003	0	1	04	01	H2997_003_0	11	15	$0-$80 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	80.00	2		2						
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H2997	003	0	1	04	01	H2997_003_0	11	8	35% Coinsurance Group	000000000000000001000000011100000000000100000	2		1	35	35	2			2		2						
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H2997	005	0	1	04	01	H2997_005_0	8	8	25% Coinsurance Group	000000000000000001000000000000000000000100000	2		1	25	25	2			2		2						
H2997	005	0	1	04	01	H2997_005_0	8	6	$20 Copayment Group	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	5	$50 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	9	$0-$250 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	0.00	250.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	1	20% Coinsurance Group	000000000000000000000000011010000000000001000	2		1	20	20	2			2		2						
H2997	005	0	1	04	01	H2997_005_0	8	4	$40 Copayment Group	011110000111010000000100000000000000000000001	2		2			1	40.00	40.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	11	$200 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	12	$35 Copayment Group	000000000000000000100000000000000000000000000	2		2			1	35.00	35.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	13	$35-$200 Copayment Group	000000000000000010000000000000000000000000000	2		2			1	35.00	200.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	2	$0 Copayment Group	000000100000100000000010000100000010111000110	2		2			1	0.00	0.00	2		2						
H2997	005	0	1	04	01	H2997_005_0	8	3	10% Coinsurance Group	000001000000000000000000000000000000000000000	2		1	10	10	2			2		2						
H2997	005	0	1	04	01	H2997_005_0	8	10	$230 Copayment Group	000000000000000000001000000000000000000000000	2		2			1	230.00	230.00	2		2						
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H2997	006	0	1	04	01	H2997_006_0	8	8	25% Coinsurance Group	000000000000000001000000000000000000000100000	2		1	25	25	2			2		2						
H2997	006	0	1	04	01	H2997_006_0	8	7	$0-$200 Copayment Group	000000000000000100000000000000000000000000000	2		2			1	0.00	200.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	6	$50 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	5	10% Coinsurance Group	000001000000000000000000000000000000000000000	2		1	10	10	2			2		2						
H2997	006	0	1	04	01	H2997_006_0	8	3	$40 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	40.00	40.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	2	$30 Copayment Group	011100000101000000000000000000000000000000001	2		2			1	30.00	30.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	15	$35-$200	000000000000000010000000000000000000000000000	2		2			1	35.00	200.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	14	$35 Copayment Group	000000000000000000100000000000000000000000000	2		2			1	35.00	35.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	13	$20 Copayment Group	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	12	$0 Copayment Group	000000000000000000000010000100000010111000110	2		2			1	0.00	0.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	11	$200 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	10	$100 Copayment Group	000000000000000000001000000000000000000000000	2		2			1	100.00	100.00	2		2						
H2997	006	0	1	04	01	H2997_006_0	8	1	20% Coinsurance Group	000000000000000000000000011010000000000001000	2		1	20	20	2			2		2						
H2997	006	0	1	04	01	H2997_006_0	8	4	$10 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	10.00	10.00	2		2						
H2997	803	0	1	04	01	H2997_803_0	8	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H2997	803	0	1	04	01	H2997_803_0	8	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H2997	803	0	1	04	01	H2997_803_0	8	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
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H3206	001	0	1	04	01	H3206_001_0	12	1	0.00	000001000000000000000010000010001000110000000	2		2			1	0.00	0.00	2		2						
H3206	001	0	1	04	01	H3206_001_0	12	2	35.00	011100101000101000000000000000000010000000000	2		2			1	35.00	35.00	2		2						
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H3209	001	0	1	04	01	H3209_001_0	4	5	Group 5	000000000000000100000000000000000010000001000	2		1	0	30	2			2		2						
H3209	002	0	1	04	01	H3209_002_0	6	1	Group 1	011111111111111011111111011100001000011100101	2		1	30	30	2			2		2						
H3209	002	0	1	04	01	H3209_002_0	6	3	Group 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H3209	002	0	1	04	01	H3209_002_0	6	4	Group 4	000000000000000000000000000000100000100010010	2		2			1	0.00	0.00	2		2						
H3209	002	0	1	04	01	H3209_002_0	6	2	Group 2	000000000000000100000000000000000010000001000	2		1	0	30	2			2		2						
H3283	001	0	1	04	01	H3283_001_0	7	1	Outpatient Services Group 1	111111111111111111111111011111011010111101111	2		1	20	20	2			2		2						
H3283	001	0	1	04	01	H3283_001_0	7	2	Outpatient Services Group 2	000000000000000000000000100000000000000000000	2		2			1	0.00	0.00	2		2						
H3283	002	0	1	04	01	H3283_002_0	8	2	Outpatient Services Group 2	000000000000000000000000100000000000000000000	2		2			1	0.00	0.00	2		2						
H3283	002	0	1	04	01	H3283_002_0	8	1	Outpatient Services Group 1	111111111111111111111111011111011010111101111	2		1	20	20	2			2		2						
H3283	801	0	1	04	01	H3283_801_0	5	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3283	801	0	1	04	01	H3283_801_0	5	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3283	801	0	1	04	01	H3283_801_0	5	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3283	802	0	1	04	01	H3283_802_0	5	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3283	802	0	1	04	01	H3283_802_0	5	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3283	802	0	1	04	01	H3283_802_0	5	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3335	002	0	1	04	01	H3335_002_0	9	7	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	002	0	1	04	01	H3335_002_0	9	5	$45 Copayment	000000000100100000000000000000000000000000000	2		2			1	45.00	45.00	2		2						
H3335	002	0	1	04	01	H3335_002_0	9	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	002	0	1	04	01	H3335_002_0	9	3	$150 Copayment	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H3335	002	0	1	04	01	H3335_002_0	9	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	002	0	1	04	01	H3335_002_0	9	1	30% coinsurance	011101011001001111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	002	0	1	04	01	H3335_002_0	9	6	Preventive Services	000000000000000000000000000000000010000000000	2		2			1	0.00	45.00	2		2						
H3335	002	0	1	04	01	H3335_002_0	9	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	005	0	1	04	01	H3335_005_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	005	0	1	04	01	H3335_005_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	005	0	1	04	01	H3335_005_0	7	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	005	0	1	04	01	H3335_005_0	7	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	005	0	1	04	01	H3335_005_0	7	4	$0 Copayment	000000000000000000000000000010000000000010000	2		2			1	0.00	0.00	2		2						
H3335	005	0	1	04	01	H3335_005_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	006	0	1	04	01	H3335_006_0	7	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	006	0	1	04	01	H3335_006_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	006	0	1	04	01	H3335_006_0	7	4	$0 Copayment	000000000000000000000000000010000000000010000	2		2			1	0.00	0.00	2		2						
H3335	006	0	1	04	01	H3335_006_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	006	0	1	04	01	H3335_006_0	7	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	006	0	1	04	01	H3335_006_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	008	0	1	04	01	H3335_008_0	7	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	008	0	1	04	01	H3335_008_0	7	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	008	0	1	04	01	H3335_008_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	008	0	1	04	01	H3335_008_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	008	0	1	04	01	H3335_008_0	7	4	$0 Copayment	000000000000000000000000000010000000000010000	2		2			1	0.00	0.00	2		2						
H3335	008	0	1	04	01	H3335_008_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	009	0	1	04	01	H3335_009_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	009	0	1	04	01	H3335_009_0	7	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	009	0	1	04	01	H3335_009_0	7	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	009	0	1	04	01	H3335_009_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	009	0	1	04	01	H3335_009_0	7	4	$0 Copayment	000000000000000000000000000010000000000010000	2		2			1	0.00	0.00	2		2						
H3335	009	0	1	04	01	H3335_009_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	014	0	1	04	01	H3335_014_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	014	0	1	04	01	H3335_014_0	7	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	014	0	1	04	01	H3335_014_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	014	0	1	04	01	H3335_014_0	7	4	$0 Copayment	000000000000000000000000000010000000000010000	2		2			1	0.00	0.00	2		2						
H3335	014	0	1	04	01	H3335_014_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	014	0	1	04	01	H3335_014_0	7	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	015	0	1	04	01	H3335_015_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	015	0	1	04	01	H3335_015_0	7	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	015	0	1	04	01	H3335_015_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	015	0	1	04	01	H3335_015_0	7	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	015	0	1	04	01	H3335_015_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	015	0	1	04	01	H3335_015_0	7	4	$0 Copayment	000000000000000000000000000010000000000010000	2		2			1	0.00	0.00	2		2						
H3335	018	0	1	04	01	H3335_018_0	6	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	018	0	1	04	01	H3335_018_0	6	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	018	0	1	04	01	H3335_018_0	6	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	018	0	1	04	01	H3335_018_0	6	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	018	0	1	04	01	H3335_018_0	6	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	018	0	1	04	01	H3335_018_0	6	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	021	0	1	04	01	H3335_021_0	6	1	30% coinsurance	011101111101101111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	021	0	1	04	01	H3335_021_0	6	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	021	0	1	04	01	H3335_021_0	6	6	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	021	0	1	04	01	H3335_021_0	6	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	021	0	1	04	01	H3335_021_0	6	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	021	0	1	04	01	H3335_021_0	6	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	032	0	1	04	01	H3335_032_0	9	3	$150 Copayment	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H3335	032	0	1	04	01	H3335_032_0	9	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	032	0	1	04	01	H3335_032_0	9	1	30% coinsurance	011101011001001111111010011100000000011101111	2		1	30	30	2			2		2						
H3335	032	0	1	04	01	H3335_032_0	9	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	032	0	1	04	01	H3335_032_0	9	5	$45 Copayment	000000000100100000000000000000000000000000000	2		2			1	45.00	45.00	2		2						
H3335	032	0	1	04	01	H3335_032_0	9	6	Preventive Services	000000000000000000000000000000000010000000000	2		2			1	0.00	45.00	2		2						
H3335	032	0	1	04	01	H3335_032_0	9	7	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	032	0	1	04	01	H3335_032_0	9	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	037	0	1	04	01	H3335_037_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	037	0	1	04	01	H3335_037_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	037	0	1	04	01	H3335_037_0	7	1	30% coinsurance	000001000000000111111010011100000000011100000	2		1	30	30	2			2		2						
H3335	037	0	1	04	01	H3335_037_0	7	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	037	0	1	04	01	H3335_037_0	7	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	037	0	1	04	01	H3335_037_0	7	7	$45 copay	011100001101101000000000000000000000000001111	2		2			1	45.00	45.00	2		2						
H3335	037	0	1	04	01	H3335_037_0	7	6	$20 Copay	000000110000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3335	037	0	1	04	01	H3335_037_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	038	0	1	04	01	H3335_038_0	7	1	30% coinsurance	000001000000000111111010011100000000011100000	2		1	30	30	2			2		2						
H3335	038	0	1	04	01	H3335_038_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	038	0	1	04	01	H3335_038_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	038	0	1	04	01	H3335_038_0	7	7	$45 copay	011100001101101000000000000000000000000001111	2		2			1	45.00	45.00	2		2						
H3335	038	0	1	04	01	H3335_038_0	7	6	$20 Copay	000000110000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3335	038	0	1	04	01	H3335_038_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	038	0	1	04	01	H3335_038_0	7	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	038	0	1	04	01	H3335_038_0	7	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	041	0	1	04	01	H3335_041_0	6	1	30% coinsurance	011101011001001111111010011100000000111101111	2		1	30	30	2			2		2						
H3335	041	0	1	04	01	H3335_041_0	6	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	041	0	1	04	01	H3335_041_0	6	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	041	0	1	04	01	H3335_041_0	6	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	041	0	1	04	01	H3335_041_0	6	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	35	2			2		2						
H3335	041	0	1	04	01	H3335_041_0	6	6	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	041	0	1	04	01	H3335_041_0	6	7	$35 Copay	000000000100100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H3335	041	0	1	04	01	H3335_041_0	6	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	042	0	1	04	01	H3335_042_0	6	7	$35 Copay	000000000100100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H3335	042	0	1	04	01	H3335_042_0	6	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	042	0	1	04	01	H3335_042_0	6	1	30% coinsurance	011101011001001111111010011100000000111101111	2		1	30	30	2			2		2						
H3335	042	0	1	04	01	H3335_042_0	6	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	042	0	1	04	01	H3335_042_0	6	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	042	0	1	04	01	H3335_042_0	6	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	042	0	1	04	01	H3335_042_0	6	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	35	2			2		2						
H3335	042	0	1	04	01	H3335_042_0	6	6	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	043	0	1	04	01	H3335_043_0	6	1	30% coinsurance	011101011001001111111010011100000000111101111	2		1	30	30	2			2		2						
H3335	043	0	1	04	01	H3335_043_0	6	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	043	0	1	04	01	H3335_043_0	6	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	043	0	1	04	01	H3335_043_0	6	7	$35 Copay	000000000100100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H3335	043	0	1	04	01	H3335_043_0	6	6	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	043	0	1	04	01	H3335_043_0	6	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	35	2			2		2						
H3335	043	0	1	04	01	H3335_043_0	6	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	043	0	1	04	01	H3335_043_0	6	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	044	0	1	04	01	H3335_044_0	6	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	044	0	1	04	01	H3335_044_0	6	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	044	0	1	04	01	H3335_044_0	6	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	044	0	1	04	01	H3335_044_0	6	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	044	0	1	04	01	H3335_044_0	6	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	35	2			2		2						
H3335	044	0	1	04	01	H3335_044_0	6	6	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	044	0	1	04	01	H3335_044_0	6	7	$35 Copay	000000000100100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H3335	044	0	1	04	01	H3335_044_0	6	1	30% coinsurance	011101011001001111111010011100000000111101111	2		1	30	30	2			2		2						
H3335	045	0	1	04	01	H3335_045_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	045	0	1	04	01	H3335_045_0	7	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	045	0	1	04	01	H3335_045_0	7	7	$35 Copay	000000000100100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H3335	045	0	1	04	01	H3335_045_0	7	6	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3335	045	0	1	04	01	H3335_045_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	35	2			2		2						
H3335	045	0	1	04	01	H3335_045_0	7	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	045	0	1	04	01	H3335_045_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	045	0	1	04	01	H3335_045_0	7	1	30% coinsurance	011101011001001111111010011100000000111101111	2		1	30	30	2			2		2						
H3335	051	0	1	04	01	H3335_051_0	7	1	30% coinsurance	000001000000000111111010011100000000011100000	2		1	30	30	2			2		2						
H3335	051	0	1	04	01	H3335_051_0	7	4	$0 Copayment	000000000000000000000000000010000000000000000	2		2			1	0.00	0.00	2		2						
H3335	051	0	1	04	01	H3335_051_0	7	8	Supplemental Education/Wellness Programs	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3335	051	0	1	04	01	H3335_051_0	7	5	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3335	051	0	1	04	01	H3335_051_0	7	6	$20 Copay	000000110000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3335	051	0	1	04	01	H3335_051_0	7	7	$45 copay	011100001101101000000000000000000000000001111	2		2			1	45.00	45.00	2		2						
H3335	051	0	1	04	01	H3335_051_0	7	3	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3335	051	0	1	04	01	H3335_051_0	7	2	50% Coinsurance	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	801	0	1	04	01	H3335_801_0	6	4	50% Coinsurance	000000000000000000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	801	0	1	04	01	H3335_801_0	6	3	$0 Copayment	000001000000000000000000000000000000000000000	2		2			1	0.00	0.00	2		2						
H3335	801	0	1	04	01	H3335_801_0	6	2	40% Coinsurance	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3335	801	0	1	04	01	H3335_801_0	6	1	20% Coinsurance	011100111101101111111011011110000010011101111	2		1	20	20	2			2		2						
H3335	811	0	1	04	01	H3335_811_0	6	2	40% Coinsurance	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3335	811	0	1	04	01	H3335_811_0	6	3	$0 Copayment	000001000000000000000000000000000000000000000	2		2			1	0.00	0.00	2		2						
H3335	811	0	1	04	01	H3335_811_0	6	4	50% Coinsurance	000000000000000000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	811	0	1	04	01	H3335_811_0	6	1	20% Coinsurance	011100111101101111111011011110000010011101111	2		1	20	20	2			2		2						
H3335	813	0	1	04	01	H3335_813_0	6	4	50% Coinsurance	000000000000000000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	813	0	1	04	01	H3335_813_0	6	3	$0 Copayment	000001000000000000000000000000000000000000000	2		2			1	0.00	0.00	2		2						
H3335	813	0	1	04	01	H3335_813_0	6	2	40% Coinsurance	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3335	813	0	1	04	01	H3335_813_0	6	1	20% Coinsurance	011100111101101111111011011110000010011101111	2		1	20	20	2			2		2						
H3335	819	0	1	04	01	H3335_819_0	6	3	$0 Copayment	000001000000000000000000000000000000000000000	2		2			1	0.00	0.00	2		2						
H3335	819	0	1	04	01	H3335_819_0	6	1	20% Coinsurance	011100111101101111111011011110000010011101111	2		1	20	20	2			2		2						
H3335	819	0	1	04	01	H3335_819_0	6	4	50% Coinsurance	000000000000000000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	819	0	1	04	01	H3335_819_0	6	2	40% Coinsurance	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3335	820	0	1	04	01	H3335_820_0	6	4	50% Coinsurance	000000000000000000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	820	0	1	04	01	H3335_820_0	6	2	40% Coinsurance	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3335	820	0	1	04	01	H3335_820_0	6	3	$0 Copayment	000001000000000000000000000000000000000000000	2		2			1	0.00	0.00	2		2						
H3335	820	0	1	04	01	H3335_820_0	6	1	20% Coinsurance	011100111101101111111011011110000010011101111	2		1	20	20	2			2		2						
H3335	822	0	1	04	01	H3335_822_0	6	2	40% Coinsurance	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3335	822	0	1	04	01	H3335_822_0	6	3	$0 Copayment	000001000000000000000000000000000000000000000	2		2			1	0.00	0.00	2		2						
H3335	822	0	1	04	01	H3335_822_0	6	4	50% Coinsurance	000000000000000000000100000000000000000000000	2		1	50	50	2			2		2						
H3335	822	0	1	04	01	H3335_822_0	6	1	20% Coinsurance	011100111101101111111011011110000010011101111	2		1	20	20	2			2		2						
H3342	001	0	1	04	01	H3342_001_0	9	1	$30 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	9	50% Coinsurance Group	100000000000000000000000000000000000000000001	2		1	50	50	2			2		2						
H3342	001	0	1	04	01	H3342_001_0	9	11	$75 to $150 Copayment Group	000000000000000010100000000000000000000000000	2		2			1	75.00	150.00	2		3	2			1	30.00	50.00
H3342	001	0	1	04	01	H3342_001_0	9	12	$0 Copayment Group	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	13	$0 - $50 Copayment Group	000000000000000100000000000000000000000000100	2		2			1	0.00	50.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	14	$50 - $125 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	50.00	125.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	15	$50 Copayment Group	000000000000000000000000000000001000000000000	2		2			1	50.00	50.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	2	$0 - $100 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	100.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	3	$50 Copayment Group	011101010101000000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	4	$100 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	100.00	100.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	5	$125 Copayment Group	000000000000000000001000000000000000000000000	2		2			1	125.00	125.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	6	$200 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3342	001	0	1	04	01	H3342_001_0	9	7	10% Coinsurance Group	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3342	001	0	1	04	01	H3342_001_0	9	8	20% Coinsurance Group	000000000000000001000010011100000000011111000	2		1	20	20	2			2		2						
H3342	001	0	1	04	01	H3342_001_0	9	10	$50 to $100 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	100.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	2	$0 - $100 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	100.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	3	$50 Copayment Group	011101010101000000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	4	$100 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	100.00	100.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	5	$125 Copayment Group	000000000000000000001000000000000000000000000	2		2			1	125.00	125.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	6	$200 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	7	10% Coinsurance Group	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3342	002	0	1	04	01	H3342_002_0	8	8	20% Coinsurance Group	000000000000000001000010011100000000011111000	2		1	20	20	2			2		2						
H3342	002	0	1	04	01	H3342_002_0	8	9	50% Coinsurance Group	100000000000000000000000000000000000000000001	2		1	50	50	2			2		2						
H3342	002	0	1	04	01	H3342_002_0	8	1	$30 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	10	$50 to $100 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	100.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	11	$75 to $150 Copayment Group	000000000000000010100000000000000000000000000	2		2			1	75.00	150.00	2		3	2			1	30.00	50.00
H3342	002	0	1	04	01	H3342_002_0	8	12	$0 Copayment Group	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	13	$0 - $50 Copayment Group	000000000000000100000000000000000000000000100	2		2			1	0.00	50.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	14	$50 - $125 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	50.00	125.00	2		2						
H3342	002	0	1	04	01	H3342_002_0	8	15	$50 Copayment Group	000000000000000000000000000000001000000000000	2		2			1	50.00	50.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	8	20% Coinsurance Group	000000000000000000000010000100000000011101000	2		1	20	20	2			2		2						
H3342	012	0	1	04	01	H3342_012_0	8	9	$0 to $100 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	100.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	6	$500 Copayment Group	000000000000000000001000000000000000000000000	2		2			1	500.00	500.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	5	$250 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	250.00	250.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	4	$100 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	100.00	100.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	3	30% Coinsurance Group	000000000000000001000000011000000000000000000	2		1	30	30	2			2		2						
H3342	012	0	1	04	01	H3342_012_0	8	2	$65 Copayment Group	011101010101000000000000000000000000000000101	2		2			1	65.00	65.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	15	$0 Copayment Group	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	14	$150 - $175 Copayment Group	000000000000000010100000000000000000000000000	2		2			1	150.00	175.00	2		3	2			1	40.00	65.00
