pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_c_pos_outpt_group_num_id	pbp_c_pos_group_lbl	pbp_c_pos_oupt_bencat_bens	pbp_c_pos_outpt_mc_bencats	pbp_c_pos_outpt_nmc_bencats	pbp_c_pos_outpt_coins_yn	pbp_c_pos_outpt_coins_min_pct	pbp_c_pos_outpt_coins_max_pct	pbp_c_pos_outpt_copay_yn	pbp_c_pos_outpt_copay_min_amt	pbp_c_pos_outpt_copay_max_amt	pbp_c_pos_outpt_maxplan_yn	pbp_c_pos_outpt_maxplan_amt	pbp_c_pos_outpt_maxplan_per	pbp_c_pos_outpt_deduct_yn	pbp_c_pos_outpt_deduct_amt	pbp_c_pos_outpt_cost_share	pbp_c_pos_outpt_cs_coins_yn	pbp_c_pos_outpt_cs_coins_min	pbp_c_pos_outpt_cs_coins_max	pbp_c_pos_outpt_cs_copay_yn	pbp_c_pos_outpt_cs_copay_min	pbp_c_pos_outpt_cs_copay_max
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H0307	015	0	1	02	01	H0307_015_0	6	14		01	000000000000000000000000000010000000		1	30	30	1	0.00	100.00	2			2								
H0307	015	0	1	02	01	H0307_015_0	6	13		11	000000000000000000000010000000100010	000000100000000000001100	2			1	0.00	0.00	2			2		2						
H0307	015	0	1	02	01	H0307_015_0	6	12		01	000000000000000000000000000100010000		1	20	20	2			2			2								
H0307	015	0	1	02	01	H0307_015_0	6	11		10		000000010110000010000000	1	50	50	2			2			2								
H0307	015	0	1	02	01	H0307_015_0	6	10		01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H0307	015	0	1	02	01	H0307_015_0	6	1		01	000010010111110000000000000001001001		2			1	40.00	40.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H0316	002	0	1	02	01	H0316_002_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	25.00	25.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	30	2			2			2								
H0316	002	0	1	02	01	H0316_002_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	25.00	55.00	2			2								
H0316	002	0	1	02	01	H0316_002_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	55.00	55.00	2			2		2						
H0316	002	0	1	02	01	H0316_002_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	30	30	2			2			2		2						
H0316	002	0	1	02	01	H0316_002_0	7	4	Group 4	01	000000000000000100000000000000000000		1	30	30	1	12.00	12.00	2			2		2						
H0332	003	0	1	02	01	H0332_003_0	5	1	Group 1	01	000000010101000110111000000000000000		1	20	20	2			2			2		2						
H0332	004	0	1	02	01	H0332_004_0	5	1	Group 1	01	000000010101000110111000000000000000		1	20	20	2			2			2		2						
H0332	804	0	1	02	01	H0332_804_0	1	1		01	000000010101000110111000000000000000		1	20	20	2			2			2		2						
H0332	805	0	1	02	01	H0332_805_0	1	1		01	000000010101000110111000000000000000		1	20	20	2			2			2		2						
H0332	808	0	1	02	01	H0332_808_0	1	1		01	000000010101000110111000000000000000		1	20	20	2			2			2		2						
H0332	809	0	1	02	01	H0332_809_0	1	1		01	000000010101000110111000000000000000		1	20	20	2			2			2		2						
H0408	002	0	1	02	01	H0408_002_0	6	1	Group 1	11	011111111111111011111111111001111101	000001100000000000001000	1	30	30	2			2			2		2						
H0408	002	0	1	02	01	H0408_002_0	6	4	Group 4	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H0408	002	0	1	02	01	H0408_002_0	6	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H0408	002	0	1	02	01	H0408_002_0	6	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H0630	019	0	1	02	01	H0630_019_0	8	1	Plus Choice POS Benefit	11	011100101111111111110110110010000101	000000000000000000001010	1	30	30	2			1	1000.00	3	2		2						
H0712	001	0	1	02	01	H0712