H3342	012	0	1	04	01	H3342_012_0	8	13	$50 - $100 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	100.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	12	$65 Copayment Group	000000000000000000000000000000001000000000000	2		2			1	65.00	65.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	11	$0 - $75 Copayment Group	000000000000000100000000000000000000000000000	2		2			1	0.00	75.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	10	$65 - $500 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	65.00	500.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	1	$40 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3342	012	0	1	04	01	H3342_012_0	8	7	10% Coinsurance Group	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3342	013	0	1	04	01	H3342_013_0	7	12	$0 Copayment Group	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	13	$50 - $200 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	50.00	200.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	14	$0 to $75 Copayment Group	000000000000000100000000000000000000000000000	2		2			1	0.00	75.00	2		3	2			1	30.00	50.00
H3342	013	0	1	04	01	H3342_013_0	7	15	$50 Copayment Group	000000000000000000000000000000001000000000000	2		2			1	50.00	50.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	2	$0 - $100 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	100.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	3	$50 Copayment Group	011101010101000000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	4	$100 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	100.00	100.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	5	$0 - $50 Copayment Group	000000000000000000000000000000000000000000100	2		2			1	0.00	50.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	6	$200 Copayment Group	000000000000000000001001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	7	10% Coinsurance Group	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3342	013	0	1	04	01	H3342_013_0	7	8	20% Coinsurance Group	000000000000000001000010011100000000011111000	2		1	20	20	2			2		2						
H3342	013	0	1	04	01	H3342_013_0	7	9	50% Coinsurance Group	100000000000000000000000000000000000000000001	2		1	50	50	2			2		2						
H3342	013	0	1	04	01	H3342_013_0	7	11	$125 to $150 Copayment Group	000000000000000010100000000000000000000000000	2		2			1	125.00	150.00	2		3	2			1	30.00	50.00
H3342	013	0	1	04	01	H3342_013_0	7	1	$30 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3342	013	0	1	04	01	H3342_013_0	7	10	$50 to $100 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	100.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	9	50% Coinsurance Group	100000000000000000000000000000000000000000001	2		1	50	50	2			2		2						
H3342	014	0	1	04	01	H3342_014_0	7	8	20% Coinsurance Group	000000000000000001000010011100000000011111000	2		1	20	20	2			2		2						
H3342	014	0	1	04	01	H3342_014_0	7	6	$200 Copayment Group	000000000000000000001001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	7	10% Coinsurance Group	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3342	014	0	1	04	01	H3342_014_0	7	5	$0 - $50 Copayment Group	000000000000000000000000000000000000000000100	2		2			1	0.00	50.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	4	$100 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	100.00	100.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	3	$50 Copayment Group	011101010101000000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	2	$0 - $100 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	100.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	15	$50 Copayment Group	000000000000000000000000000000001000000000000	2		2			1	50.00	50.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	14	$0 to $75 Copayment Group	000000000000000100000000000000000000000000000	2		2			1	0.00	75.00	2		3	2			1	30.00	50.00
H3342	014	0	1	04	01	H3342_014_0	7	13	$50 - $200 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	50.00	200.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	12	$0 Copayment Group	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	11	$125 to $150 Copayment Group	000000000000000010100000000000000000000000000	2		2			1	125.00	150.00	2		3	2			1	30.00	50.00
H3342	014	0	1	04	01	H3342_014_0	7	10	$50 to $100 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	100.00	2		2						
H3342	014	0	1	04	01	H3342_014_0	7	1	$30 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	10	$50 to $100 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	100.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	9	50% Coinsurance Group	100000000000000000000000000000000000000000001	2		1	50	50	2			2		2						
H3342	015	0	1	04	01	H3342_015_0	7	11	$125 to $150 Copayment Group	000000000000000010100000000000000000000000000	2		2			1	125.00	150.00	2		3	2			1	30.00	50.00
H3342	015	0	1	04	01	H3342_015_0	7	12	$0 Copayment Group	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	13	$50 - $200 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	50.00	200.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	14	$0 to $75 Copayment Group	000000000000000100000000000000000000000000000	2		2			1	0.00	75.00	2		3	2			1	30.00	50.00
H3342	015	0	1	04	01	H3342_015_0	7	15	$50 Copayment Group	000000000000000000000000000000001000000000000	2		2			1	50.00	50.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	2	$0 - $100 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	100.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	3	$50 Copayment Group	011101010101000000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	4	$100 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	100.00	100.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	5	$0 - $50 Copayment Group	000000000000000000000000000000000000000000100	2		2			1	0.00	50.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	6	$200 Copayment Group	000000000000000000001001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3342	015	0	1	04	01	H3342_015_0	7	7	10% Coinsurance Group	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3342	015	0	1	04	01	H3342_015_0	7	8	20% Coinsurance Group	000000000000000001000010011100000000011111000	2		1	20	20	2			2		2						
H3342	015	0	1	04	01	H3342_015_0	7	1	$30 Copayment Group	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3342	808	0	1	04	01	H3342_808_0	6	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H3342	808	0	1	04	01	H3342_808_0	6	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H3342	808	0	1	04	01	H3342_808_0	6	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H3342	809	0	1	04	01	H3342_809_0	4	1	Non-Mental Health Services	111111111101101111111011111111111101111111111	2		1	20	20	2			2		2						
H3342	809	0	1	04	01	H3342_809_0	4	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H3342	809	0	1	04	01	H3342_809_0	4	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H3342	810	0	1	04	01	H3342_810_0	4	1	Non-Mental Health Services	111111111101101111111011111111111101111111111	2		1	20	20	2			2		2						
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H3342	811	0	1	04	01	H3342_811_0	4	1	Non-Mental Health Services	111111111101101111111011111111111101111111111	2		1	20	20	2			2		2						
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H3344	003	0	1	04	01	H3344_003_0	7	1	30% coinsurance	011101001000001111111010000100000010011101001	2		1	30	30	2			2		2						
H3344	003	0	1	04	01	H3344_003_0	7	2	45% Coinsurance	000010000010010000000100000000000000000000000	2		1	45	45	2			2		2						
H3344	003	0	1	04	01	H3344_003_0	7	3	50% Coinsurance	000000010000000000000000011000000000000000000	2		1	50	50	2			2		2						
H3344	003	0	1	04	01	H3344_003_0	7	4	$0 copayment	000000000000000000000000000010001000100000010	2		2			1	0.00	0.00	2		2						
H3344	003	0	1	04	01	H3344_003_0	7	5	$50 Copayment	000000000000000000000001000000000000000000000	2		2			1	50.00	50.00	2		2						
H3344	003	0	1	04	01	H3344_003_0	7	6	$30 copayment	000000100101100000000000000000000000000000100	2		2			1	30.00	30.00	2		2						
H3344	003	0	1	04	01	H3344_003_0	7	7	50% OON Dental	000000000000000000000000000000000000000010000	2		1	50	50	2			2		2						
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H3344	005	0	1	04	01	H3344_005_0	10	7	50% OON Dental	000000000000000000000000000000000000000010000	2		1	50	50	2			2		2						
H3344	005	0	1	04	01	H3344_005_0	10	6	$40 Copayment	000000100101100000000000000000000000000000100	2		2			1	40.00	40.00	2		2						
H3344	005	0	1	04	01	H3344_005_0	10	5	50% Coinsurance	000000010000000000000000011000000000000000000	2		1	50	50	2			2		2						
H3344	005	0	1	04	01	H3344_005_0	10	4	45% Coinsurance	000010000010010000000100000000000000000000000	2		1	45	45	2			2		2						
H3344	005	0	1	04	01	H3344_005_0	10	3	30% Coinsurance	011101001000001111111010000100000010011101001	2		1	30	30	2			2		2						
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H3344	006	0	1	04	01	H3344_006_0	5	5	50%	000000010000000000000000011000000000000000000	2		1	50	50	2			2		2						
H3344	006	0	1	04	01	H3344_006_0	5	6	$40 copayment	000000100101100000000000000000000000000000100	2		2			1	40.00	40.00	2		2						
H3344	006	0	1	04	01	H3344_006_0	5	3	30% Coinsurance	011101001000001111111010000100000010011101001	2		1	30	30	2			2		2						
H3344	006	0	1	04	01	H3344_006_0	5	2	$180 copayment	000000000000000000000001000000000000000000000	2		2			1	180.00	180.00	2		2						
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H3346	002	0	1	04	01	H3346_002_0	7	5	50% Coinsurance	000000000000000000000000000001000000000000000	2		1	50	50	2			2		2						
H3346	002	0	1	04	01	H3346_002_0	7	4	$75	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H3346	002	0	1	04	01	H3346_002_0	7	3	$600 Annual Limit	100000000000000000000000000000000000000000000	1	600.00	2			1	0.00	0.00	2		2						
H3346	002	0	1	04	01	H3346_002_0	7	7	$300 Annual Limit	000000000000000000000000000000000000000010000	1	300.00	2			1	0.00	0.00	2		2						
H3346	002	0	1	04	01	H3346_002_0	7	10	No Coverage	000000000000100000000000100000110000000000000	2		2			1	0.00	0.00	2		2						
H3346	002	0	1	04	01	H3346_002_0	7	1	25% Coinsurance	000001000000000111011000011100000000000100000	2		1	25	25	2			2		2						
H3346	002	0	1	04	01	H3346_002_0	7	9	$20 Chiro Copay	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3346	002	0	1	04	01	H3346_002_0	7	8	$100 Annual limit	000000000000000000000000000000000000000000010	1	100.00	2			1	0.00	0.00	2		2						
H3346	002	0	1	04	01	H3346_002_0	7	2	$35 Copay	011110101111011000100100000000000000000001101	2		2			1	35.00	35.00	2		2						
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H3346	007	0	1	04	01	H3346_007_0	7	6	$0 Copay	000000000000000000000010000010000010111000000	2		2			1	0.00	0.00	2		2						
H3346	007	0	1	04	01	H3346_007_0	7	7	$300 Annual Limit	000000000000000000000000000000000000000010000	1	300.00	2			1	0.00	0.00	2		2						
H3346	007	0	1	04	01	H3346_007_0	7	8	$100 Annual limit	000000000000000000000000000000000000000000010	1	100.00	2			1	0.00	0.00	2		2						
H3346	007	0	1	04	01	H3346_007_0	7	9	$20 Chiro Copay	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3346	007	0	1	04	01	H3346_007_0	7	1	25% Coinsurance	000001000000000111011000011100000000000100000	2		1	25	25	2			2		2						
H3346	007	0	1	04	01	H3346_007_0	7	10	No Coverage	000000000000100000000000100000110000000000000	2		2			1	0.00	0.00	2		2						
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H3346	007	0	1	04	01	H3346_007_0	7	4	$75	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H3346	007	0	1	04	01	H3346_007_0	7	3	$600 Annual Limit	100000000000000000000000000000000000000000000	1	600.00	2			1	0.00	0.00	2		2						
H3346	802	0	1	04	01	H3346_802_0	1	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
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H3404	002	0	1	04	01	H3404_002_0	10	4	No Cost Sharing	000001000000000001000010000010000010111000000	2		2			1	0.00	0.00	2		2						
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H3404	002	0	1	04	01	H3404_002_0	10	6	$20-$40 Copay	000000000000100000000000000000000000000000000	2		2			1	20.00	40.00	2		2						
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H3410	002	7	1	09	04	H3410_002_7	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	7	1	09	04	H3410_002_7	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	7	1	09	04	H3410_002_7	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
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H3410	002	7	1	09	04	H3410_002_7	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
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H3410	002	8	1	09	04	H3410_002_8	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
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H3410	002	8	1	09	04	H3410_002_8	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	8	1	09	04	H3410_002_8	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	8	1	09	04	H3410_002_8	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	8	1	09	04	H3410_002_8	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	8	1	09	04	H3410_002_8	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	9	1	09	04	H3410_002_9	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	9	1	09	04	H3410_002_9	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	9	1	09	04	H3410_002_9	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	9	1	09	04	H3410_002_9	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	9	1	09	04	H3410_002_9	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	9	1	09	04	H3410_002_9	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	9	1	09	04	H3410_002_9	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	9	1	09	04	H3410_002_9	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	9	1	09	04	H3410_002_9	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	9	1	09	04	H3410_002_9	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	9	1	09	04	H3410_002_9	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	10	1	09	04	H3410_002_10	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	10	1	09	04	H3410_002_10	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	10	1	09	04	H3410_002_10	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	10	1	09	04	H3410_002_10	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	10	1	09	04	H3410_002_10	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	11	1	09	04	H3410_002_11	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	11	1	09	04	H3410_002_11	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	11	1	09	04	H3410_002_11	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	11	1	09	04	H3410_002_11	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	11	1	09	04	H3410_002_11	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	12	1	09	04	H3410_002_12	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	12	1	09	04	H3410_002_12	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	12	1	09	04	H3410_002_12	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	12	1	09	04	H3410_002_12	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	13	1	09	04	H3410_002_13	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	13	1	09	04	H3410_002_13	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	13	1	09	04	H3410_002_13	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	13	1	09	04	H3410_002_13	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	13	1	09	04	H3410_002_13	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	13	1	09	04	H3410_002_13	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	13	1	09	04	H3410_002_13	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	13	1	09	04	H3410_002_13	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	13	1	09	04	H3410_002_13	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	13	1	09	04	H3410_002_13	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	13	1	09	04	H3410_002_13	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	14	1	09	04	H3410_002_14	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	14	1	09	04	H3410_002_14	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	14	1	09	04	H3410_002_14	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	14	1	09	04	H3410_002_14	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	14	1	09	04	H3410_002_14	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	15	1	09	04	H3410_002_15	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	15	1	09	04	H3410_002_15	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	15	1	09	04	H3410_002_15	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	15	1	09	04	H3410_002_15	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	15	1	09	04	H3410_002_15	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	16	1	09	04	H3410_002_16	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	16	1	09	04	H3410_002_16	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	16	1	09	04	H3410_002_16	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	16	1	09	04	H3410_002_16	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	16	1	09	04	H3410_002_16	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	17	1	09	04	H3410_002_17	5	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	17	1	09	04	H3410_002_17	5	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	17	1	09	04	H3410_002_17	5	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	17	1	09	04	H3410_002_17	5	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	18	1	09	04	H3410_002_18	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	18	1	09	04	H3410_002_18	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	18	1	09	04	H3410_002_18	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	18	1	09	04	H3410_002_18	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	18	1	09	04	H3410_002_18	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	18	1	09	04	H3410_002_18	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	002	18	1	09	04	H3410_002_18	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	18	1	09	04	H3410_002_18	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	18	1	09	04	H3410_002_18	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	18	1	09	04	H3410_002_18	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	18	1	09	04	H3410_002_18	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	002	19	1	09	04	H3410_002_19	4	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	002	19	1	09	04	H3410_002_19	4	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	002	19	1	09	04	H3410_002_19	4	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	002	19	1	09	04	H3410_002_19	4	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	002	19	1	09	04	H3410_002_19	4	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	7	1	09	04	H3410_003_7	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	7	1	09	04	H3410_003_7	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	7	1	09	04	H3410_003_7	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	7	1	09	04	H3410_003_7	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	7	1	09	04	H3410_003_7	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	8	1	09	04	H3410_003_8	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	8	1	09	04	H3410_003_8	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	8	1	09	04	H3410_003_8	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	8	1	09	04	H3410_003_8	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	8	1	09	04	H3410_003_8	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	9	1	09	04	H3410_003_9	7	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	9	1	09	04	H3410_003_9	7	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	9	1	09	04	H3410_003_9	7	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	9	1	09	04	H3410_003_9	7	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	10	1	09	04	H3410_003_10	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	10	1	09	04	H3410_003_10	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	10	1	09	04	H3410_003_10	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	10	1	09	04	H3410_003_10	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	10	1	09	04	H3410_003_10	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	11	1	09	04	H3410_003_11	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	11	1	09	04	H3410_003_11	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	11	1	09	04	H3410_003_11	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	11	1	09	04	H3410_003_11	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	11	1	09	04	H3410_003_11	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	11	1	09	04	H3410_003_11	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	11	1	09	04	H3410_003_11	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	11	1	09	04	H3410_003_11	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	11	1	09	04	H3410_003_11	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	11	1	09	04	H3410_003_11	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	11	1	09	04	H3410_003_11	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	12	1	09	04	H3410_003_12	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	12	1	09	04	H3410_003_12	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	12	1	09	04	H3410_003_12	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	12	1	09	04	H3410_003_12	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	12	1	09	04	H3410_003_12	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	13	1	09	04	H3410_003_13	8	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	13	1	09	04	H3410_003_13	8	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	13	1	09	04	H3410_003_13	8	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	13	1	09	04	H3410_003_13	8	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	13	1	09	04	H3410_003_13	8	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	14	1	09	04	H3410_003_14	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	14	1	09	04	H3410_003_14	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	14	1	09	04	H3410_003_14	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	14	1	09	04	H3410_003_14	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	14	1	09	04	H3410_003_14	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	15	1	09	04	H3410_003_15	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	15	1	09	04	H3410_003_15	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	15	1	09	04	H3410_003_15	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	15	1	09	04	H3410_003_15	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	15	1	09	04	H3410_003_15	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	16	1	09	04	H3410_003_16	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	16	1	09	04	H3410_003_16	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	16	1	09	04	H3410_003_16	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	16	1	09	04	H3410_003_16	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	16	1	09	04	H3410_003_16	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	17	1	09	04	H3410_003_17	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	17	1	09	04	H3410_003_17	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	17	1	09	04	H3410_003_17	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	17	1	09	04	H3410_003_17	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	17	1	09	04	H3410_003_17	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	18	1	09	04	H3410_003_18	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	18	1	09	04	H3410_003_18	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	18	1	09	04	H3410_003_18	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	18	1	09	04	H3410_003_18	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	18	1	09	04	H3410_003_18	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	8	Partial Hosp/OP Obs	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	6	Zero Cost Share	011101000000000110100010000010100010100011010	2		2			1	0.00	0.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	7	OP Rehabilition	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H3410	003	19	1	09	04	H3410_003_19	6	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3410	003	19	1	09	04	H3410_003_19	6	2	OP Radiology, Pt B Drugs, OP Surg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H3410	003	19	1	09	04	H3410_003_19	6	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3410	003	19	1	09	04	H3410_003_19	6	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3410	003	19	1	09	04	H3410_003_19	6	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H3410	004	7	1	09	04	H3410_004_7	7	3	Mental Health	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
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H3812	001	0	1	04	01	H3812_001_0	5	13	Group 13	000000000000100000000000000000000000000000000	2		2			1	25.00	45.00	2		2						
H3812	001	0	1	04	01	H3812_001_0	5	14	Group 14	100000000000000000000000000000000000000000000	2		2			1	340.00	390.00	2		2						
H3812	001	0	1	04	01	H3812_001_0	5	2	Group 2	011100011101001000000000000000000000000001101	2		2			1	45.00	45.00	2		2						
H3812	001	0	1	04	01	H3812_001_0	5	3	Group 3	000001000000000011011000001100001000011100010	2		1	30	30	2			2		2						
H3812	001	0	1	04	01	H3812_001_0	5	4	Group 4	000000000000000100000000000000000000000000000	2		1	30	30	1	18.00	18.00	2		2						
H3812	001	0	1	04	01	H3812_001_0	5	5	Group 5	000000000000000000100000000000000000000000000	2		2			1	21.00	21.00	2		2						
H3812	005	0	1	04	01	H3812_005_0	3	4	Group 4	000000000000000000000000100000000000000000000	2		1	75	75	2			2		2						
H3812	005	0	1	04	01	H3812_005_0	3	3	Group 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H3812	005	0	1	04	01	H3812_005_0	3	2	Group 2	000000000000000000000000000000100000000000010	2		2			1	0.00	0.00	2		2						
H3812	005	0	1	04	01	H3812_005_0	3	1	Group 1	011111111111111011111111011100001000011101101	2		1	30	30	2			2		2						
H3812	005	0	1	04	01	H3812_005_0	3	5	Group 5	000000000000000100000000000000000010000000000	2		1	0	30	2			2		2						
H3813	001	0	1	04	01	H3813_001_0	9	1	$300.00 copay	000000000000000000010000000000000000000000000	2		2			1	300.00	300.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	10	$200 copayment	000000000000000000001000000000000000000000000	2		2			1	200.00	200.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	2	$100.00 copay	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	3	20% coinsurance	000000000000000011100000011010000000000100000	2		1	20	20	2			2		2						
H3813	001	0	1	04	01	H3813_001_0	9	9	$20 to $35 copayment	000000000000100000000000000000000000000000000	2		2			1	20.00	35.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	5	$35.00 copayment	011110001101001000000000000000000000000001101	2		2			1	35.00	35.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	6	$20.00 copayment	000000110000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	7	$10.00 to 20% coinsurance	000000000000000000000000000100000000000000000	2		1	20	20	1	10.00	10.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	8	$0 copayment	000001000000000100000010000000000010011000010	2		2			1	0.00	0.00	2		2						
H3813	001	0	1	04	01	H3813_001_0	9	4	$20 to $30 copayment	000000000010110000000100000000000000000000000	2		2			1	20.00	30.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	8	$0 copayment	000001000000000100000010000000000010011000010	2		2			1	0.00	0.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	9	$20 to $35 copayment	000000000000100000000000000000000000000000000	2		2			1	20.00	35.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	7	$10.00 to 20% coinsurance	000000000000000000000000000100000000000000000	2		1	20	20	1	10.00	10.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	6	$20.00 copayment	000000110000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	5	$35.00 copayment	011110001101001000000000000000000000000001101	2		2			1	35.00	35.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	4	$20 to $30 copayment	000000000010110000000100000000000000000000000	2		2			1	20.00	30.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	3	20% coinsurance	000000000000000011100000011010000000000100000	2		1	20	20	2			2		2						
H3813	003	0	1	04	01	H3813_003_0	10	1	$300.00 copay	000000000000000000010000000000000000000000000	2		2			1	300.00	300.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	10	$200 copayment	000000000000000000001000000000000000000000000	2		2			1	200.00	200.00	2		2						
H3813	003	0	1	04	01	H3813_003_0	10	2	$100.00 copay	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3813	802	0	1	04	01	H3813_802_0	8	7	$0 to $10%	000000000000000000000000000100000000000000000	2		1	10	10	1	0.00	0.00	2		2						
H3813	802	0	1	04	01	H3813_802_0	8	6	10% coinsurance	000000000000000011100000011010000000000100000	2		1	10	10	2			2		2						
H3813	802	0	1	04	01	H3813_802_0	8	5	zero copayment	000001000000000100000010000000000010011000010	2		2			1	0.00	0.00	2		2						
H3813	802	0	1	04	01	H3813_802_0	8	4	$125.00 copayment	000000000000000000011000000000000000000000000	2		2			1	125.00	125.00	2		2						
H3813	802	0	1	04	01	H3813_802_0	8	3	$50.00 copayment	000000000000000000000001000000000000000000000	2		2			1	50.00	50.00	2		2						
H3813	802	0	1	04	01	H3813_802_0	8	2	$20.00 copayment	011110011111111000000100000000000000000001101	2		2			1	20.00	20.00	2		2						
H3813	802	0	1	04	01	H3813_802_0	8	1	$15.00 copayment	000000100000000000000000000000000000000000000	2		2			1	15.00	15.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	1	$35 copay	011100111111111000000100000000000000000001001	2		2			1	35.00	35.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	10	$225	000000000000000000001000000000000000000000000	2		2			1	225.00	225.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	9	$0 to $225 copay	000000000000000000010000000000000000000000000	2		2			1	0.00	225.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	8	$0 to $35	000000000000000000000000000000000000000000100	2		2			1	0.00	35.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	7	$0 - no cost sharing	000010000000000100000010000100000010111000010	2		2			1	0.00	0.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	6	10% to 20%	000000000000000000000000000000000000000100000	2		1	10	20	2			2		2						
H3817	001	0	1	04	01	H3817_001_0	5	5	30% coinsurance	000000000000000010000000011000000000000000000	2		1	30	30	2			2		2						
H3817	001	0	1	04	01	H3817_001_0	5	4	20% coinsurance	000001000000000001100000000000000000000000000	2		1	20	20	2			2		2						
H3817	001	0	1	04	01	H3817_001_0	5	3	End-Stage Renal Disease	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3817	001	0	1	04	01	H3817_001_0	5	2	$100 copay	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3817	001	0	1	04	01	H3817_001_0	5	11	$500 preventive dental	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3817	002	0	1	04	01	H3817_002_0	7	1	$35 copay	011100111111111000000100000000000000000001001	2		2			1	35.00	35.00	2		2						
H3817	002	0	1	04	01	H3817_002_0	7	8	$0 to $35	000000000000000000000000000000000000000000100	2		2			1	0.00	35.00	2		2						
H3817	002	0	1	04	01	H3817_002_0	7	7	$0 - no cost sharing	000010000000000100000010000100000010111000010	2		2			1	0.00	0.00	2		2						
H3817	002	0	1	04	01	H3817_002_0	7	6	10% to 20%	000000000000000000000000000000000000000100000	2		1	10	20	2			2		2						
H3817	002	0	1	04	01	H3817_002_0	7	5	30% coinsurance	000000000000000010000000011000000000000000000	2		1	30	30	2			2		2						
H3817	002	0	1	04	01	H3817_002_0	7	9	$0 to $225	000000000000000000010000000000000000000000000	2		2			1	0.00	225.00	2		2						
H3817	002	0	1	04	01	H3817_002_0	7	3	10% coinsurance	000000000000000000000000000010000000000000000	2		1	10	10	2			2		2						
H3817	002	0	1	04	01	H3817_002_0	7	2	$100 copay	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3817	002	0	1	04	01	H3817_002_0	7	11	$500 preventive dental	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3817	002	0	1	04	01	H3817_002_0	7	10	$225 copay	000000000000000000001000000000000000000000000	2		2			1	225.00	225.00	2		2						
H3817	002	0	1	04	01	H3817_002_0	7	4	20% coinsurance	000001000000000001100000000000000000000000000	2		1	20	20	2			2		2						
H3817	003	0	1	04	01	H3817_003_0	6	6	$0 to $200	000000000000000000010000000000000000000000000	2		2			1	0.00	200.00	2		2						
H3817	003	0	1	04	01	H3817_003_0	6	7	0% to 10%	000000000000000000000000000000000000000100000	2		1	0	10	2			2		2						
H3817	003	0	1	04	01	H3817_003_0	6	8	30%	000000000000000010000000000000000000000000000	2		1	30	30	2			2		2						
H3817	003	0	1	04	01	H3817_003_0	6	9	$0 to $25	000000000000000000000000000000000000000000100	2		2			1	0.00	25.00	2		2						
H3817	003	0	1	04	01	H3817_003_0	6	1	$25 copay	011100111111111000000100000000000000000001001	2		2			1	25.00	25.00	2		2						
H3817	003	0	1	04	01	H3817_003_0	6	10	$500 preventive dental	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3817	003	0	1	04	01	H3817_003_0	6	11	$0 copay	000010000000000100000010000100000010111000010	2		2			1	0.00	0.00	2		2						
H3817	003	0	1	04	01	H3817_003_0	6	2	$100 copay	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3817	003	0	1	04	01	H3817_003_0	6	3	10% coinsurance	000001000000000000100000000010000000000000000	2		1	10	10	2			2		2						
H3817	003	0	1	04	01	H3817_003_0	6	4	20% coinsurance	000000000000000001000000011000000000000000000	2		1	20	20	2			2		2						
H3817	003	0	1	04	01	H3817_003_0	6	5	$200 copay	000000000000000000001000000000000000000000000	2		2			1	200.00	200.00	2		2						
H3817	801	0	1	04	01	H3817_801_0	4	4	20%	011110111101101011111101011110000000011101101	2		1	20	20	2			2		2						
H3817	801	0	1	04	01	H3817_801_0	4	3	0% to 20%	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
H3817	801	0	1	04	01	H3817_801_0	4	2	40%	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3817	801	0	1	04	01	H3817_801_0	4	1	$0	000001000000000000000010000000000010000000010	2		2			1	0.00	0.00	2		2						
H3817	802	0	1	04	01	H3817_802_0	4	1	$0	000001000000000000000010000000000010000000010	2		2			1	0.00	0.00	2		2						
H3817	802	0	1	04	01	H3817_802_0	4	4	20%	011110111101101011111101011110000000011101101	2		1	20	20	2			2		2						
H3817	802	0	1	04	01	H3817_802_0	4	3	0% to 20%	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
H3817	802	0	1	04	01	H3817_802_0	4	2	40%	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3832	001	0	1	04	01	H3832_001_0	5	9	Group 9 - 0 to 30%	000000000000000000000000000100000000000000000	2		1	0	30	2			2		2						
H3832	001	0	1	04	01	H3832_001_0	5	8	Group 8 - $150	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	6	Group 6 - $21	000000000000000000100000000000000000000000000	2		2			1	21.00	21.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	5	Group 5 - $0 - $10	000000000000000100000000000000000000000000000	2		2			1	0.00	10.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	4	Group 4 - $45	000010000000000000000000000000000000000000000	2		2			1	45.00	45.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	3	Group 3 - $35	011100111101101000000000000000000000000001001	2		2			1	35.00	35.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	2	Group 2 - $0	000000000000000000000010000000000010111000010	2		2			1	0.00	0.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	11	Group  11 - $0 to $35	000000000000000000000000000000000000000000100	2		2			1	0.00	35.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	7	Group 7 - $35 to $45	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
H3832	001	0	1	04	01	H3832_001_0	5	1	Group 1 - 30%	000001000000000011011000011000000000000100000	2		1	30	30	2			2		2						
H3832	001	0	1	04	01	H3832_001_0	5	10	Group 10 - 20%	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H3832	006	0	1	04	01	H3832_006_0	9	5	Group 5 - 25%	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H3832	006	0	1	04	01	H3832_006_0	9	4	Group 4 - $100	000000000000000000011001000000000000000000000	2		2			1	100.00	100.00	2		2						
H3832	006	0	1	04	01	H3832_006_0	9	3	Group 3 - $30	011110111111111010100100000000000000000001001	2		2			1	30.00	30.00	2		2						
H3832	006	0	1	04	01	H3832_006_0	9	2	Group 2 - $0	000000000000000001000010000000000010111000010	2		2			1	0.00	0.00	2		2						
H3832	006	0	1	04	01	H3832_006_0	9	1	Group 1 - 30%	000001000000000000000000000000000000000100000	2		1	30	30	2			2		2						
H3832	006	0	1	04	01	H3832_006_0	9	9	Group 9 - $0 to $30	000000000000000000000000000000000000000000100	2		2			1	0.00	30.00	2		2						
H3832	006	0	1	04	01	H3832_006_0	9	8	Group 8 - 20%	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H3832	006	0	1	04	01	H3832_006_0	9	6	Group 6 - 0% to 25%	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H3832	006	0	1	04	01	H3832_006_0	9	7	Group 7 - $0 to $30	000000000000000100000000000000000000000000000	2		2			1	0.00	30.00	2		2						
H3832	801	0	1	04	01	H3832_801_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3832	801	0	1	04	01	H3832_801_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3832	801	0	1	04	01	H3832_801_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3832	802	0	1	04	01	H3832_802_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3832	802	0	1	04	01	H3832_802_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3832	802	0	1	04	01	H3832_802_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3832	805	0	1	04	01	H3832_805_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3832	805	0	1	04	01	H3832_805_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3832	805	0	1	04	01	H3832_805_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3832	806	0	1	04	01	H3832_806_0	3	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3832	806	0	1	04	01	H3832_806_0	3	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3832	806	0	1	04	01	H3832_806_0	3	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3909	001	0	1	04	01	H3909_001_0	7	1	Group 1	011111111111111111111110011100000010011101111	2		1	30	30	2			2		2						
H3909	001	0	1	04	01	H3909_001_0	7	2	Group 2	000000000000000000000000000010000000000000000	2		2			1	25.00	25.00	2		2						
H3909	001	0	1	04	01	H3909_001_0	7	4	Group4	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3909	001	0	1	04	01	H3909_001_0	7	3	Group 3	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H3909	007	0	1	04	01	H3909_007_0	5	4	Group4	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H3909	007	0	1	04	01	H3909_007_0	5	3	Group 3	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H3909	007	0	1	04	01	H3909_007_0	5	2	Group 2	000000000000000000000000000010000000000000000	2		2			1	25.00	25.00	2		2						
H3909	007	0	1	04	01	H3909_007_0	5	1	Group 1	011111111111111111111110011100000010011101111	2		1	30	30	2			2		2						
H3909	801	0	1	04	01	H3909_801_0	4	1	Group #1	011101111101101111111111011110000010011101111	2		1	30	30	2			2		2						
H3909	801	0	1	04	01	H3909_801_0	4	2	Group #2	000010000010010000000000000000000000000000000	2		1	40	40	2			1	500.00	2						
H3909	802	0	1	04	01	H3909_802_0	4	1	Group #1	011101111101101111111111011110000010011101111	2		1	30	30	2			2		2						
H3909	802	0	1	04	01	H3909_802_0	4	2	Group #2	000010000010010000000000000000000000000000000	2		1	40	40	2			1	500.00	2						
H3912	001	0	1	04	01	H3912_001_0	3	2	Group 2	000000000000000000000000000000000000000010010	2		2			1	0.00	0.00	2		2						
H3912	001	0	1	04	01	H3912_001_0	3	3	Group 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H3912	001	0	1	04	01	H3912_001_0	3	4	Group 4	000000000000000000000000100000000000000000000	2		1	75	75	2			2		2						
H3912	001	0	1	04	01	H3912_001_0	3	5	Group 5	000000000000000100000000000000000010000001000	2		1	0	30	2			2		2						
H3912	001	0	1	04	01	H3912_001_0	3	1	Group 1	011111111111111011111111011100001000011100101	2		1	30	30	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	20	20	2		
H3916	001	0	1	04	01	H3916_001_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	20	20	2			2		3	1	20	20	2		
H3916	001	0	1	04	01	H3916_001_0	7	12	Group 12	000000000000000000000000000000000000000001000	2		1	20	50	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	20	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	10	Group 10	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	20	2			2		3	1	20	20	2		
H3916	001	0	1	04	01	H3916_001_0	7	4	Group 4	011111111111111000011110000000000000000000011	2		1	20	20	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	5	Group 5	000000000000000000000001000000000000000000000	2		1	20	20	1	100.00	100.00	2		2						
H3916	001	0	1	04	01	H3916_001_0	7	6	Group 6	000000000000000000000000101100000000000010000	2		1	50	50	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	001	0	1	04	01	H3916_001_0	7	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	001	0	1	04	01	H3916_001_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	002	0	1	04	01	H3916_002_0	7	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	6	Group 6	000000000000000000000000101100000000000010000	2		1	50	50	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	5	Group 5	000000000000000000000001000000000000000000000	2		1	20	20	1	100.00	100.00	2		2						
H3916	002	0	1	04	01	H3916_002_0	7	4	Group 4	011111111111111000011110000000000000000000011	2		1	20	20	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	20	20	2		
H3916	002	0	1	04	01	H3916_002_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	20	20	2			2		3	1	20	20	2		
H3916	002	0	1	04	01	H3916_002_0	7	12	Group 12	000000000000000000000000000000000000000001000	2		1	20	50	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	20	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	10	Group 10	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	002	0	1	04	01	H3916_002_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	20	2			2		3	1	20	20	2		
H3916	005	0	1	04	01	H3916_005_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	20	2			2		3	1	20	20	2		
H3916	005	0	1	04	01	H3916_005_0	7	10	Group 10	100000000000000000000000000000000000000000000	1	1000.00	1	0	0	2			2		2						
H3916	005	0	1	04	01	H3916_005_0	7	6	Group 6	000000000000000000000000101100000000000010000	2		1	50	50	2			2		2						
H3916	005	0	1	04	01	H3916_005_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	20	2			2		2						
H3916	005	0	1	04	01	H3916_005_0	7	12	Group 12	000000000000000000000000000000000000000001000	2		1	20	50	2			2		2						
H3916	005	0	1	04	01	H3916_005_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	005	0	1	04	01	H3916_005_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	20	20	2			2		3	1	20	20	2		
H3916	005	0	1	04	01	H3916_005_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	20	20	2		
H3916	005	0	1	04	01	H3916_005_0	7	4	Group 4	011111111111111000011110000000000000000000011	2		1	20	20	2			2		2						
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H3916	012	0	1	04	01	H3916_012_0	6	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	012	0	1	04	01	H3916_012_0	6	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	012	0	1	04	01	H3916_012_0	6	10	Group 10	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	012	0	1	04	01	H3916_012_0	6	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	012	0	1	04	01	H3916_012_0	6	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	012	0	1	04	01	H3916_012_0	6	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	012	0	1	04	01	H3916_012_0	6	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	012	0	1	04	01	H3916_012_0	6	6	Group 6	000000000000000000000000101100000000000000000	2		1	50	50	2			2		2						
H3916	012	0	1	04	01	H3916_012_0	6	5	Group 5	000000000000000000000001000000000000000000000	2		1	30	30	1	100.00	100.00	2		2						
H3916	012	0	1	04	01	H3916_012_0	6	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	015	0	1	04	01	H3916_015_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	20	2			2		2						
H3916	015	0	1	04	01	H3916_015_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	20	2			2		3	1	20	20	2		
H3916	015	0	1	04	01	H3916_015_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	20	20	2			2		3	1	20	20	2		
H3916	015	0	1	04	01	H3916_015_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	20	20	2		
H3916	015	0	1	04	01	H3916_015_0	7	4	Group 4	011111111111111000011110000000000000000001011	2		1	20	20	2			2		2						
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H3916	015	0	1	04	01	H3916_015_0	7	6	Group 6	000000000000000000000000101100000000000000000	2		1	50	50	2			2		2						
H3916	015	0	1	04	01	H3916_015_0	7	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	015	0	1	04	01	H3916_015_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	015	0	1	04	01	H3916_015_0	7	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	015	0	1	04	01	H3916_015_0	7	5	Group 5	000000000000000000000001000000000000000000000	2		1	20	20	1	100.00	100.00	2		2						
H3916	018	0	1	04	01	H3916_018_0	7	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	018	0	1	04	01	H3916_018_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	018	0	1	04	01	H3916_018_0	7	10	Group 10	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	018	0	1	04	01	H3916_018_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	018	0	1	04	01	H3916_018_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	018	0	1	04	01	H3916_018_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	018	0	1	04	01	H3916_018_0	7	4	Group 4	011111111111111000011110000000000000000001011	2		1	30	30	2			2		2						
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H3916	018	0	1	04	01	H3916_018_0	7	6	Group 6	000000000000000000000000101100000000000000000	2		1	50	50	2			2		2						
H3916	018	0	1	04	01	H3916_018_0	7	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	018	0	1	04	01	H3916_018_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	019	0	1	04	01	H3916_019_0	8	11	Group 11	000000000000000000000000000000000000000001000	2		1	30	50	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	10	Group 10	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	019	0	1	04	01	H3916_019_0	8	9	Group 9	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	019	0	1	04	01	H3916_019_0	8	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	6	Group 6	000000000000000000000000101100001000100010000	2		1	50	50	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	5	Group 5	000000000000000000000001000000000000000000000	2		1	30	30	1	75.00	75.00	2		2						
H3916	019	0	1	04	01	H3916_019_0	8	4	Group 4	011111111111111000011110000000000000000000011	2		1	30	30	2			2		2						
H3916	019	0	1	04	01	H3916_019_0	8	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	6	Group 6	000000000000000000000000101100001000100010000	2		1	50	50	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	9	Group 9	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	5	Group 5	000000000000000000000001000000000000000000000	2		1	30	30	1	75.00	75.00	2		2						
H3916	020	0	1	04	01	H3916_020_0	8	4	Group 4	011111111111111000011110000000000000000000011	2		1	30	30	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	020	0	1	04	01	H3916_020_0	8	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	020	0	1	04	01	H3916_020_0	8	11	Group 11	000000000000000000000000000000000000000001000	2		1	30	50	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	10	Group 10	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	020	0	1	04	01	H3916_020_0	8	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	022	0	1	04	01	H3916_022_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	022	0	1	04	01	H3916_022_0	7	4	Group 4	011111111111111000011110000000000000000001011	2		1	30	30	2			2		2						
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H3916	022	0	1	04	01	H3916_022_0	7	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	022	0	1	04	01	H3916_022_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	022	0	1	04	01	H3916_022_0	7	5	Group 5	000000000000000000000001000000000000000000000	2		1	30	30	1	100.00	100.00	2		2						
H3916	022	0	1	04	01	H3916_022_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	022	0	1	04	01	H3916_022_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	022	0	1	04	01	H3916_022_0	7	10	Group 10	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	022	0	1	04	01	H3916_022_0	7	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	022	0	1	04	01	H3916_022_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	024	0	1	04	01	H3916_024_0	7	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	024	0	1	04	01	H3916_024_0	7	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	024	0	1	04	01	H3916_024_0	7	5	Group 5	000000000000000000000001000000000000000000000	2		1	30	30	1	100.00	100.00	2		2						
H3916	024	0	1	04	01	H3916_024_0	7	4	Group 4	011111111111111000011110000000000000000001011	2		1	30	30	2			2		2						
H3916	024	0	1	04	01	H3916_024_0	7	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	024	0	1	04	01	H3916_024_0	7	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	024	0	1	04	01	H3916_024_0	7	6	Group 6	000000000000000000000000101100000000000000000	2		1	50	50	2			2		2						
H3916	024	0	1	04	01	H3916_024_0	7	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	024	0	1	04	01	H3916_024_0	7	9	Group 9	000000000000000000000000000000001000100000000	2		1	50	50	2			1	500.00	2						
H3916	024	0	1	04	01	H3916_024_0	7	10	Group 10	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	024	0	1	04	01	H3916_024_0	7	11	Group 11	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	9	Group 9	100000000000000000000000000000000000000000000	1	500.00	1	0	0	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	8	Group 8	000000000000000000000000010000000000000000000	2		1	0	50	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	7	Group 7	000000000000000000000000000000000010010000000	2		1	0	0	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	6	Group 6	000000000000000000000000101100001000100010000	2		1	50	50	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	4	Group 4	011111111111111000011110000000000000000000011	2		1	30	30	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	3	Group 3	000000000000000000000000000000000000001000000	2		1	0	0	2			2		3	1	30	30	2		
H3916	025	0	1	04	01	H3916_025_0	8	2	Group 2	000000000000000011100000000000000000000000000	2		1	30	30	2			2		3	1	30	30	2		
H3916	025	0	1	04	01	H3916_025_0	8	11	Group 11	000000000000000000000000000000000000000001000	2		1	30	50	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	10	Group 10	000000000000000000000000000010000000000100000	2		1	0	30	2			2		2						
H3916	025	0	1	04	01	H3916_025_0	8	1	Group 1	000000000000000100000000000000000000000000100	2		1	0	30	2			2		3	1	30	30	2		
H3916	025	0	1	04	01	H3916_025_0	8	5	Group 5	000000000000000000000001000000000000000000000	2		1	30	30	1	75.00	75.00	2		2						
H3916	801	0	1	04	01	H3916_801_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3916	801	0	1	04	01	H3916_801_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3916	801	0	1	04	01	H3916_801_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3916	802	0	1	04	01	H3916_802_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3916	802	0	1	04	01	H3916_802_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3916	802	0	1	04	01	H3916_802_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3916	804	0	1	04	01	H3916_804_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H3916	804	0	1	04	01	H3916_804_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H3916	804	0	1	04	01	H3916_804_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H3921	001	0	1	04	01	H3921_001_0	5	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H3921	001	0	1	04	01	H3921_001_0	5	8	Group 8	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
H3921	001	0	1	04	01	H3921_001_0	5	7	Group 7	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
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H3921	001	0	1	04	01	H3921_001_0	5	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3921	001	0	1	04	01	H3921_001_0	5	4	Group 4	000000000000000100000000000000000000000000000	2		1	30	30	1	15.00	15.00	2		2						
H3921	001	0	1	04	01	H3921_001_0	5	11	Group 11	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
H3921	001	0	1	04	01	H3921_001_0	5	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
H3921	001	0	1	04	01	H3921_001_0	5	13	Group 13	000000000000100000000000000000000000000000000	2		2			1	20.00	40.00	2		2						
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H3921	001	0	1	04	01	H3921_001_0	5	3	Group 3	000001000000000011011000001100001000011100010	2		1	30	30	2			2		2						
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H3921	008	0	1	04	01	H3921_008_0	5	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
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H3924	001	0	1	04	01	H3924_001_0	5	4	Preventive Dental OON	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
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H3924	001	0	1	04	01	H3924_001_0	5	6	Hearing Aid OON	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
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H3924	003	0	1	04	01	H3924_003_0	5	4	Preventive Dental OON	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3924	003	0	1	04	01	H3924_003_0	5	5	Eyewear OON	000000000000000000000000000000000000000000010	1	200.00	2			1	0.00	0.00	2		2						
H3924	003	0	1	04	01	H3924_003_0	5	6	Hearing Aid OON	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
H3924	021	0	1	04	01	H3924_021_0	4	6	Hearing Aid OON	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
H3924	021	0	1	04	01	H3924_021_0	4	1	Primary Care Physician Services	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H3924	021	0	1	04	01	H3924_021_0	4	2	Specialty OON Services	000000010101000000000000000000001010000001101	2		2			1	35.00	35.00	2		2						
H3924	021	0	1	04	01	H3924_021_0	4	3	All Other Medicare Services	011111001010111111111111011110000000111100000	2		1	20	20	2			2		2						
H3924	021	0	1	04	01	H3924_021_0	4	4	Preventive Dental OON	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3924	021	0	1	04	01	H3924_021_0	4	5	Eyewear OON	000000000000000000000000000000000000000000010	1	200.00	2			1	0.00	0.00	2		2						
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H3924	023	0	1	04	01	H3924_023_0	5	6	Hearing Aid OON	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
H3924	023	0	1	04	01	H3924_023_0	5	5	Eyewear OON	000000000000000000000000000000000000000000010	1	200.00	2			1	0.00	0.00	2		2						
H3924	023	0	1	04	01	H3924_023_0	5	4	Preventive Dental OON	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3924	023	0	1	04	01	H3924_023_0	5	3	All other Medicare Services	011111001010111111111111011110000000111100000	2		1	20	20	2			2		2						
H3924	023	0	1	04	01	H3924_023_0	5	1	Primary Care Physician Services	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
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H3924	046	0	1	04	01	H3924_046_0	6	7	Hearing Aid	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
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H3924	047	0	1	04	01	H3924_047_0	4	5	Preventive Dental	000000000000000000000000000000000000000010000	2		1	25	25	2			2		2						
H3924	047	0	1	04	01	H3924_047_0	4	1	Primary Care Physician Care Services	000000100000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3924	047	0	1	04	01	H3924_047_0	4	6	Eyewear	000000000000000000000000000000000000000000010	1	200.00	2			1	0.00	0.00	2		2						
H3924	047	0	1	04	01	H3924_047_0	4	7	Hearing Aid	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
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H3924	048	0	1	04	01	H3924_048_0	6	2	Specialty OON Services	000000010101000000000000000000001010011001101	2		2			1	45.00	45.00	2		2						
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H3924	048	0	1	04	01	H3924_048_0	6	5	Preventive Dental	000000000000000000000000000000000000000010000	2		1	25	25	2			2		2						
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H3924	051	0	1	04	01	H3924_051_0	3	3	Other OON Services	011101001000101111111011011110000000100100000	2		1	25	25	2			2		2						
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H3924	051	0	1	04	01	H3924_051_0	3	7	Hearing Aid	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
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H3924	052	0	1	04	01	H3924_052_0	6	7	Hearing Aid	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
H3924	052	0	1	04	01	H3924_052_0	6	1	Primary Care Physician Care Services	000000100000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H3924	052	0	1	04	01	H3924_052_0	6	2	Specialty OON Services	000000010101000000000000000000001010011001101	2		2			1	45.00	45.00	2		2						
H3924	053	0	1	04	01	H3924_053_0	3	6	Hearing Aid OON	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
H3924	053	0	1	04	01	H3924_053_0	3	4	Preventive Dental OON	000000000000000000000000000000000000000010000	2		1	20	20	2			2		2						
H3924	053	0	1	04	01	H3924_053_0	3	5	Eyewear OON	000000000000000000000000000000000000000000010	1	200.00	2			1	0.00	0.00	2		2						
H3924	053	0	1	04	01	H3924_053_0	3	3	All Other Medicare Services	011111001010111111111111011110000000111100000	2		1	20	20	2			2		2						
H3924	053	0	1	04	01	H3924_053_0	3	2	Specialty OON Services	000000010101000000000000000000001010000001101	2		2			1	35.00	35.00	2		2						
H3924	053	0	1	04	01	H3924_053_0	3	1	Primary Care Physician Services	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
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H3924	054	0	1	04	01	H3924_054_0	4	6	Hearing Aid OON	100000000000000000000000000000000000000000000	1	800.00	2			1	0.00	0.00	2		2						
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H4605	002	0	1	04	01	H4605_002_0	7	4	20% coinsurance	000001000000000001100000000000000000000000000	2		1	20	20	2			2		2						
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H4605	004	0	1	04	01	H4605_004_0	6	9	$0 to $25	000000000000000000000000000000000000000000100	2		2			1	0.00	25.00	2		2						
H4605	004	0	1	04	01	H4605_004_0	6	1	$25 copay	011100111111111000000100000000000000000001001	2		2			1	25.00	25.00	2		2						
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H4754	001	0	1	04	01	H4754_001_0	9	3	$40 Copay	000000000100000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H4754	001	0	1	04	01	H4754_001_0	9	2	20% coinsurance	011110001011011000011110011100000000011101101	2		1	20	20	2			2		2						
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H5215	005	0	1	04	01	H5215_005_0	11	7	20% Cost Share Group	000000000000000000000000011000000000000000000	2		1	20	20	2			2		2						
H5215	005	0	1	04	01	H5215_005_0	11	6	10% Cost Share Group	000000000000000000000000000100000000000000000	2		1	10	10	2			2		2						
H5215	005	0	1	04	01	H5215_005_0	11	5	$100 Cost Share Group	000000000000000000011000000000000000000000000	2		2			1	100.00	100.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	4	$40 Cost Share Group	000001000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	3	$35 Cost Share Group	011110010010010001000110000010001110111000111	2		2			1	35.00	35.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	2	$30 Cost Share Group	000000000000000000100000010000000000000001000	2		2			1	30.00	30.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	13	$0 Cost Share Group	100000000000000000000000000000000000000000000	1	100.00	2			1	0.00	0.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	12	30% Cost Share Group	000000000000000000000000000000000000000100000	2		1	30	30	2			2		2						
H5215	005	0	1	04	01	H5215_005_0	11	11	$25 Cost Share Group	000000001101101100000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	10	$50 Cost Share Group	000000000000000010000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H5215	005	0	1	04	01	H5215_005_0	11	1	$20 Cost Share Group	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	1	$20 Cost Share Group	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	10	$50 Cost Share Group	000000000000000010000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	11	$25 Cost Share Group	000000001101101100000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	12	30% Cost Share Group	000000000000000000000000000000000000000100000	2		1	30	30	2			2		2						
H5215	006	0	1	04	01	H5215_006_0	9	13	$0 Cost Share Group	100000000000000000000000000000000000000000000	1	100.00	2			1	0.00	0.00	2		2						
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H5215	006	0	1	04	01	H5215_006_0	9	9	$65 Cost Share Group	000000000000000000000001000000000000000000000	2		2			1	65.00	65.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	4	$40 Cost Share Group	000001000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	5	$100 Cost Share Group	000000000000000000011000000000000000000000000	2		2			1	100.00	100.00	2		2						
H5215	006	0	1	04	01	H5215_006_0	9	6	10% Cost Share Group	000000000000000000000000000100000000000000000	2		1	10	10	2			2		2						
H5215	006	0	1	04	01	H5215_006_0	9	7	20% Cost Share Group	000000000000000000000000011000000000000000000	2		1	20	20	2			2		2						
H5215	006	0	1	04	01	H5215_006_0	9	8	50% Cost Share Group	000000000000000000000000000000000100100000000	2		1	50	50	2			2		2						
H5215	006	0	1	04	01	H5215_006_0	9	3	$35 Cost Share Group	011110010010010001000110000010001110111000111	2		2			1	35.00	35.00	2		2						
H5215	007	0	1	04	01	H5215_007_0	9	1	0%-20% Cost Share Group	011110111101101111111011011110000110111110111	2		1	0	20	2			2		2						
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H5215	007	0	1	04	01	H5215_007_0	9	3	0 - 50% Cost Share Group	000000000000000000000000000000000000000001000	2		1	0	50	2			2		2						
H5215	007	0	1	04	01	H5215_007_0	9	4	0% Cost Share Group	000001000000000000000000000000001100000000000	2		1	0	0	2			2		2						
H5215	008	0	1	04	01	H5215_008_0	10	1	$40 Cost Share Group	011100000000000000000010000110000000000000000	2		2			1	40.00	40.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	11	$35 Cost Share Group	000000001101101000000000000000000100000000000	2		2			1	35.00	35.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	10	$95 Cost Share Group	000000000000000000000001000000000000000000000	2		2			1	95.00	95.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	2	$50 Cost Share Group	000010000000000000000000000000001000000000000	2		2			1	50.00	50.00	2		2						
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H5215	008	0	1	04	01	H5215_008_0	10	4	$125 Cost Share Group	000000000000000010000000000000000000000000000	2		2			1	125.00	125.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	5	50% Cost Share Group	000000000000000000000000000000000100100000000	2		1	50	50	2			2		2						
H5215	008	0	1	04	01	H5215_008_0	10	6	$0 Cost Share Group	000000000000000000000000000000000000001000000	2		2			1	0.00	0.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	9	$20 Cost Share Group	000000100000000100000000000000000010110000000	2		2			1	20.00	20.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	8	$215 Cost Share Group	000000000000000000011000000000000000000000000	2		2			1	215.00	215.00	2		2						
H5215	008	0	1	04	01	H5215_008_0	10	7	$45 Cost Share Group	000000010010010000000100000000000000000001111	2		2			1	45.00	45.00	2		2						
H5215	806	0	1	04	01	H5215_806_0	3	1	20% Cost Share Group	011110111101101111111011111110000010111101111	2		1	0	20	2			2		2						
H5215	806	0	1	04	01	H5215_806_0	3	2	40% Cost Share Group	000000000010010000000100000000000000000000000	2		1	0	40	2			2		2						
H5215	806	0	1	04	01	H5215_806_0	3	3	0% Cost Share Group	000001000000000000000000000000000000000000000	2		1	0	0	2			2		2						
H5215	807	0	1	04	01	H5215_807_0	3	1	20% Cost Share Group	011110111101101111111011111110000010111101111	2		1	0	20	2			2		2						
H5215	807	0	1	04	01	H5215_807_0	3	2	0% Cost Share Group	000001000000000000000000000000000000000000000	2		1	0	0	2			2		2						
H5215	807	0	1	04	01	H5215_807_0	3	3	40% Cost Share Group	000000000010010000000100000000000000000000000	2		1	0	40	2			2		2						
H5215	808	0	1	04	01	H5215_808_0	3	3	0% Cost Share Group	000001000000000000000000000000000000000000000	2		1	0	0	2			2		2						
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H5424	001	0	1	04	01	H5424_001_0	3	3	Group 3	000001000000000011011000001100001000011100000	2		1	30	30	2			2		2						
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H5424	001	0	1	04	01	H5424_001_0	3	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
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H5424	003	0	1	04	01	H5424_003_0	2	11	Group 11	000000000000000000000000000000000010000000010	2		1	0	30	2			2		2						
H5424	003	0	1	04	01	H5424_003_0	2	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
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H5424	003	0	1	04	01	H5424_003_0	2	15	Group 15	000000010000000000000000000000000000000000000	2		1	50	50	1	50.00	50.00	2		2						
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H5424	003	0	1	04	01	H5424_003_0	2	3	Group 3	000001000000000011011000001100001000011100000	2		1	30	30	2			2		2						
H5424	003	0	1	04	01	H5424_003_0	2	4	Group 4	000000000000000100000000000000000000000000000	2		1	30	30	1	10.00	10.00	2		2						
H5424	003	0	1	04	01	H5424_003_0	2	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H5424	003	0	1	04	01	H5424_003_0	2	8	Group 8	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
H5424	003	0	1	04	01	H5424_003_0	2	7	Group 7	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H5424	003	0	1	04	01	H5424_003_0	2	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H5424	003	0	1	04	01	H5424_003_0	2	5	Group 5	000000000000000000100000000000000000000000000	2		2			1	21.00	21.00	2		2						
H5424	003	0	1	04	01	H5424_003_0	2	6	Group 6	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
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H5424	005	0	1	04	01	H5424_005_0	4	5	Group 5	000000000000000000000000000000000000000010000	2		1	75	75	2			2		2						
H5424	005	0	1	04	01	H5424_005_0	4	3	Group 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
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H5424	005	0	1	04	01	H5424_005_0	4	1	Group 1	011111111111111011111111011100001000011101101	2		1	30	30	2			2		2						
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H5429	001	0	1	04	01	H5429_001_0	8	3	Partial Hospitalization	000010000000000000000000000000000000000000000	2		2			1	268.00	268.00	2		2						
H5429	001	0	1	04	01	H5429_001_0	8	2	Home Health and Labs	100001000000000000000010011110000000111101001	2		1	30	30	2			2		2						
H5429	001	0	1	04	01	H5429_001_0	8	11	Outpatient Radiology	000000000000000111100000000000000000000000000	2		1	30	30	2			2		1	2			1	25.00	40.00
H5429	001	0	1	04	01	H5429_001_0	8	10	Dental and Vision	000000000000000000000000000000000000000010110	1	500.00	1	50	50	2			1	2000.00	2						
H5429	001	0	1	04	01	H5429_001_0	8	9	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H5429	001	0	1	04	01	H5429_001_0	8	5	SCPs	000000010111110000000100000000000000000000000	2		2			1	40.00	40.00	2		2						
H5429	001	0	1	04	01	H5429_001_0	8	6	Cardiac Rehab and PT/OT/ST	011100001000001000000000000000000000000000000	2		1	25	25	1	25.00	25.00	2		2						
H5429	001	0	1	04	01	H5429_001_0	8	7	ASC	000000000000000000001000000000000000000000000	2		1	10	10	2			2		2						
H5429	001	0	1	04	01	H5429_001_0	8	8	Outpatient Hospital	000000000000000000010000000000000000000000000	2		1	25	25	2			2		2						
H5429	001	0	1	04	01	H5429_001_0	8	1	Preventive Services	000000000000000000000000000000000011000000000	2		2			2			2		2						
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H5434	002	0	1	04	01	H5434_002_0	6	6	Hearing exams and aids	000000000000000000000000000000000000000000001	2		1	30	30	2			2		2						
H5434	002	0	1	04	01	H5434_002_0	6	5	Dental	000000000000000000000000000000000000000011000	2		1	30	50	2			2		2						
H5434	002	0	1	04	01	H5434_002_0	6	4	$0 copayment	100001000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H5434	002	0	1	04	01	H5434_002_0	6	3	Renal Dialysis	000000000000000000000000000010000000000000000	2		1	20	20	1	25.00	25.00	2		2						
H5434	002	0	1	04	01	H5434_002_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H5434	002	0	1	04	01	H5434_002_0	6	1	30% coinsurance	011110111111111111111110011100000010011100100	2		1	30	30	2			1	1000.00	2						
H5434	801	0	1	04	01	H5434_801_0	4	1	$0 coinsurance	000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H5434	801	0	1	04	01	H5434_801_0	4	2	All other	011110111111111111111111011110000000111101111	2		1	22	22	2			2		2						
H5434	802	0	1	04	01	H5434_802_0	4	1	$0 coinsurance	000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H5434	802	0	1	04	01	H5434_802_0	4	2	All other	011110111111111111111111011110000000111101111	2		1	22	22	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	5	Copayment $15	000000000000000000000000000010000000000000000	2		2			1	15.00	15.00	2		2						
H5439	001	0	1	04	01	H5439_001_0	6	4	No Cost	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H5439	001	0	1	04	01	H5439_001_0	6	9	Copayment $40	000000000100000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5439	001	0	1	04	01	H5439_001_0	6	7	Coinsurance 20%	000000000000000000000000000000000000000100000	2		1	20	20	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	6	Copayment $50	000010010010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5439	001	0	1	04	01	H5439_001_0	6	8	Copayment $30	000000100000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H5439	001	0	1	04	01	H5439_001_0	6	13	Coinsurance 15% or 20%	000000000000000000000000000100000000000000000	2		1	15	20	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	12	Coinsurance 15%	000000000000000000000000011000000000000000000	2		1	15	15	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	11	Coinsurance 5%	000001000000000000000000000000000000000000000	2		1	5	5	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	10	Coinsurance 30%	000000000000000000011000000000000000000000000	2		1	30	30	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	1	Coinsurance 10%	000000000000100111100010000000001010011001101	2		1	10	10	2			2		2						
H5439	001	0	1	04	01	H5439_001_0	6	2	Copayment $200	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H5439	001	0	1	04	01	H5439_001_0	6	3	Copayment $35	011100001001001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5439	002	0	1	04	01	H5439_002_0	6	1	Copayment $30	000000100000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H5439	002	0	1	04	01	H5439_002_0	6	4	No Cost	000001000000000000000000000000000000100001010	2		2			1	0.00	0.00	2		2						
H5439	002	0	1	04	01	H5439_002_0	6	5	Copayment $20	000000000000000000000000000010000000000000000	2		2			1	20.00	20.00	2		2						
H5439	002	0	1	04	01	H5439_002_0	6	6	Coinsurance 30%	000000000000000111111110000000001010011000101	2		1	30	30	2			2		2						
H5439	002	0	1	04	01	H5439_002_0	6	7	Coinsurance 10% or 20%	000000000000000000000000000100000000000000000	2		1	10	20	2			2		2						
H5439	002	0	1	04	01	H5439_002_0	6	8	Coinsurance 10%	000000000000000000000000011000000000000100000	2		1	10	10	2			2		2						
H5439	002	0	1	04	01	H5439_002_0	6	2	Copayment $250	000000000000000000000001000000000000000000000	2		2			1	250.00	250.00	2		2						
H5439	002	0	1	04	01	H5439_002_0	6	3	Copayment $40	011110011111111000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	1	Copayment $30	000000100000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	10	Coinsurance 10%	000001000000000000000000000000000000000000000	2		1	10	10	2			2		2						
H5439	003	0	1	04	01	H5439_003_0	6	4	No Cost	000000000000000000000000000000000000100001010	2		2			1	0.00	0.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	5	Copayment $20	000000000000000000000000000010000000000000000	2		2			1	20.00	20.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	6	Coinsurance 30%	000000000000000111100110000000001010011000101	2		1	30	30	2			2		2						
H5439	003	0	1	04	01	H5439_003_0	6	7	Coinsurance 20%	000000000000000000000000011100000000000100000	2		1	20	20	2			2		2						
H5439	003	0	1	04	01	H5439_003_0	6	8	Copayment $200	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	9	Copayment $100	000000000000000000001000000000000000000000000	2		2			1	100.00	100.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	2	Copayment $250	000000000000000000000001000000000000000000000	2		2			1	250.00	250.00	2		2						
H5439	003	0	1	04	01	H5439_003_0	6	3	Copayment $40	011110011111111000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
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H5520	001	0	1	04	01	H5520_001_0	3	6	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	001	0	1	04	01	H5520_001_0	3	7	Group $100	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H5520	001	0	1	04	01	H5520_001_0	3	8	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	001	0	1	04	01	H5520_001_0	3	10	Group $175	000000000000000000001000000000000000000000000	2		2			1	175.00	175.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	2	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	3	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	4	Group 18%	000000000000000011000000011010000000000100000	2		1	18	18	2			2		2						
H5520	002	0	1	04	01	H5520_002_0	6	5	Group 20% with $35 Deductible	000000000000000000000000000000000000000010000	1	500.00	1	20	20	2			1	35.00	2						
H5520	002	0	1	04	01	H5520_002_0	6	6	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	7	Group $175	000000000000000000001001000000000000000000000	2		2			1	175.00	175.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	8	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	9	Group $200	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	1	Group $20	000000100101000000100000000000000000000000001	2		2			1	20.00	20.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	10	Group $15 - $20	000000000000100000000000000000000000000000000	2		2			1	15.00	20.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	11	Group $0	000011000000000000000010000000001010111000010	2		2			1	0.00	0.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	12	Group $20 or 0% - 18%	000000000000000100000000000000000000000000000	2		1	0	18	1	20.00	20.00	2		1	2			1	20.00	20.00
H5520	002	0	1	04	01	H5520_002_0	6	13	Group $0 or 18%	000000000000000000000000000100000000000000000	2		1	18	18	1	0.00	0.00	2		2						
H5520	002	0	1	04	01	H5520_002_0	6	14	Group $0 - $20	000000000000000000000000000000000000000000100	2		2			1	0.00	20.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	9	Group $200	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	1	Group $20	000000100101000000100000000000000000000000001	2		2			1	20.00	20.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	7	Group $100	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	6	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	5	Group 20% with $35 Deductible	000000000000000000000000000000000000000010000	1	500.00	1	20	20	2			1	35.00	2						
H5520	003	0	1	04	01	H5520_003_0	3	4	Group 20%	000000000000000011000000011010000000000100000	2		1	20	20	2			2		2						
H5520	003	0	1	04	01	H5520_003_0	3	3	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	2	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	15	Group $0 - $20	000000000000000000000000000000000000000000100	2		2			1	0.00	20.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	14	Group $0 or 20%	000000000000000000000000000100000000000000000	2		1	20	20	1	0.00	0.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	13	Group $15- $20	000000000000100000000000000000000000000000000	2		2			1	15.00	20.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	12	Group $0 or 0% - 20%	000000000000000100000000000000000000000000000	2		1	0	20	1	0.00	0.00	2		1	2			1	20.00	20.00
H5520	003	0	1	04	01	H5520_003_0	3	11	Group $0	000011000000000000000010000000001010111000010	2		2			1	0.00	0.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	10	Group $175	000000000000000000001000000000000000000000000	2		2			1	175.00	175.00	2		2						
H5520	003	0	1	04	01	H5520_003_0	3	8	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	8	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	9	Group $200	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	7	Group $175	000000000000000000001001000000000000000000000	2		2			1	175.00	175.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	6	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	5	Group 20% with $35 Deductible	000000000000000000000000000000000000000010000	1	500.00	1	20	20	2			1	35.00	2						
H5520	004	0	1	04	01	H5520_004_0	6	4	Group 18%	000000000000000011000000011010000000000100000	2		1	18	18	2			2		2						
H5520	004	0	1	04	01	H5520_004_0	6	3	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	2	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	14	Group $0 - $20	000000000000000000000000000000000000000000100	2		2			1	0.00	20.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	13	Group $0 or 18%	000000000000000000000000000100000000000000000	2		1	18	18	1	0.00	0.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	12	Group $20 or 0% - 18%	000000000000000100000000000000000000000000000	2		1	0	18	1	20.00	20.00	2		1	2			1	20.00	20.00
H5520	004	0	1	04	01	H5520_004_0	6	11	Group $0	000011000000000000000010000000001010111000010	2		2			1	0.00	0.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	10	Group $15 - $20	000000000000100000000000000000000000000000000	2		2			1	15.00	20.00	2		2						
H5520	004	0	1	04	01	H5520_004_0	6	1	Group $20	000000100101000000100000000000000000000000001	2		2			1	20.00	20.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	9	Group 17%	000000000000000000010000000000000000000000000	2		1	17	17	2			2		2						
H5520	005	0	1	04	01	H5520_005_0	6	8	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	1	Group $20	000000100101000000100000000000000000000000001	2		2			1	20.00	20.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	10	Group 15%	000000000000000000001000000000000000000000000	2		1	15	15	2			2		2						
H5520	005	0	1	04	01	H5520_005_0	6	11	Group $0	000011000000000000000010000000001010111000000	2		2			1	0.00	0.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	12	Group $20 or 0% - 20%	000000000000000100000000000000000000000000000	2		1	0	20	1	20.00	20.00	2		1	2			1	20.00	20.00
H5520	005	0	1	04	01	H5520_005_0	6	13	Group $0 or 20%	000000000000000000000000000100000000000000000	2		1	20	20	1	0.00	0.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	14	Group $0 - $20	000000000000000000000000000000000000000000100	2		2			1	0.00	20.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	2	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	3	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	4	Group 20%	000000000000000011000000011010000000000100010	2		1	20	20	2			2		2						
H5520	005	0	1	04	01	H5520_005_0	6	5	Group $15 - $20	000000000000100000000000000000000000000000000	2		2			1	15.00	20.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	6	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	005	0	1	04	01	H5520_005_0	6	7	Group $250	000000000000000000000001000000000000000000000	2		2			1	250.00	250.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	7	Group $250	000000000000000000000001000000000000000000000	2		2			1	250.00	250.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	9	Group 17%	000000000000000000010000000000000000000000000	2		1	17	17	2			2		2						
H5520	006	0	1	04	01	H5520_006_0	5	1	Group $20	000000100101000000100000000000000000000000001	2		2			1	20.00	20.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	10	Group 15%	000000000000000000001000000000000000000000000	2		1	15	15	2			2		2						
H5520	006	0	1	04	01	H5520_006_0	5	11	Group $0	000011000000000000000010000000001010111000000	2		2			1	0.00	0.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	12	Group $20 or 0% - 20%	000000000000000100000000000000000000000000000	2		1	0	20	1	20.00	20.00	2		1	2			1	20.00	20.00
H5520	006	0	1	04	01	H5520_006_0	5	8	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	14	Group $0 - $20	000000000000000000000000000000000000000000100	2		2			1	0.00	20.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	2	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	3	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	4	Group 20%	000000000000000011000000011010000000000100010	2		1	20	20	2			2		2						
H5520	006	0	1	04	01	H5520_006_0	5	5	Group $15 - $20	000000000000100000000000000000000000000000000	2		2			1	15.00	20.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	6	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	006	0	1	04	01	H5520_006_0	5	13	Group $0 or 20%	000000000000000000000000000100000000000000000	2		1	20	20	1	0.00	0.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	2	Group $20	000000100101000000000000000000000000000000001	2		2			1	20.00	20.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	3	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	4	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	5	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	6	Group $75	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	7	Group $200	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	8	Group 12%	000000000000000011000000011010000000000100000	2		1	12	12	2			2		2						
H5520	009	0	1	04	01	H5520_009_0	5	9	Group 20% + $35 Deductible	000000000000000000000000000000000000000010000	1	500.00	1	20	20	2			1	35.00	2						
H5520	009	0	1	04	01	H5520_009_0	5	1	Group $0	100011000000000000100010000000001010111000010	2		2			1	0.00	0.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	10	Group $0 or 0% - 12%	000000000000000100000000000000000000000000000	2		1	0	12	1	0.00	0.00	2		1	2			1	20.00	20.00
H5520	009	0	1	04	01	H5520_009_0	5	11	Group $20 - $65	000000000000000000000000000000000000000001000	2		2			1	20.00	65.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	12	Group $15 - $20	000000000000100000000000000000000000000000000	2		2			1	15.00	20.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	13	Group $100	000000000000000000001000000000000000000000000	2		2			1	100.00	100.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	14	Group $0 or 12%	000000000000000000000000000100000000000000000	2		1	12	12	1	0.00	0.00	2		2						
H5520	009	0	1	04	01	H5520_009_0	5	15	$0 - $20	000000000000000000000000000000000000000000100	2		2			1	0.00	20.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	1	Group $0	100011000000000000100010000000001010111000010	2		2			1	0.00	0.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	10	Group $0 or 0% - 12%	000000000000000100000000000000000000000000000	2		1	0	12	1	0.00	0.00	2		1	2			1	10.00	10.00
H5520	010	0	1	04	01	H5520_010_0	5	9	Group 20% + $35 Deductible	000000000000000000000000000000000000000010000	1	500.00	1	20	20	2			1	35.00	2						
H5520	010	0	1	04	01	H5520_010_0	5	8	Group 12%	000000000000000011000000011010000000000100000	2		1	12	12	2			2		2						
H5520	010	0	1	04	01	H5520_010_0	5	7	Group $125	000000000000000000010000000000000000000000000	2		2			1	125.00	125.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	6	Group $100	000000000000000000001001000000000000000000000	2		2			1	100.00	100.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	5	Group $50	000000000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	4	Group $35	011100001000001000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	3	Group $15	000000010000000000000000000001000000000000000	2		2			1	15.00	15.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	2	Group $10	000000100101000000000000000000000000000000001	2		2			1	10.00	10.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	11	Group $10 - $65	000000000000000000000000000000000000000001000	2		2			1	10.00	65.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	12	Group $10 - $15	000000000000100000000000000000000000000000000	2		2			1	10.00	15.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	13	Group $0 - $10	000000000000000000000000000000000000000000100	2		2			1	0.00	10.00	2		2						
H5520	010	0	1	04	01	H5520_010_0	5	14	$0 or 12%	000000000000000000000000000100000000000000000	2		1	12	12	1	0.00	0.00	2		2						
H5520	807	0	1	04	01	H5520_807_0	3	3	Group 20%	011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5520	807	0	1	04	01	H5520_807_0	3	2	Group 40%	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5520	807	0	1	04	01	H5520_807_0	3	1	Group 0%	000001000000000000000000000000000010100000000	2		1	0	0	2			2		2						
H5520	808	0	1	04	01	H5520_808_0	3	1	Group 0%	000001000000000000000000000000000010100000000	2		1	0	0	2			2		2						
H5520	808	0	1	04	01	H5520_808_0	3	2	Group 40%	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5520	808	0	1	04	01	H5520_808_0	3	3	Group 20%	011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5520	809	0	1	04	01	H5520_809_0	3	3	Group 20%	011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5520	809	0	1	04	01	H5520_809_0	3	2	Group 40%	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5520	809	0	1	04	01	H5520_809_0	3	1	Group 0%	000001000000000000000000000000000010100000000	2		1	0	0	2			2		2						
H5521	012	0	1	04	01	H5521_012_0	5	1	Tier 1	011111111111111111111110011100000010011101111	2		1	25	25	2			2		2						
H5521	012	0	1	04	01	H5521_012_0	5	2	Tier 2	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H5521	012	0	1	04	01	H5521_012_0	5	3	Tier 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H5521	012	0	1	04	01	H5521_012_0	5	4	Tier 4	000000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H5521	013	0	1	04	01	H5521_013_0	4	2	Tier 2	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H5521	013	0	1	04	01	H5521_013_0	4	1	Tier 1	011111111111111111111110011100000010011101101	2		1	30	30	2			2		2						
H5521	013	0	1	04	01	H5521_013_0	4	4	Tier 4	100000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H5521	013	0	1	04	01	H5521_013_0	4	3	Tier 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H5521	015	0	1	04	01	H5521_015_0	5	3	Tier 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H5521	015	0	1	04	01	H5521_015_0	5	1	Tier 1	011111111111111111111110011100000010011101101	2		1	30	30	2			2		2						
H5521	015	0	1	04	01	H5521_015_0	5	2	Tier 2	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H5521	015	0	1	04	01	H5521_015_0	5	4	Tier 4	000000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
H5521	016	0	1	04	01	H5521_016_0	4	4	Tier 4	100000000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
H5521	016	0	1	04	01	H5521_016_0	4	1	Tier 1	011111111111111111111110011100000010011101111	2		1	30	30	2			2		2						
H5521	016	0	1	04	01	H5521_016_0	4	2	Tier 2	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H5521	016	0	1	04	01	H5521_016_0	4	3	Tier 3	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H5521	020	0	1	04	01	H5521_020_0	4	4	Tier 4	100000000000000000000000000000000000100000010	2		2			1	0.00	0.00	2		2						
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H5526	004	0	1	04	01	H5526_004_0	9	7	Specialist Services	011100011101101101100010100000000010011001111	2		2			1	40.00	40.00	2		2						
H5526	004	0	1	04	01	H5526_004_0	9	6	DME/Prosthetics	000000000000000000000000011100000000000000000	2		1	35	35	2			2		2						
H5526	004	0	1	04	01	H5526_004_0	9	3	Mental Health/Subs Abuse/Psychiatric Svc	000010000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H5526	806	0	1	04	01	H5526_806_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H5526	806	0	1	04	01	H5526_806_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5526	806	0	1	04	01	H5526_806_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5526	808	0	1	04	01	H5526_808_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5526	808	0	1	04	01	H5526_808_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H5526	808	0	1	04	01	H5526_808_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5526	810	0	1	04	01	H5526_810_0	3	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H5526	810	0	1	04	01	H5526_810_0	3	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5526	810	0	1	04	01	H5526_810_0	3	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5528	001	0	1	04	01	H5528_001_0	9	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	001	0	1	04	01	H5528_001_0	9	5	$75 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5528	001	0	1	04	01	H5528_001_0	9	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	001	0	1	04	01	H5528_001_0	9	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	001	0	1	04	01	H5528_001_0	9	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	001	0	1	04	01	H5528_001_0	9	1	25% Cost Sharing w/o sep off visit copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	001	0	1	04	01	H5528_001_0	9	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	002	0	1	04	01	H5528_002_0	10	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	002	0	1	04	01	H5528_002_0	10	5	$125 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H5528	002	0	1	04	01	H5528_002_0	10	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	002	0	1	04	01	H5528_002_0	10	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	002	0	1	04	01	H5528_002_0	10	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	002	0	1	04	01	H5528_002_0	10	1	25% Cost Sharing w/o sep off vist copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	002	0	1	04	01	H5528_002_0	10	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	003	0	1	04	01	H5528_003_0	12	1	25% Cost Sharing w/o sep off vist copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	003	0	1	04	01	H5528_003_0	12	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	003	0	1	04	01	H5528_003_0	12	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	003	0	1	04	01	H5528_003_0	12	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	003	0	1	04	01	H5528_003_0	12	5	$75 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5528	003	0	1	04	01	H5528_003_0	12	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	003	0	1	04	01	H5528_003_0	12	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	004	0	1	04	01	H5528_004_0	8	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	004	0	1	04	01	H5528_004_0	8	5	$75 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5528	004	0	1	04	01	H5528_004_0	8	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	004	0	1	04	01	H5528_004_0	8	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	004	0	1	04	01	H5528_004_0	8	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	004	0	1	04	01	H5528_004_0	8	1	25% Cost Sharing w/o sep off visit copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	004	0	1	04	01	H5528_004_0	8	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	005	0	1	04	01	H5528_005_0	10	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	005	0	1	04	01	H5528_005_0	10	5	$125 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H5528	005	0	1	04	01	H5528_005_0	10	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	005	0	1	04	01	H5528_005_0	10	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	005	0	1	04	01	H5528_005_0	10	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	005	0	1	04	01	H5528_005_0	10	1	25% Cost Sharing w/o sep off vist copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	005	0	1	04	01	H5528_005_0	10	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	008	0	1	04	01	H5528_008_0	12	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	008	0	1	04	01	H5528_008_0	12	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	008	0	1	04	01	H5528_008_0	12	5	$75 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5528	008	0	1	04	01	H5528_008_0	12	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	008	0	1	04	01	H5528_008_0	12	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	008	0	1	04	01	H5528_008_0	12	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	008	0	1	04	01	H5528_008_0	12	1	25% Cost Sharing w/o sep off vist copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	009	0	1	04	01	H5528_009_0	8	1	25% Cost Sharing w/o sep off visit copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	009	0	1	04	01	H5528_009_0	8	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	009	0	1	04	01	H5528_009_0	8	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	009	0	1	04	01	H5528_009_0	8	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	009	0	1	04	01	H5528_009_0	8	5	$75 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5528	009	0	1	04	01	H5528_009_0	8	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	009	0	1	04	01	H5528_009_0	8	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	010	0	1	04	01	H5528_010_0	10	1	25% Cost Sharing w/o sep off vist copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	010	0	1	04	01	H5528_010_0	10	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	010	0	1	04	01	H5528_010_0	10	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	010	0	1	04	01	H5528_010_0	10	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	010	0	1	04	01	H5528_010_0	10	5	$125 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H5528	010	0	1	04	01	H5528_010_0	10	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	010	0	1	04	01	H5528_010_0	10	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	011	0	1	04	01	H5528_011_0	13	5	$75 Cost Sharing	000000000000000000000001000000000000000000000	2		2			1	75.00	75.00	2		2						
H5528	011	0	1	04	01	H5528_011_0	13	2	$0 Cost Sharing	000001000000000000000000000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	011	0	1	04	01	H5528_011_0	13	1	25% Cost Sharing w/o sep off vist copay	000010100110110000011110000000001010000001101	2		1	25	25	2			2		2						
H5528	011	0	1	04	01	H5528_011_0	13	3	$40 Cost Sharing	000000010001000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H5528	011	0	1	04	01	H5528_011_0	13	4	50% Cost Sharing	011100001000001000000000000000000000000110110	2		1	50	50	2			2		2						
H5528	011	0	1	04	01	H5528_011_0	13	7	25% Cost Sharing with sep ofc vist copay	000000000000000111100000000000000000001000000	2		1	25	25	2			2		1	1	25	25	2		
H5528	011	0	1	04	01	H5528_011_0	13	6	30% Cost Sharing	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H5528	018	0	1	04	01	H5528_018_0	12	1	$0 Cost Sharing	011111111111111111111111011110001010111111111	2		2			1	0.00	0.00	2		2						
H5528	018	0	1	04	01	H5528_018_0	12	2	OTC Benefit	000000000000000000000000000000100000000000000	2		2			1	660.00	660.00	2		2						
H5528	019	0	1	04	01	H5528_019_0	10	1	35% Cost Sharing	011110111111111111111110011100001010001111111	2		1	35	35	2			2		2						
H5528	019	0	1	04	01	H5528_019_0	10	2	$0 Cost Sharing	000001000000000000000001000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	020	0	1	04	01	H5528_020_0	10	1	35% Cost Sharing	011110111111111111111110011100001010001111111	2		1	35	35	2			2		2						
H5528	020	0	1	04	01	H5528_020_0	10	2	$0 Cost Sharing	000001000000000000000001000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	021	0	1	04	01	H5528_021_0	10	1	35% Cost Sharing	011110111111111111111110011100001010001111111	2		1	35	35	2			2		2						
H5528	021	0	1	04	01	H5528_021_0	10	2	$0 Cost Sharing	000001000000000000000001000010000000110000000	2		2			1	0.00	0.00	2		2						
H5528	804	0	1	04	01	H5528_804_0	6	3	0% Coinsurance	000001000000000000000000000000000010100000000	2		1	0	0	2			2		2						
H5528	804	0	1	04	01	H5528_804_0	6	2	40% Coinsurance	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5528	804	0	1	04	01	H5528_804_0	6	1	20% Coinsurance	011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5528	807	0	1	04	01	H5528_807_0	6	2	40% Coinsurance	000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H5528	807	0	1	04	01	H5528_807_0	6	1	20% Coinsurance	011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H5528	807	0	1	04	01	H5528_807_0	6	3	0% Coinsurance	000001000000000000000000000000000010100000000	2		1	0	0	2			2		2						
H5529	001	0	1	04	01	H5529_001_0	9	4	$45 - $275	000000000000000000010000000000000000000000000	2		2			1	45.00	275.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	3	0% - 30%	000000000000000100000000000000000000000000000	2		1	0	30	2			2		2						
H5529	001	0	1	04	01	H5529_001_0	9	7	$90	000000001000001000000000000000000000000000000	2		2			1	90.00	90.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	8	$50	000010000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	9	$150	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	6	$45	000000010101000000000000000000000000000000001	2		2			1	45.00	45.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	10	$0	011101000000000000000010000000000010111001110	2		2			1	0.00	0.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	11	$275	000000000000000000001000000000000000000000000	2		2			1	275.00	275.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	2	30%	000000000000000010100000011100000000000000000	2		1	30	30	2			2		2						
H5529	001	0	1	04	01	H5529_001_0	9	5	$30	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H5529	001	0	1	04	01	H5529_001_0	9	1	20%	000000000000000001000000000010000000000110000	2		1	20	20	2			2		2						
H5529	004	0	1	04	01	H5529_004_0	9	1	20%	000000000000000001000000000010000000000110000	2		1	20	20	2			2		2						
H5529	004	0	1	04	01	H5529_004_0	9	9	$150	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	8	$50	000010000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	7	$60	000000001000001000000000000000000000000000000	2		2			1	60.00	60.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	6	$25	000000010101000000000000000000000000000000001	2		2			1	25.00	25.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	5	$15	000000100000100000000000000000000000000000000	2		2			1	15.00	15.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	4	$25 - $225	000000000000000000010000000000000000000000000	2		2			1	25.00	225.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	10	$0	011101000000000000000010000000000010111001110	2		2			1	0.00	0.00	2		2						
H5529	004	0	1	04	01	H5529_004_0	9	2	25%	000000000000000010100000011100000000000000000	2		1	25	25	2			2		2						
H5529	004	0	1	04	01	H5529_004_0	9	3	0% - 25%	000000000000000100000000000000000000000000000	2		1	0	25	2			2		2						
H5529	004	0	1	04	01	H5529_004_0	9	11	$225	000000000000000000001000000000000000000000000	2		2			1	225.00	225.00	2		2						
H5529	804	0	1	04	01	H5529_804_0	6	1	Non-Mental Health Services	111111111101101111111011111111111101111111111	2		1	20	20	2			2		2						
H5529	804	0	1	04	01	H5529_804_0	6	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H5529	804	0	1	04	01	H5529_804_0	6	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H5529	805	0	1	04	01	H5529_805_0	6	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H5529	805	0	1	04	01	H5529_805_0	6	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H5529	805	0	1	04	01	H5529_805_0	6	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H5529	806	0	1	04	01	H5529_806_0	6	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H5529	806	0	1	04	01	H5529_806_0	6	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H5529	806	0	1	04	01	H5529_806_0	6	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H5529	807	0	1	04	01	H5529_807_0	6	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H5529	807	0	1	04	01	H5529_807_0	6	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H5529	807	0	1	04	01	H5529_807_0	6	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H5530	001	0	1	04	01	H5530_001_0	9	1	20%	000000000000000001000000000010000000000100000	2		1	20	20	2			2		2						
H5530	001	0	1	04	01	H5530_001_0	9	10	$40 - $275	000000000000000000010000000000000000000000000	2		2			1	40.00	275.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	9	$100	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	8	$50	000010000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	7	$80	000000001000001000000000000000000000000000000	2		2			1	80.00	80.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	11	$0	011101000000000000000010000000000010111001110	2		2			1	0.00	0.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	5	$20	000000100000100000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	4	$275	000000000000000000001000000000000000000000000	2		2			1	275.00	275.00	2		2						
H5530	001	0	1	04	01	H5530_001_0	9	3	0% - 30%	000000000000000100000000000000000000000000000	2		1	0	30	2			2		2						
H5530	001	0	1	04	01	H5530_001_0	9	2	30%	000000000000000010100000011100000000000000000	2		1	30	30	2			2		2						
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H6169	054	0	1	09	04	H6169_054_0	5	1		011100001000001000000000000000000000000000111	2		2			1	15.00	20.00	2		2						
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H6169	056	0	1	09	04	H6169_056_0	5	9		000000000000000011100000000000000000000000000	2		1	20	20	2			2		1	2			1	10.00	40.00
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H6169	056	0	1	09	04	H6169_056_0	5	15		000000000000000000001000000000000000000000000	2		2			1	75.00	75.00	2		2						
H6169	056	0	1	09	04	H6169_056_0	5	2		000010000000000000000000000000000000000000000	2		2			1	200.00	200.00	2		2						
H6169	056	0	1	09	04	H6169_056_0	5	3		000001000000000000000000000000000000000000000	2		1	15	15	2			2		2						
H6169	056	0	1	09	04	H6169_056_0	5	4		000000100000000000000000000000000000000000000	2		2			1	10.00	10.00	2		2						
H6169	056	0	1	09	04	H6169_056_0	5	5		000000000100000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6169	056	0	1	09	04	H6169_056_0	5	6		000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H6169	056	0	1	09	04	H6169_056_0	5	7		000000000001100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H6169	056	0	1	09	04	H6169_056_0	5	8		000000000000000100000000000000000000001000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
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H6169	057	0	1	09	04	H6169_057_0	4	5		000000000100000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	6		000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H6169	057	0	1	09	04	H6169_057_0	4	7		000000000001100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	8		000000000000000100000000000000000000001000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H6169	057	0	1	09	04	H6169_057_0	4	9		000000000000000011100000000000000000000000000	2		1	20	20	2			2		1	2			1	10.00	40.00
H6169	057	0	1	09	04	H6169_057_0	4	1		011100001000001000000000000000000000000000111	2		2			1	15.00	20.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	10		000000000000000000010001000000000000000000000	2		2			1	150.00	150.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	11		000000000000000000000000011100000000000100000	2		1	20	20	2			2		2						
H6169	057	0	1	09	04	H6169_057_0	4	12		000000010000000000000000000000000000000000000	2		1	50	50	2			2		2						
H6169	057	0	1	09	04	H6169_057_0	4	13		000000000000000000000000000010000000000000000	2		2			1	30.00	30.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	14		000000000000000000000010000000000010110001000	2		2			1	0.00	0.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	15		000000000000000000001000000000000000000000000	2		2			1	75.00	75.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	2		000010000000000000000000000000000000000000000	2		2			1	200.00	200.00	2		2						
H6169	057	0	1	09	04	H6169_057_0	4	3		000001000000000000000000000000000000000000000	2		1	15	15	2			2		2						
H6169	057	0	1	09	04	H6169_057_0	4	4		000000100000000000000000000000000000000000000	2		2			1	10.00	10.00	2		2						
H6169	801	0	1	09	04	H6169_801_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H6169	801	0	1	09	04	H6169_801_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H6169	801	0	1	09	04	H6169_801_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H6169	802	0	1	09	04	H6169_802_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H6169	802	0	1	09	04	H6169_802_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H6169	802	0	1	09	04	H6169_802_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H6169	803	0	1	09	04	H6169_803_0	4	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
H6169	803	0	1	09	04	H6169_803_0	4	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
H6169	803	0	1	09	04	H6169_803_0	4	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
H6328	001	0	1	04	01	H6328_001_0	8	8	$10 to $25 copay	000000000000000100100000000000000000000000000	2		2			1	10.00	25.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	9	$75 to $200 Copay	000000000000000010000000000000000000000000000	2		2			1	75.00	200.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	1	$20 Copay	011100111000001000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	10	20% Coinsurance	000000000000000000000000000100000000011000000	2		1	20	20	2			2		2						
H6328	001	0	1	04	01	H6328_001_0	8	11	30% Coinsurance	000000000000000001000010000000000000000100000	2		1	30	30	2			2		2						
H6328	001	0	1	04	01	H6328_001_0	8	12	30% for DME	000000000000000000000000011000000000000000000	2		1	30	30	2			2		2						
H6328	001	0	1	04	01	H6328_001_0	8	7	$200 Copay	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	14	0% Coinsurance	100000000000000000000000000000000000000000000	2		1	0	0	2			2		2						
H6328	001	0	1	04	01	H6328_001_0	8	2	$30 Copay	000000000101100000000000000000000010100001101	2		2			1	30.00	30.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	3	$40 Copay	000001000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	4	$50 Copay	000000000010010000000100000010000000000000000	2		2			1	50.00	50.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	5	$100 Copay	000010000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	6	$150 Copay	000000000000000000001000000000000000000000000	2		2			1	150.00	150.00	2		2						
H6328	001	0	1	04	01	H6328_001_0	8	13	50% Coinsurance	000000000000000000000000000000000000000010010	2		1	50	50	2			2		2						
H6328	002	0	1	04	01	H6328_002_0	6	8	$125 Copay	000010000000000000000000000000000000000000000	2		2			1	125.00	125.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	9	$175 Copay	000000000000000000001000000000000000000000000	2		2			1	175.00	175.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	7	$100 Copay	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	6	$55 Copay	000000000010010000000100000010000000000000000	2		2			1	55.00	55.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	5	$40 Copay	000001000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	4	$35 Copay	000000000101100000000000000000000000000001101	2		2			1	35.00	35.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	3	$30 Copay	000000000000000000000000000000000010100000000	2		2			1	30.00	30.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	2	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	15	50% Coinsurance	000000000000000000000000000000000000000000010	2		1	50	50	2			2		2						
H6328	002	0	1	04	01	H6328_002_0	6	14	30% Coinsurance	000000000000000001000010011000000000000100000	2		1	30	30	2			2		2						
H6328	002	0	1	04	01	H6328_002_0	6	13	20% Coinsurance	000000000000000000000000000100000000011000000	2		1	20	20	2			2		2						
H6328	002	0	1	04	01	H6328_002_0	6	12	$75 to $200 Copay	000000000000000010000000000000000000000000000	2		2			1	75.00	200.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	11	$10 to $25 Copay	000000000000000100100000000000000000000000000	2		2			1	10.00	25.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	10	$225 Copay	000000000000000000010000000000000000000000000	2		2			1	225.00	225.00	2		2						
H6328	002	0	1	04	01	H6328_002_0	6	1	$20 Copay	011100011000001000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	1	$20 Copay	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	9	$200 Copay	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	7	$150 Copay	000010000000000000000000000000000000000000000	2		2			1	150.00	150.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	6	$60 Copay	000000000010010000000100000010000000000000000	2		2			1	60.00	60.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	5	$45 Copay	000001000101100000000000000000000000000001101	2		2			1	45.00	45.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	4	$35 Copay	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	3	$30 Copay	000000000000000000000000000000000010100000000	2		2			1	30.00	30.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	2	$25 Copay	011100001000001000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	15	50% Coinsurance	000000000000000000000000000000000000000000010	2		1	50	50	2			2		2						
H6328	003	0	1	04	01	H6328_003_0	5	14	30% Coinsurance	000000000000000001000010011000000000000100000	2		1	30	30	2			2		2						
H6328	003	0	1	04	01	H6328_003_0	5	13	20% Coinsurance	000000000000000000000000000100000000011000000	2		1	20	20	2			2		2						
H6328	003	0	1	04	01	H6328_003_0	5	12	$75 to $250 Copay	000000000000000010000000000000000000000000000	2		2			1	75.00	250.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	11	$10 to $25 Copay	000000000000000100100000000000000000000000000	2		2			1	10.00	25.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	10	$250 Copay	000000000000000000010000000000000000000000000	2		2			1	250.00	250.00	2		2						
H6328	003	0	1	04	01	H6328_003_0	5	8	$175 Copay	000000000000000000001000000000000000000000000	2		2			1	175.00	175.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	14	0% Coinsurance	100000000000000000000000000000000000000000000	2		1	0	0	2			2		2						
H6328	005	0	1	04	01	H6328_005_0	5	2	$30 Copay	000000000101100000000000000000000010100001101	2		2			1	30.00	30.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	3	$40copay	000001000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	4	$50 Copay	000000000010010000000100000010000000000000000	2		2			1	50.00	50.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	5	$100 Copay	000010000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	6	$150 Copay	000000000000000000001000000000000000000000000	2		2			1	150.00	150.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	7	$200 Copay	000000000000000000010000000000000000000000000	2		2			1	200.00	200.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	8	$10 to $25 copay	000000000000000100100000000000000000000000000	2		2			1	10.00	25.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	9	$75 to $200 Copay	000000000000000010000000000000000000000000000	2		2			1	75.00	200.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	1	$20 Copay	011100111000001000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H6328	005	0	1	04	01	H6328_005_0	5	10	20% Coinsurance	000000000000000000000000000100000000011000000	2		1	20	20	2			2		2						
H6328	005	0	1	04	01	H6328_005_0	5	11	30% Coinsurance	000000000000000001000010000000000000000100000	2		1	30	30	2			2		2						
H6328	005	0	1	04	01	H6328_005_0	5	12	30% for DME	000000000000000000000000011000000000000000000	2		1	30	30	2			2		2						
H6328	005	0	1	04	01	H6328_005_0	5	13	50% Coinsurance	000000000000000000000000000000000000000010010	2		1	50	50	2			2		2						
H6328	006	0	1	04	01	H6328_006_0	4	1	$20 Copay	011100011000001000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	10	$225 Copay	000000000000000000010000000000000000000000000	2		2			1	225.00	225.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	9	$175 Copay	000000000000000000001000000000000000000000000	2		2			1	175.00	175.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	8	$150 Copay	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	7	$125 Copay	000010000000000000000000000000000000000000000	2		2			1	125.00	125.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	6	$55 Copay	000000000010010000000100000010000000000000000	2		2			1	55.00	55.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	5	$40 Copay	000001000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	4	$35 Copay	000000000101100000000000000000000000000001101	2		2			1	35.00	35.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	3	$30 Copay	000000000000000000000000000000000010100000000	2		2			1	30.00	30.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	11	$10 to $25 Copay	000000000000000100100000000000000000000000000	2		2			1	10.00	25.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	12	$75 to $200 Copay	000000000000000010000000000000000000000000000	2		2			1	75.00	200.00	2		2						
H6328	006	0	1	04	01	H6328_006_0	4	13	20% Coinsurance	000000000000000000000000000100000000011000000	2		1	20	20	2			2		2						
H6328	006	0	1	04	01	H6328_006_0	4	14	30% Coinsurance	000000000000000001000010011000000000000100000	2		1	30	30	2			2		2						
H6328	006	0	1	04	01	H6328_006_0	4	15	50% Coinsurance	000000000000000000000000000000000000000000010	2		1	50	50	2			2		2						
H6328	006	0	1	04	01	H6328_006_0	4	2	$25 Copay	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H6328	801	0	1	04	01	H6328_801_0	5	1	20% Coinsurance	111111111101101111111111111110000010011111111	2		1	20	20	2			2		2						
H6328	801	0	1	04	01	H6328_801_0	5	2	45% Coinsurance	000000000010010000000000000000000000000000000	2		1	45	45	2			2		2						
H6328	802	0	1	04	01	H6328_802_0	2	2	45% Coinsurance	000000000010010000000000000000000000000000000	2		1	45	45	2			2		2						
H6328	802	0	1	04	01	H6328_802_0	2	1	20% Coinsurance	111111111101101111111111111110000010011111111	2		1	20	20	2			2		2						
H6328	803	0	1	04	01	H6328_803_0	2	2	45% Coinsurance	000000000010010000000000000000000000000000000	2		1	45	45	2			2		2						
H6328	803	0	1	04	01	H6328_803_0	2	1	20% Coinsurance	111111111101101111111111111110000010011111111	2		1	20	20	2			2		2						
H6328	804	0	1	04	01	H6328_804_0	2	2	45% Coinsurance	000000000010010000000000000000000000000000000	2		1	45	45	2			2		2						
H6328	804	0	1	04	01	H6328_804_0	2	1	20% Coinsurance	111111111101101111111111111110000010011111111	2		1	20	20	2			2		2						
H6411	002	0	1	04	01	H6411_002_0	7	7		000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H6411	002	0	1	04	01	H6411_002_0	7	6		000000000000000000000000000000000000000100000	2		1	0	30	2			2		2						
H6411	002	0	1	04	01	H6411_002_0	7	5		000000000000000000000000000010000000000000000	2		1	0	20	2			2		2						
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H6528	006	0	1	04	01	H6528_006_0	5	9	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
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H6528	006	0	1	04	01	H6528_006_0	5	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
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H6528	007	0	1	04	01	H6528_007_0	5	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
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H6528	012	0	1	04	01	H6528_012_0	7	5	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
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H6528	013	0	1	04	01	H6528_013_0	6	13	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
H6528	013	0	1	04	01	H6528_013_0	6	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
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H6528	013	0	1	04	01	H6528_013_0	6	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H6528	013	0	1	04	01	H6528_013_0	6	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H6528	013	0	1	04	01	H6528_013_0	6	5	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H6528	013	0	1	04	01	H6528_013_0	6	6	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
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H6528	015	0	1	04	01	H6528_015_0	7	4	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
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H6528	016	0	1	04	01	H6528_016_0	6	8	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
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H6528	016	0	1	04	01	H6528_016_0	6	14	$160 Copayment	000000000000000000000001000000000000000000000	2		2			1	160.00	160.00	2		2						
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H7306	803	0	1	04	01	H7306_803_0	2	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
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H7787	001	0	1	04	01	H7787_001_0	7	5	$40-60 copay	000000000000000000000000000000000010011000001	2		2			1	40.00	60.00	2		2						
H7787	001	0	1	04	01	H7787_001_0	7	6	50% coinsirance	000000000000000000000000000000000000000010000	2		1	50	50	2			2		2						
H7787	001	0	1	04	01	H7787_001_0	7	7	$0- $60 copay	000000000000000000000000000000000000100000100	2		2			1	0.00	60.00	2		2						
H7787	001	0	1	04	01	H7787_001_0	7	4	$50 copay	000000000000000000000001000000000000000000000	2		2			1	50.00	50.00	2		2						
H7787	001	0	1	04	01	H7787_001_0	7	3	$60 copay	000000011101101000000000000000000000000000000	2		2			1	60.00	60.00	2		2						
H7787	001	0	1	04	01	H7787_001_0	7	2	$40 copay	000001100000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H7787	001	0	1	04	01	H7787_001_0	7	1	30% coinsurance	011110000010010111111110011110000000000101000	2		1	30	30	2			2		2						
H7787	001	0	1	04	01	H7787_001_0	7	8	0- 30% coinsurance	000000000000000000000000000000000000000000010	2		1	0	30	2			2		2						
H7787	002	0	1	04	01	H7787_002_0	2	3	$60 copay	000000011101101000000000000000000000000000000	2		2			1	60.00	60.00	2		2						
H7787	002	0	1	04	01	H7787_002_0	2	2	$40	000001100000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H7787	002	0	1	04	01	H7787_002_0	2	1	30% coinsurance	011110000010010111111110011110000000000101000	2		1	30	30	2			2		2						
H7787	002	0	1	04	01	H7787_002_0	2	4	$50 copay	000000000000000000000001000000000000000000000	2		2			1	50.00	50.00	2		2						
H7787	002	0	1	04	01	H7787_002_0	2	7	$0-$60	000000000000000000000000000000000000000000100	2		2			1	0.00	60.00	2		2						
H7787	002	0	1	04	01	H7787_002_0	2	6	0-30%	000000000000000000000000000000000000000000010	2		1	0	30	2			2		2						
H7787	002	0	1	04	01	H7787_002_0	2	5	$40-60 copay	000000000000000000000000000000000010111000001	2		2			1	40.00	60.00	2		2						
H7787	004	0	1	04	01	H7787_004_0	7	7	0-$60	000000000000000000000000000000000000100000100	2		2			1	0.00	60.00	2		2						
H7787	004	0	1	04	01	H7787_004_0	7	6	50%	000000000000000000000000000000000000000010000	2		1	50	50	2			2		2						
H7787	004	0	1	04	01	H7787_004_0	7	5	$40-60 copay	000000000000000000000000000000000010011000001	2		2			1	40.00	60.00	2		2						
H7787	004	0	1	04	01	H7787_004_0	7	4	$50 copay	000000000000000000000001000000000000000000000	2		2			1	50.00	50.00	2		2						
H7787	004	0	1	04	01	H7787_004_0	7	1	30% coinsurance	011110000010010111111110011110000000000101000	2		1	30	30	2			2		2						
H7787	004	0	1	04	01	H7787_004_0	7	2	$40 copay	000001100000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H7787	004	0	1	04	01	H7787_004_0	7	3	$60 copay	000000011101101000000000000000000000000000000	2		2			1	60.00	60.00	2		2						
H7787	004	0	1	04	01	H7787_004_0	7	8	0-30%	000000000000000000000000000000000000000000010	2		1	0	30	2			2		2						
H7917	008	0	1	04	01	H7917_008_0	7	1	30% Cost Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	008	0	1	04	01	H7917_008_0	7	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	008	0	1	04	01	H7917_008_0	7	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	008	0	1	04	01	H7917_008_0	7	8	$175	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	008	0	1	04	01	H7917_008_0	7	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	008	0	1	04	01	H7917_008_0	7	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	008	0	1	04	01	H7917_008_0	7	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	008	0	1	04	01	H7917_008_0	7	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	009	0	1	04	01	H7917_009_0	6	1	30% Cost Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	009	0	1	04	01	H7917_009_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	009	0	1	04	01	H7917_009_0	6	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	009	0	1	04	01	H7917_009_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	009	0	1	04	01	H7917_009_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	009	0	1	04	01	H7917_009_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	009	0	1	04	01	H7917_009_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	009	0	1	04	01	H7917_009_0	6	8	$175	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	010	0	1	04	01	H7917_010_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	010	0	1	04	01	H7917_010_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	010	0	1	04	01	H7917_010_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	010	0	1	04	01	H7917_010_0	6	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	010	0	1	04	01	H7917_010_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	010	0	1	04	01	H7917_010_0	6	1	30% Cost Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	010	0	1	04	01	H7917_010_0	6	8	$175	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	010	0	1	04	01	H7917_010_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	011	0	1	04	01	H7917_011_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	011	0	1	04	01	H7917_011_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	011	0	1	04	01	H7917_011_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	011	0	1	04	01	H7917_011_0	6	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	011	0	1	04	01	H7917_011_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	011	0	1	04	01	H7917_011_0	6	8	$175	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	011	0	1	04	01	H7917_011_0	6	1	30% Cost Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	011	0	1	04	01	H7917_011_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	012	0	1	04	01	H7917_012_0	6	8	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	012	0	1	04	01	H7917_012_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	012	0	1	04	01	H7917_012_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	012	0	1	04	01	H7917_012_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	012	0	1	04	01	H7917_012_0	6	3	$175 Allowable	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	012	0	1	04	01	H7917_012_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	012	0	1	04	01	H7917_012_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	012	0	1	04	01	H7917_012_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	013	0	1	04	01	H7917_013_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	013	0	1	04	01	H7917_013_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	013	0	1	04	01	H7917_013_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	013	0	1	04	01	H7917_013_0	6	8	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	013	0	1	04	01	H7917_013_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	013	0	1	04	01	H7917_013_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	013	0	1	04	01	H7917_013_0	6	3	$175 Allowable	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	013	0	1	04	01	H7917_013_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	014	0	1	04	01	H7917_014_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	014	0	1	04	01	H7917_014_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	014	0	1	04	01	H7917_014_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	014	0	1	04	01	H7917_014_0	6	8	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	014	0	1	04	01	H7917_014_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	014	0	1	04	01	H7917_014_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	014	0	1	04	01	H7917_014_0	6	3	$175 Allowable	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	014	0	1	04	01	H7917_014_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	015	0	1	04	01	H7917_015_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	015	0	1	04	01	H7917_015_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	015	0	1	04	01	H7917_015_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	015	0	1	04	01	H7917_015_0	6	8	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	015	0	1	04	01	H7917_015_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	015	0	1	04	01	H7917_015_0	6	3	$175 Allowable	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	015	0	1	04	01	H7917_015_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	015	0	1	04	01	H7917_015_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	030	0	1	04	01	H7917_030_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	030	0	1	04	01	H7917_030_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	030	0	1	04	01	H7917_030_0	6	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	030	0	1	04	01	H7917_030_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	030	0	1	04	01	H7917_030_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	030	0	1	04	01	H7917_030_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	030	0	1	04	01	H7917_030_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	030	0	1	04	01	H7917_030_0	6	8	$175 Allowable Group	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	031	0	1	04	01	H7917_031_0	7	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	031	0	1	04	01	H7917_031_0	7	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	031	0	1	04	01	H7917_031_0	7	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	031	0	1	04	01	H7917_031_0	7	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	031	0	1	04	01	H7917_031_0	7	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	031	0	1	04	01	H7917_031_0	7	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	031	0	1	04	01	H7917_031_0	7	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	031	0	1	04	01	H7917_031_0	7	8	$175 Allowable Group	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	032	0	1	04	01	H7917_032_0	6	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	032	0	1	04	01	H7917_032_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	032	0	1	04	01	H7917_032_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	032	0	1	04	01	H7917_032_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	032	0	1	04	01	H7917_032_0	6	8	$175 Allowable Group	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	032	0	1	04	01	H7917_032_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	032	0	1	04	01	H7917_032_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	032	0	1	04	01	H7917_032_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	033	0	1	04	01	H7917_033_0	6	1	30% Cosr Share Group	011110111011111111111100000100000010011100000	2		1	30	30	2			2		2						
H7917	033	0	1	04	01	H7917_033_0	6	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H7917	033	0	1	04	01	H7917_033_0	6	3	$15	000000000000000000000000000000000000000000001	2		2			1	15.00	15.00	2		2						
H7917	033	0	1	04	01	H7917_033_0	6	7	40% cost share group	000001000100000000000000011000000000000001000	2		1	40	40	2			2		2						
H7917	033	0	1	04	01	H7917_033_0	6	6	ESRD	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H7917	033	0	1	04	01	H7917_033_0	6	5	$35 GROUP	000000000000000000000000000000000000000000100	2		2			1	35.00	35.00	2		2						
H7917	033	0	1	04	01	H7917_033_0	6	4	Zero Cost Share OON Group	000000000000000000000010000000000000100000000	2		1	0	0	2			2		2						
H7917	033	0	1	04	01	H7917_033_0	6	8	$175 Allowable Group	000000000000000000000000000000000000000000010	1	175.00	1	0	0	2			2		2						
H7917	801	0	1	04	01	H7917_801_0	5	2	All Others	011101111101101111111111011110000010011101111	2		1	0	20	2			2		2						
H7917	801	0	1	04	01	H7917_801_0	5	3	Partial Hospitalization	000010000010000000000000000000000000000000000	2		1	50	50	2			2		2						
H7917	801	0	1	04	01	H7917_801_0	5	1	MH-Psych	000000000000010000000000000000000000000000000	2		1	45	45	2			2		2						
H7917	802	0	1	04	01	H7917_802_0	5	1	MH-Psych	000000000000010000000000000000000000000000000	2		1	45	45	2			2		2						
H7917	802	0	1	04	01	H7917_802_0	5	3	Partial Hospitalization	000010000010000000000000000000000000000000000	2		1	50	50	2			2		2						
H7917	802	0	1	04	01	H7917_802_0	5	2	All Others	011101111101101111111111011110000010011101111	2		1	0	20	2			2		2						
H7917	803	0	1	04	01	H7917_803_0	5	3	Partial Hospitalization	000010000010000000000000000000000000000000000	2		1	50	50	2			2		2						
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H8552	005	0	1	04	01	H8552_005_0	8	4	$200 OON Copayment Group	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H8552	005	0	1	04	01	H8552_005_0	8	3	$40 OON Copayment Group	000000010000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H8552	005	0	1	04	01	H8552_005_0	8	2	$35 OON Copayment  Group	000000100000100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
H8552	005	0	1	04	01	H8552_005_0	8	1	30% OON Coinsurance Group	011111001010011011111110001100000000011000001	2		1	30	30	2			2		2						
H8552	005	0	1	04	01	H8552_005_0	8	10	$0 - 30% OON Group	000000000000000000000000000000000010000000000	2		1	30	30	1	0.00	0.00	2		2						
H8552	801	0	1	04	01	H8552_801_0	7	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H8552	801	0	1	04	01	H8552_801_0	7	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H8552	801	0	1	04	01	H8552_801_0	7	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H8552	802	0	1	04	01	H8552_802_0	5	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H8552	802	0	1	04	01	H8552_802_0	5	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H8552	802	0	1	04	01	H8552_802_0	5	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H8552	803	0	1	04	01	H8552_803_0	5	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H8552	803	0	1	04	01	H8552_803_0	5	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H8552	803	0	1	04	01	H8552_803_0	5	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H8552	804	0	1	04	01	H8552_804_0	5	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H8552	804	0	1	04	01	H8552_804_0	5	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H8552	804	0	1	04	01	H8552_804_0	5	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H8558	002	0	1	04	01	H8558_002_0	9	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H8558	002	0	1	04	01	H8558_002_0	9	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H8558	002	0	1	04	01	H8558_002_0	9	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H8558	002	0	1	04	01	H8558_002_0	9	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H8558	002	0	1	04	01	H8558_002_0	9	12	OP Diagnostic Services	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H8558	002	0	1	04	01	H8558_002_0	9	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H8558	012	0	1	04	01	H8558_012_0	7	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H8558	012	0	1	04	01	H8558_012_0	7	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H8558	012	0	1	04	01	H8558_012_0	7	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H8558	012	0	1	04	01	H8558_012_0	7	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H8558	012	0	1	04	01	H8558_012_0	7	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H8558	012	0	1	04	01	H8558_012_0	7	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H8558	012	0	1	04	01	H8558_012_0	7	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H8558	012	0	1	04	01	H8558_012_0	7	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H8558	012	0	1	04	01	H8558_012_0	7	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H8558	012	0	1	04	01	H8558_012_0	7	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H8558	012	0	1	04	01	H8558_012_0	7	12	OP Diagnostic Services	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H8558	012	0	1	04	01	H8558_012_0	7	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H8558	013	0	1	04	01	H8558_013_0	7	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H8558	013	0	1	04	01	H8558_013_0	7	12	OP Diagnostic Services	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H8558	013	0	1	04	01	H8558_013_0	7	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H8558	013	0	1	04	01	H8558_013_0	7	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H8558	013	0	1	04	01	H8558_013_0	7	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H8604	001	0	1	04	01	H8604_001_0	8	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	001	0	1	04	01	H8604_001_0	8	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	001	0	1	04	01	H8604_001_0	8	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	001	0	1	04	01	H8604_001_0	8	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	001	0	1	04	01	H8604_001_0	8	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	002	0	1	04	01	H8604_002_0	5	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	002	0	1	04	01	H8604_002_0	5	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	002	0	1	04	01	H8604_002_0	5	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	002	0	1	04	01	H8604_002_0	5	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	002	0	1	04	01	H8604_002_0	5	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	003	0	1	04	01	H8604_003_0	8	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	003	0	1	04	01	H8604_003_0	8	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	003	0	1	04	01	H8604_003_0	8	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	003	0	1	04	01	H8604_003_0	8	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	003	0	1	04	01	H8604_003_0	8	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	004	0	1	04	01	H8604_004_0	5	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	004	0	1	04	01	H8604_004_0	5	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	004	0	1	04	01	H8604_004_0	5	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	004	0	1	04	01	H8604_004_0	5	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	004	0	1	04	01	H8604_004_0	5	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	005	0	1	04	01	H8604_005_0	8	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	005	0	1	04	01	H8604_005_0	8	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	005	0	1	04	01	H8604_005_0	8	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	005	0	1	04	01	H8604_005_0	8	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	005	0	1	04	01	H8604_005_0	8	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	006	0	1	04	01	H8604_006_0	8	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	006	0	1	04	01	H8604_006_0	8	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	006	0	1	04	01	H8604_006_0	8	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	006	0	1	04	01	H8604_006_0	8	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	006	0	1	04	01	H8604_006_0	8	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	801	0	1	04	01	H8604_801_0	6	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	801	0	1	04	01	H8604_801_0	6	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	801	0	1	04	01	H8604_801_0	6	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
H8604	801	0	1	04	01	H8604_801_0	6	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	801	0	1	04	01	H8604_801_0	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	802	0	1	04	01	H8604_802_0	6	4	SCP	000000011111111000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
H8604	802	0	1	04	01	H8604_802_0	6	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	125.00	125.00	2		2						
H8604	802	0	1	04	01	H8604_802_0	6	3	$20 PCP / $45 Urgent Care	000000100000000000000000000000000000000000000	2		2			1	20.00	45.00	2		2						
H8604	802	0	1	04	01	H8604_802_0	6	1	20% Coinsurance	011111000000000111111010000010001010111100010	2		1	20	20	2			2		2						
H8604	802	0	1	04	01	H8604_802_0	6	2	DME	000000000000000000000000011100000000000000000	2		1	30	30	2			2		2						
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H8644	003	0	1	04	01	H8644_003_0	4	3		000000000000000000000000000000000000000100000	2		1	0	30	2			2		2						
H8644	003	0	1	04	01	H8644_003_0	4	4		000000000000000000000010000000000000000000110	2		2			1	0.00	0.00	2		2						
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H8644	005	0	1	04	01	H8644_005_0	5	6		000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
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H9947	001	0	1	04	01	H9947_001_0	8	12	$175 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
H9947	001	0	1	04	01	H9947_001_0	8	11	$0 Copayment Group	000000000000000000000010000100000000110000110	2		2			1	0.00	0.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	5	10% Coinsurance Group	000001000000000000000000000000000000000000000	2		1	10	10	2			2		2						
H9947	002	0	1	04	01	H9947_002_0	8	7	$0-$200 Copayment Group	000000000000000110000000000000000000000000000	2		2			1	0.00	200.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	3	$20 Copayment Group	000000110000100000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	2	$30 Copayment Group	011100000101000000000000000000000000000000001	2		2			1	30.00	30.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	15	$0-$30 Copayment Group	000000000000000000000000000000000010000000000	2		2			1	0.00	30.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	14	$100 Copayment Group	000000000000000000100000000000000000000000000	2		2			1	100.00	100.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	13	30% Coinsurance Group	000000000000000000000000011000000000000000000	2		1	30	30	2			2		2						
H9947	002	0	1	04	01	H9947_002_0	8	12	$0 Copayment Group	000000000000000000000010000100000000111000110	2		2			1	0.00	0.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	11	$210 Copayment Group	000000000000000000000001000000000000000000000	2		2			1	210.00	210.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	10	$295 Copayment Group	000000000000000000001000000000000000000000000	2		2			1	295.00	295.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	1	20% Coinsurance Group	000000000000000000000000000010000000000001000	2		1	20	20	2			2		2						
H9947	002	0	1	04	01	H9947_002_0	8	6	$50 Copayment Group	000000001000001000000000000000000000000000000	2		2			1	50.00	50.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	8	25% Coinsurance Group	000000000000000001000000000000000000000100000	2		1	25	25	2			2		2						
H9947	002	0	1	04	01	H9947_002_0	8	9	$0-$295 Copayment Group	000000000000000000010000000000000000000000000	2		2			1	0.00	295.00	2		2						
H9947	002	0	1	04	01	H9947_002_0	8	4	$40 Copayment Group	000010000010010000000100000000000000000000000	2		2			1	40.00	40.00	2		2						
H9947	003	0	1	04	01	H9947_003_0	10	2	0% - 35% OON Costshare Group	000000000000000100011000000000000000000000100	2		1	0	35	2			2		2						
H9947	003	0	1	04	01	H9947_003_0	10	1	35% OON Coinsurance Group	000010111111111011100100011000000000000100001	2		1	35	35	2			2		2						
H9947	003	0	1	04	01	H9947_003_0	10	3	20% OON Group	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
H9947	003	0	1	04	01	H9947_003_0	10	5	$0 OON Copayment Group	011101000000000000000010000100000010111001010	2		2			1	0.00	0.00	2		2						
H9947	003	0	1	04	01	H9947_003_0	10	4	$275 OON Copayment Group	000000000000000000000001000000000000000000000	2		2			1	275.00	275.00	2		2						
H9947	801	0	1	04	01	H9947_801_0	6	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H9947	801	0	1	04	01	H9947_801_0	6	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H9947	801	0	1	04	01	H9947_801_0	6	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H9947	802	0	1	04	01	H9947_802_0	5	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H9947	802	0	1	04	01	H9947_802_0	5	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H9947	802	0	1	04	01	H9947_802_0	5	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H9947	803	0	1	04	01	H9947_803_0	5	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H9947	803	0	1	04	01	H9947_803_0	5	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H9947	803	0	1	04	01	H9947_803_0	5	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H9947	804	0	1	04	01	H9947_804_0	5	1	Non-Mental Health Services	111111111101101111111011111111111100111111111	2		1	20	20	2			2		2						
H9947	804	0	1	04	01	H9947_804_0	5	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
H9947	804	0	1	04	01	H9947_804_0	5	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
H9988	002	0	1	04	01	H9988_002_0	7	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H9988	002	0	1	04	01	H9988_002_0	7	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H9988	002	0	1	04	01	H9988_002_0	7	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H9988	002	0	1	04	01	H9988_002_0	7	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H9988	002	0	1	04	01	H9988_002_0	7	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H9988	002	0	1	04	01	H9988_002_0	7	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H9988	002	0	1	04	01	H9988_002_0	7	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H9988	002	0	1	04	01	H9988_002_0	7	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H9988	002	0	1	04	01	H9988_002_0	7	12	OP Radiology	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H9988	002	0	1	04	01	H9988_002_0	7	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H9988	002	0	1	04	01	H9988_002_0	7	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H9988	002	0	1	04	01	H9988_002_0	7	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H9988	004	0	1	04	01	H9988_004_0	8	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H9988	004	0	1	04	01	H9988_004_0	8	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H9988	004	0	1	04	01	H9988_004_0	8	12	OP Radiology	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H9988	004	0	1	04	01	H9988_004_0	8	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H9988	004	0	1	04	01	H9988_004_0	8	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H9988	004	0	1	04	01	H9988_004_0	8	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H9988	014	0	1	04	01	H9988_014_0	7	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H9988	014	0	1	04	01	H9988_014_0	7	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H9988	014	0	1	04	01	H9988_014_0	7	12	OP Radiology	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H9988	014	0	1	04	01	H9988_014_0	7	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H9988	014	0	1	04	01	H9988_014_0	7	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
H9988	015	0	1	04	01	H9988_015_0	7	1	Specialist Services	000000000101100000000000000000000000011000101	2		2			1	40.00	40.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	10	Diabetic Supplies	000000000000000000000000000100000000000000000	2		1	0	25	2			2		2						
H9988	015	0	1	04	01	H9988_015_0	7	11	Chiro	000000010000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	12	OP Radiology	000000000000000110100000000000000000000000000	2		2			1	0.00	0.00	2		1	2			1	10.00	40.00
H9988	015	0	1	04	01	H9988_015_0	7	2	OP Radiology, Part B Drugs, OPSurg	000000000000000001011000000000000000000100000	2		1	20	20	2			2		2						
H9988	015	0	1	04	01	H9988_015_0	7	9	PCP	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	4	OP MH  SA	000000000010010000000100000000000000000000000	2		1	50	50	2			2		2						
H9988	015	0	1	04	01	H9988_015_0	7	5	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	6	Zero Cost Share	011101000000000000000010000010100010100011010	2		2			1	0.00	0.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	7	OP Rehabilitation Therapy	000000001000001000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	8	Partial Hospitalization OP Observation	000010000000000000000000000000000000000000000	2		2			1	65.00	65.00	2		2						
H9988	015	0	1	04	01	H9988_015_0	7	3	DME, Prosthetics and Supplies	000000000000000000000000011000000000000000000	2		1	25	25	2			2		2						
R3175	001	0	1	31	11	R3175_001_0	3	10	Group 10	000000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	11	Group 11	000000000000000000000000000000000010000000010	2		1	0	40	2			2		2						
R3175	001	0	1	31	11	R3175_001_0	3	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
R3175	001	0	1	31	11	R3175_001_0	3	2	Group 2	011100011101001000000000000000000000000001101	2		2			1	45.00	45.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	3	Group 3	000001000000000011011000001100001000011100000	2		1	40	40	2			2		2						
R3175	001	0	1	31	11	R3175_001_0	3	4	Group 4	000000000000000100000000000000000000000000000	2		1	40	40	1	20.00	20.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	5	Group 5	000000000000000000100000000000000000000000000	2		2			1	28.00	28.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	6	Group 6	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	7	Group 7	000000000000000000000001000000000000000000000	2		2			1	290.00	290.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	8	Group 8	000000000010110000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R3175	001	0	1	31	11	R3175_001_0	3	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R3175	001	0	1	31	11	R3175_001_0	3	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	10	Group 10	100000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R3175	002	0	1	31	11	R3175_002_0	3	8	Group 8	000000000010110000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	7	Group 7	000000000000000000000001000000000000000000000	2		2			1	290.00	290.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	6	Group 6	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	5	Group 5	000000000000000000100000000000000000000000000	2		2			1	28.00	28.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	4	Group 4	000000000000000100000000000000000000000000000	2		1	40	40	1	20.00	20.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	3	Group 3	000001000000000011011000001100001000011100000	2		1	40	40	2			2		2						
R3175	002	0	1	31	11	R3175_002_0	3	2	Group 2	011100001101001000000000000000000000000001101	2		2			1	45.00	45.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	14	Group 14	000000010000000000000000000000000000000000000	2		1	50	50	1	50.00	50.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	13	Group 13	000000000000000000000000000001000000000000000	2		2			1	50.00	50.00	2		2						
R3175	002	0	1	31	11	R3175_002_0	3	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
R3175	002	0	1	31	11	R3175_002_0	3	11	Group 11	000000000000000000000000000000000010000000010	2		1	0	40	2			2		2						
R3175	003	0	1	31	11	R3175_003_0	4	6	Group 6	000000000000000000000000000000000000000100000	2		1	30	30	2			2		2						
R3175	003	0	1	31	11	R3175_003_0	4	3	Group 3	000000000000000000000000000000000000000010000	2		1	75	75	2			2		2						
R3175	003	0	1	31	11	R3175_003_0	4	5	Group 5	000000000000000000000000000000100000100000010	2		2			1	0.00	0.00	2		2						
R3175	003	0	1	31	11	R3175_003_0	4	4	Group 4	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R3175	003	0	1	31	11	R3175_003_0	4	1	Group 1	011111111111111011111111011100001000011001101	2		1	45	45	2			2		2						
R3175	003	0	1	31	11	R3175_003_0	4	2	Group 2	000000000000000100000000000000000010000000000	2		1	0	45	2			2		2						
R3175	801	0	1	31	11	R3175_801_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R3175	801	0	1	31	11	R3175_801_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R3175	801	0	1	31	11	R3175_801_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R3175	801	0	1	31	11	R3175_801_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R3175	802	0	1	31	11	R3175_802_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R3175	802	0	1	31	11	R3175_802_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R3175	802	0	1	31	11	R3175_802_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R3175	802	0	1	31	11	R3175_802_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R3332	001	0	1	31	11	R3332_001_0	12	1	30% coinsurance	000010000000100111101100000000000010011100100	2		1	30	30	2			2		2						
R3332	001	0	1	31	11	R3332_001_0	12	10	Cardiac and Pulmonary Rehab	011100000000000000000000000000000000000000000	2		1	40	40	1	40.00	40.00	2		2						
R3332	001	0	1	31	11	R3332_001_0	12	2	Ambulance	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
R3332	001	0	1	31	11	R3332_001_0	12	3	Renal Dialysis	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R3332	001	0	1	31	11	R3332_001_0	12	9	40%	000000000000000000010010011100000000000000000	2		1	40	40	2			2		2						
R3332	001	0	1	31	11	R3332_001_0	12	5	Dental	000000000000000000000000000000000000000011000	2		1	30	50	2			2		2						
R3332	001	0	1	31	11	R3332_001_0	12	6	Hearing exams and aids	000000000000000000000000000000000000000000001	2		1	30	30	2			2		2						
R3332	001	0	1	31	11	R3332_001_0	12	7	Eye exams and eye wear	000000000000000000000000000000000000000000010	1	125.00	2			1	20.00	20.00	2		2						
R3332	001	0	1	31	11	R3332_001_0	12	8	$40 Copayment	000000111111011000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R3332	001	0	1	31	11	R3332_001_0	12	4	$0 copayment	100001000000000000000000000000000000100000000	2		2			1	0.00	0.00	2		2						
R3444	008	0	1	31	11	R3444_008_0	8	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
R3444	008	0	1	31	11	R3444_008_0	8	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
R3444	008	0	1	31	11	R3444_008_0	8	5	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
R3444	008	0	1	31	11	R3444_008_0	8	4	0% - 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
R3444	008	0	1	31	11	R3444_008_0	8	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R3444	009	0	1	31	11	R3444_009_0	8	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	5	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	6	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	7	$30 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	30.00	50.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	8	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	13	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	12	40% Copayment	000001000000000000000000010000000000000000000	2		1	40	40	2			2		2						
R3444	009	0	1	31	11	R3444_009_0	8	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
R3444	009	0	1	31	11	R3444_009_0	8	10	$150 Copayment	000000000000000000011001000000000000000000000	2		2			1	150.00	150.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
R3444	009	0	1	31	11	R3444_009_0	8	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
R3444	011	0	1	31	11	R3444_011_0	7	4	20% Coinsurance	011110111101101111111011011110000000000101101	2		1	20	20	2			2		2						
R3444	011	0	1	31	11	R3444_011_0	7	3	0% - 20% Coinsurance	000000000000000000000000000000000000000000010	2		1	0	20	2			2		2						
R3444	011	0	1	31	11	R3444_011_0	7	2	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R3444	011	0	1	31	11	R3444_011_0	7	1	$0 Copayment	000001000000000000000000100000000010111010000	2		2			1	0.00	0.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	8	$30 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	30.00	50.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
R3444	012	0	1	31	11	R3444_012_0	7	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
R3444	012	0	1	31	11	R3444_012_0	7	10	$150 Copayment	000000000000000000011001000000000000000000000	2		2			1	150.00	150.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
R3444	012	0	1	31	11	R3444_012_0	7	13	40% Coinsurance	000001000000000000000000000000000000000000000	2		1	40	40	2			2		2						
R5287	001	0	1	31	11	R5287_001_0	4	6	Group 6	000000000000000000000001000000000000000000000	2		2			1	280.00	280.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	5	Group 5	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	4	Group 4	000000000000000000100000000000000000000000000	2		2			1	24.00	24.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	7	Group 7	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	8	Group 8	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R5287	001	0	1	31	11	R5287_001_0	4	9	Group 9	000000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	3	Group 3	000000000000000100000000000000000000000000000	2		1	40	40	1	20.00	20.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	10	Group 10	000001000000000000000000010000000000000100000	2		1	50	50	2			2		2						
R5287	001	0	1	31	11	R5287_001_0	4	11	Group 11	000000000000000000000000000000000010000000000	2		1	0	40	2			2		2						
R5287	001	0	1	31	11	R5287_001_0	4	12	Group 12	000000100000000000000000000000000000000010000	2		2			1	40.00	40.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	13	Group 13	000000000000100000000000000000000000000000000	2		2			1	40.00	50.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	14	Group 14	100000000000000000000000000000000000000000000	2		2			1	340.00	390.00	2		2						
R5287	001	0	1	31	11	R5287_001_0	4	2	Group 2	000000000000000011011000001100001000011000010	2		1	40	40	2			2		2						
R5287	001	0	1	31	11	R5287_001_0	4	1	Group 1	011100011101001000000000000000000000000001101	2		2			1	50.00	50.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	11	Group 11	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
R5287	002	0	1	31	11	R5287_002_0	4	10	Group 10	000001000000000000000000010000000000000100000	2		1	50	50	2			2		2						
R5287	002	0	1	31	11	R5287_002_0	4	1	Group 1	011100011101001000000000000000000000000001101	2		2			1	50.00	50.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	12	Group 12	000000100000000000000000000000000000000010000	2		2			1	40.00	40.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	9	Group 9	000000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	8	Group 8	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R5287	002	0	1	31	11	R5287_002_0	4	7	Group 7	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	6	Group 6	000000000000000000000001000000000000000000000	2		2			1	225.00	225.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	5	Group 5	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	4	Group 4	000000000000000000100000000000000000000000000	2		2			1	24.00	24.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	13	Group 13	000000000000100000000000000000000000000000000	2		2			1	40.00	50.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	14	Group 14	100000000000000000000000000000000000000000000	2		2			1	340.00	390.00	2		2						
R5287	002	0	1	31	11	R5287_002_0	4	2	Group 2	000000000000000011011000001100001000011000010	2		1	30	30	2			2		2						
R5287	002	0	1	31	11	R5287_002_0	4	3	Group 3	000000000000000100000000000000000000000000000	2		1	30	30	1	20.00	20.00	2		2						
R5287	003	0	1	31	11	R5287_003_0	4	2	Group 2	000000000000000100000000000000000010000000000	2		1	0	50	2			2		2						
R5287	003	0	1	31	11	R5287_003_0	4	1	Group 1	011111111111111011111111011100001000011101001	2		1	50	50	2			2		2						
R5287	003	0	1	31	11	R5287_003_0	4	6	Group 6	000000000000000000000000000000000000000010000	2		2			1	40.00	40.00	2		2						
R5287	003	0	1	31	11	R5287_003_0	4	5	Group 5	000000000000000000000000000000100000100000010	2		2			1	0.00	0.00	2		2						
R5287	003	0	1	31	11	R5287_003_0	4	4	Group 4	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R5287	003	0	1	31	11	R5287_003_0	4	3	Group 3	000000000000000000000000000000000000000000100	2		1	30	50	2			2		2						
R5287	003	0	1	31	11	R5287_003_0	4	7	Group 7	000000000000000000000000100000000000000000000	2		1	75	75	2			2		2						
R5342	001	0	1	31	11	R5342_001_0	5	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R5342	001	0	1	31	11	R5342_001_0	5	10	Group 10	000000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	7	Group 7	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	6	Group 6	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	5	Group 5	000000000000000000100000000000000000000000000	2		2			1	21.00	21.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	4	Group 4	000000000000000100000000000000000000000000000	2		1	30	30	1	16.00	16.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	3	Group 3	000001000000000011011000001100001000011100010	2		1	30	30	2			2		2						
R5342	001	0	1	31	11	R5342_001_0	5	2	Group 2	011100011101001000000000000000000000000001101	2		2			1	40.00	40.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	14	Group 14	100000000000000000000000000000000000000000000	2		2			1	340.00	390.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	13	Group 13	000000000000100000000000000000000000000000000	2		2			1	20.00	40.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
R5342	001	0	1	31	11	R5342_001_0	5	11	Group 11	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
R5342	001	0	1	31	11	R5342_001_0	5	8	Group 8	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R5342	001	0	1	31	11	R5342_001_0	5	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	11	Group 11	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
R5342	002	0	1	31	11	R5342_002_0	4	12	Group 12	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
R5342	002	0	1	31	11	R5342_002_0	4	13	Group 13	000000000000100000000000000000000000000000000	2		2			1	20.00	40.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	14	Group 14	100000000000000000000000000000000000000000000	2		2			1	330.00	380.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	2	Group 2	011100011101001000000000000000000000000001101	2		2			1	40.00	40.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	3	Group 3	000001000000000011011000001100001000011100010	2		1	30	30	2			2		2						
R5342	002	0	1	31	11	R5342_002_0	4	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	5	Group 5	000000000000000000100000000000000000000000000	2		2			1	21.00	21.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	6	Group 6	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	7	Group 7	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	8	Group 8	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	9	Group 9	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R5342	002	0	1	31	11	R5342_002_0	4	10	Group 10	000000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R5342	002	0	1	31	11	R5342_002_0	4	4	Group 4	000000000000000100000000000000000000000000000	2		1	30	30	1	10.00	10.00	2		2						
R5342	003	0	1	31	11	R5342_003_0	4	4	Group 4	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R5342	003	0	1	31	11	R5342_003_0	4	5	Group 5	000000000000000000000000000000100000100000010	2		2			1	0.00	0.00	2		2						
R5342	003	0	1	31	11	R5342_003_0	4	3	Group 3	000000000000000000000000100000000000000000000	2		1	75	75	2			2		2						
R5342	003	0	1	31	11	R5342_003_0	4	2	Group 2	000000000000000100000000000000000010000000000	2		1	0	30	2			2		2						
R5342	003	0	1	31	11	R5342_003_0	4	1	Group 1	011111111111111011111111011100001000011101101	2		1	30	30	2			2		2						
R5342	801	0	1	31	11	R5342_801_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R5342	801	0	1	31	11	R5342_801_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R5342	801	0	1	31	11	R5342_801_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R5342	801	0	1	31	11	R5342_801_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R5342	802	0	1	31	11	R5342_802_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R5342	802	0	1	31	11	R5342_802_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R5342	802	0	1	31	11	R5342_802_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R5342	802	0	1	31	11	R5342_802_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R5342	803	0	1	31	11	R5342_803_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R5342	803	0	1	31	11	R5342_803_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R5342	803	0	1	31	11	R5342_803_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R5342	803	0	1	31	11	R5342_803_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R5566	005	0	1	31	11	R5566_005_0	9	2	Group 2	000000000000000000000000000010000010000000000	2		1	0	40	2			2		2						
R5566	005	0	1	31	11	R5566_005_0	9	1	Group 1	011111111111111111111111011100001000011101111	2		1	40	40	2			2		2						
R5566	805	0	1	31	11	R5566_805_0	6	2	Group 2	011111111111111111111111011100000000011101111	2		1	50	50	2			2		2						
R5566	805	0	1	31	11	R5566_805_0	6	3	Group 3	000000000000000000000000000010000000000000000	2		1	20	50	2			2		2						
R5566	805	0	1	31	11	R5566_805_0	6	1	Group 1	000000000000000000000000000000000010000000000	2		1	0	50	2			2		2						
R5674	001	0	1	31	11	R5674_001_0	5	1	Group 1	000000100000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R5674	001	0	1	31	11	R5674_001_0	5	6	Group 6	000001000000000000000000000000000000000000010	2		1	40	40	2			2		2						
R5674	001	0	1	31	11	R5674_001_0	5	9	Group 9	000000000000000000000001000000000000000000000	2		1	30	30	1	150.00	150.00	2		2						
R5674	001	0	1	31	11	R5674_001_0	5	5	Group 5	000000000000100000000000000000000000000000000	2		2			1	40.00	45.00	2		2						
R5674	001	0	1	31	11	R5674_001_0	5	7	Group 7	000010000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R5674	001	0	1	31	11	R5674_001_0	5	3	Group 3	000000000000000111111000001100001000011000000	2		1	30	30	2			2		2						
R5674	001	0	1	31	11	R5674_001_0	5	2	Group 2	011100011111011000000100000000000000000001101	2		2			1	45.00	45.00	2		2						
R5674	001	0	1	31	11	R5674_001_0	5	10	Group 10	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
R5674	001	0	1	31	11	R5674_001_0	5	8	Group 8	000000000000000000000000000000000010000000000	2		1	0	30	2			2		2						
R5674	001	0	1	31	11	R5674_001_0	5	4	Group 4	000000000000000000000000000010000000000100000	2		1	20	20	2			2		2						
R5674	801	0	1	31	11	R5674_801_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R5674	801	0	1	31	11	R5674_801_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R5674	801	0	1	31	11	R5674_801_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R5674	801	0	1	31	11	R5674_801_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R5674	802	0	1	31	11	R5674_802_0	3	4	Group 4	000010000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R5674	802	0	1	31	11	R5674_802_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R5674	802	0	1	31	11	R5674_802_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R5674	802	0	1	31	11	R5674_802_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
R5674	803	0	1	31	11	R5674_803_0	3	3	Group 3	000000000000000100000000000000000000000000000	2		1	0	20	2			2		2						
R5674	803	0	1	31	11	R5674_803_0	3	2	Group 2	000001000000000000000000000000000010011000000	2		2			1	0.00	0.00	2		2						
R5674	803	0	1	31	11	R5674_803_0	3	1	Group 1	011100111101101011111111011110000000000101111	2		1	20	20	2			2		2						
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R5941	007	0	1	31	11	R5941_007_0	6	9	$150	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
R5941	007	0	1	31	11	R5941_007_0	6	1	20%	000000000000000001000000000010000000000110000	2		1	20	20	2			2		2						
R5941	007	0	1	31	11	R5941_007_0	6	10	$0	011101000000000000000010000000000010111001110	2		2			1	0.00	0.00	2		2						
R5941	007	0	1	31	11	R5941_007_0	6	11	$300	000000000000000000001000000000000000000000000	2		2			1	30.00	300.00	2		2						
R5941	007	0	1	31	11	R5941_007_0	6	3	0% - 30%	000000000000000100000000000000000000000000000	2		1	0	30	2			2		2						
R5941	008	0	1	31	11	R5941_008_0	8	8	$50	000010000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	7	$90	000000001000001000000000000000000000000000000	2		2			1	90.00	90.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	6	$45	000000010101000000000000000000000000000000001	2		2			1	45.00	45.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	5	$30	000000100000100000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	4	$45 - $300	000000000000000000010000000000000000000000000	2		2			1	45.00	300.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	3	0% - 30%	000000000000000100000000000000000000000000000	2		1	0	30	2			2		2						
R5941	008	0	1	31	11	R5941_008_0	8	2	30%	000000000000000010100000011100000000000000000	2		1	30	30	2			2		2						
R5941	008	0	1	31	11	R5941_008_0	8	11	$150	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	10	$0	011101000000000000000010000000000010111001110	2		2			1	0.00	0.00	2		2						
R5941	008	0	1	31	11	R5941_008_0	8	1	20%	000000000000000001000000000010000000000110000	2		1	20	20	2			2		2						
R5941	008	0	1	31	11	R5941_008_0	8	9	$300	000000000000000000001000000000000000000000000	2		2			1	300.00	300.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	5	$45	000000010101000000000000000000000000000000001	2		2			1	45.00	45.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	6	$100	000000001000001000000000000000000000000000000	2		2			1	100.00	100.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	7	$50	000010000010010000000100000000000000000000000	2		2			1	50.00	50.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	3	0% to 30%	000000000000000100000000000000000000000000000	2		1	0	30	2			2		2						
R5941	009	0	1	31	11	R5941_009_0	9	10	$45 to 30%	000000000000000000010000000000000000000000000	2		1	30	30	1	45.00	45.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	4	$35	000000100000100000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	2	30% Coinsurace	000000000000000010101000011100000000000000000	2		1	30	30	2			2		2						
R5941	009	0	1	31	11	R5941_009_0	9	8	$175	000000000000000000000001000000000000000000000	2		2			1	175.00	175.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	9	$0	011101000000000000000010000000000010111001110	2		2			1	0.00	0.00	2		2						
R5941	009	0	1	31	11	R5941_009_0	9	1	20% Coinsurance	000000000000000001000000000010000000000100000	2		1	20	20	2			2		2						
R5941	801	0	1	31	11	R5941_801_0	8	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
R5941	801	0	1	31	11	R5941_801_0	8	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R5941	801	0	1	31	11	R5941_801_0	8	1	Non-Mental Health Services	011111111101101111111011011110000000011101111	2		1	20	20	2			2		2						
R5941	802	0	1	31	11	R5941_802_0	7	1	Non-Mental Health Services	011111111101101111111011011110000000011101111	2		1	20	20	2			2		2						
R5941	802	0	1	31	11	R5941_802_0	7	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R5941	802	0	1	31	11	R5941_802_0	7	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
R5941	805	0	1	31	11	R5941_805_0	7	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
R5941	805	0	1	31	11	R5941_805_0	7	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R5941	805	0	1	31	11	R5941_805_0	7	1	Non-Mental Health Services	011111111101101111111011011110000000011101111	2		1	20	20	2			2		2						
R5941	806	0	1	31	11	R5941_806_0	7	1	Non-Mental Health Services	011111111101101111111011011110000000011101111	2		1	20	20	2			2		2						
R5941	806	0	1	31	11	R5941_806_0	7	2	Mental Health Services	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R5941	806	0	1	31	11	R5941_806_0	7	3	Preventive Services	000000000000000000000000000000000010000000000	2		1	0	20	2			2		2						
R6801	008	0	1	31	11	R6801_008_0	9	4	0% - 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
R6801	008	0	1	31	11	R6801_008_0	9	3	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R6801	008	0	1	31	11	R6801_008_0	9	2	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
R6801	008	0	1	31	11	R6801_008_0	9	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	13	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	4	$25 Copayment	000000100000000000000000000000000000000000000	2		2			1	25.00	25.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	5	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	6	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	7	40% Coinsurance	000001000000000000000000010000000000000000000	2		1	40	40	2			2		2						
R6801	009	0	1	31	11	R6801_009_0	9	8	$25 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	25.00	40.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	12	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
R6801	009	0	1	31	11	R6801_009_0	9	10	$150 Copayment	000000000000000000011001000000000000000000000	2		2			1	150.00	150.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
R6801	009	0	1	31	11	R6801_009_0	9	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
R6801	011	0	1	31	11	R6801_011_0	7	4	20% Coinsurance	011110111101101111111011011110000000000101101	2		1	20	20	2			2		2						
R6801	011	0	1	31	11	R6801_011_0	7	3	0% - 20% Coinsurance	000000000000000000000000000000000000000000010	2		1	0	20	2			2		2						
R6801	011	0	1	31	11	R6801_011_0	7	2	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R6801	011	0	1	31	11	R6801_011_0	7	1	$0 Copayment	000001000000000000000000100000000010111010000	2		2			1	0.00	0.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	9	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	4	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	5	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	6	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	7	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	8	$10 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	10.00	50.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
R6801	012	0	1	31	11	R6801_012_0	7	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
R6801	012	0	1	31	11	R6801_012_0	7	10	$150 Copayment	000000000000000000011001000000000000000000000	2		2			1	150.00	150.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
R6801	012	0	1	31	11	R6801_012_0	7	13	40% Coinsurance	000001000000000000000000000000000000000000000	2		1	40	40	2			2		2						
R7439	001	0	1	31	11	R7439_001_0	10	6	Group 6 - $37	011100011001101000000000000000000000000001101	2		2			1	37.00	37.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	11	Group 11 - $42	000000100100000000000000000000000000000000000	2		2			1	42.00	42.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	10	Group 10 - $45	000010000000000000000000000000000000000000000	2		2			1	45.00	45.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	1	Group 1 - 30%	000001000000000011011000011000000000000100000	2		1	30	30	2			2		2						
R7439	001	0	1	31	11	R7439_001_0	10	3	Group 3 - $0-10	000000000000000100000000000000000000000000000	2		2			1	0.00	10.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	4	Group 4 - $35 to $45	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	5	Group 5 - $150	000000000000000000000001000000000000000000000	2		2			1	150.00	150.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	2	Group 2 - $21	000000000000000000100000000000000000000000000	2		2			1	21.00	21.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	7	Group 7 - $0	000000000000000000000010000000000010111000010	2		2			1	0.00	0.00	2		2						
R7439	001	0	1	31	11	R7439_001_0	10	8	Group 8 - 20%	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R7439	001	0	1	31	11	R7439_001_0	10	9	Group 9 - 0%-30%	000000000000000000000000000100000000000000000	2		1	0	30	2			2		2						
R7439	003	0	1	31	11	R7439_003_0	9	2	Group 2 - $30	011110111111111010100100000000000000000001101	2		2			1	30.00	30.00	2		2						
R7439	003	0	1	31	11	R7439_003_0	9	3	Group 3 - $100	000000000000000000011001000000000000000000000	2		2			1	100.00	100.00	2		2						
R7439	003	0	1	31	11	R7439_003_0	9	4	Group 4 - $0	000000000000000001000010011110000010111000010	2		2			1	0.00	0.00	2		2						
R7439	003	0	1	31	11	R7439_003_0	9	5	Goup 5 - $0 to $30	000000000000000100000000000000000000000000000	2		2			1	0.00	30.00	2		2						
R7439	003	0	1	31	11	R7439_003_0	9	1	Group 1 - 30%	000001000000000000000000000000000000000000000	2		1	30	30	2			2		2						
R7439	003	0	1	31	11	R7439_003_0	9	6	Group 6 - 25%	000000000000000000000000000000000000000100000	2		1	25	25	2			2		2						
R7439	006	0	1	31	11	R7439_006_0	8	5	Goup 5 - $0 to $30	000000000000000100000000000000000000000000000	2		2			1	0.00	30.00	2		2						
R7439	006	0	1	31	11	R7439_006_0	8	6	Group 6 - 25%	000000000000000000000000000000000000000100000	2		1	25	25	2			2		2						
R7439	006	0	1	31	11	R7439_006_0	8	4	Group 4 - $0	000000000000000001000010011110000010111000010	2		2			1	0.00	0.00	2		2						
R7439	006	0	1	31	11	R7439_006_0	8	1	Group 1 - 30%	000001000000000000000000000000000000000000000	2		1	30	30	2			2		2						
R7439	006	0	1	31	11	R7439_006_0	8	2	Group 2 - $30	011110111111111010100100000000000000000001101	2		2			1	30.00	30.00	2		2						
R7439	006	0	1	31	11	R7439_006_0	8	3	Group 3 - $100	000000000000000000011001000000000000000000000	2		2			1	100.00	100.00	2		2						
R7439	801	0	1	31	11	R7439_801_0	2	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R7439	801	0	1	31	11	R7439_801_0	2	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
R7439	801	0	1	31	11	R7439_801_0	2	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
R7439	802	0	1	31	11	R7439_802_0	3	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R7439	802	0	1	31	11	R7439_802_0	3	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
R7439	802	0	1	31	11	R7439_802_0	3	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
R7439	805	0	1	31	11	R7439_805_0	2	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
R7439	805	0	1	31	11	R7439_805_0	2	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R7439	805	0	1	31	11	R7439_805_0	2	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
R7439	806	0	1	31	11	R7439_806_0	2	2		000000000010010000000000000000000000000000000	2		1	40	40	2			2		2						
R7439	806	0	1	31	11	R7439_806_0	2	3		011110111101101111111111011110000000011101111	2		1	20	20	2			2		2						
R7439	806	0	1	31	11	R7439_806_0	2	1		000001000000000000000000000000000010000000000	2		1	0	0	2			2		2						
R7444	001	0	1	31	11	R7444_001_0	6	6	Group 6	000000000010010000000100000000000000000000000	2		2			1	35.00	45.00	2		2						
R7444	001	0	1	31	11	R7444_001_0	6	5	Group 5	000000000000000100000000000000000000000000000	2		1	30	30	1	10.00	10.00	2		2						
R7444	001	0	1	31	11	R7444_001_0	6	4	Group 4	000000000000000000000000000010000000000000000	2		1	20	20	2			2		2						
R7444	001	0	1	31	11	R7444_001_0	6	3	Group 3	000000000000000000000000010000000000000000000	2		1	50	50	2			2		2						
R7444	001	0	1	31	11	R7444_001_0	6	9	Group 9	000000000000000000000000000000000010000000000	2		2			1	0.00	30.00	2		2						
R7444	001	0	1	31	11	R7444_001_0	6	1	Group 1	011101111101101011111000001100001000011101111	2		1	30	30	2			2		2						
R7444	001	0	1	31	11	R7444_001_0	6	7	Group 7	000010000000000000000000000000000000000000000	2		2			1	75.00	75.00	2		2						
R7444	001	0	1	31	11	R7444_001_0	6	8	Group 8	000000000000000000000001000000000000000000000	2		2			1	200.00	200.00	2		2						
R7444	001	0	1	31	11	R7444_001_0	6	2	Group 2	000000000000000000000010000000000000100000000	2		2			1	0.00	0.00	2		2						
R9896	008	0	1	31	11	R9896_008_0	8	1	$0 Copayment	000001000000000000000000100000100010111000000	2		2			1	0.00	0.00	2		2						
R9896	008	0	1	31	11	R9896_008_0	8	2	$15 Copayment	000000000000000000000000000000000000000010000	2		2			1	15.00	15.00	2		2						
R9896	008	0	1	31	11	R9896_008_0	8	3	0% to 20% Coinsurance	000000000001000000000000000000000000000000010	2		1	0	20	2			2		2						
R9896	008	0	1	31	11	R9896_008_0	8	4	20% Coinsurance	011110111100101111111011011110000000000101101	2		1	20	20	2			2		2						
R9896	008	0	1	31	11	R9896_008_0	8	5	40% Coinsurance	000000000010010000000100000000000000000000000	2		1	40	40	2			2		2						
R9896	009	0	1	31	11	R9896_009_0	8	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	4	$25 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	25.00	50.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	5	$30 Copayment	000000100000000000000000000000000000000000000	2		2			1	30.00	30.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	6	$30 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	30.00	40.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	7	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	8	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	9	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	2	$10 Copayment	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	13	$0 to $10 Copayment	000000000000000000000000000000000000000001000	2		2			1	0.00	10.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	12	40% Coinsurance	000001000000000000000000010000000000000000000	2		1	40	40	2			2		2						
R9896	009	0	1	31	11	R9896_009_0	8	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
R9896	009	0	1	31	11	R9896_009_0	8	10	$150 Copayment	000000000000000000011001000000000000000000000	2		2			1	150.00	150.00	2		2						
R9896	009	0	1	31	11	R9896_009_0	8	1	$0 Copayment	000000000000000000000010100100000010111000000	2		2			1	0.00	0.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	13	40% Coinsurance	000001000000000000000000000000000000000000000	2		1	40	40	2			2		2						
R9896	012	0	1	31	11	R9896_012_0	7	14	$0 to $50 Copayment	000000000001000000000000000000000000000000010	2		2			1	0.00	50.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	2	$10 Copay	000000000000000000000000000000000000000010000	2		2			1	10.00	10.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	3	$20 Copayment	000000010000000000000000000000000000000000000	2		2			1	20.00	20.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	4	$25 to $50 Copayment	000000000000000000000000000000000000000000100	2		2			1	25.00	50.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	5	$35 Copayment	000000100000000000000000000000000000000000000	2		2			1	35.00	35.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	12	30% Coinsurance	000000000000000000000000010000000000000000000	2		1	30	30	2			2		2						
R9896	012	0	1	31	11	R9896_012_0	7	7	$40 Copayment	000010000000000000000000000000000000000000000	2		2			1	40.00	40.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	8	$50 Copayment	011100001100101000000000000000000000000000001	2		2			1	50.00	50.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	9	$100 Copayment	000000000000000000000001000000000000000000000	2		2			1	100.00	100.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	11	20% Coinsurance	000000000000000111100000001010000000000100000	2		1	20	20	2			2		2						
R9896	012	0	1	31	11	R9896_012_0	7	10	$150 Copayment	000000000000000000011000000000000000000000000	2		2			1	150.00	150.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	1	$0 Copayment	000000000000000000000010100100000010111001000	2		2			1	0.00	0.00	2		2						
R9896	012	0	1	31	11	R9896_012_0	7	6	$35 to $40 Copayment	000000000010010000000100000000000000000000000	2		2			1	35.00	40.00	2		2						
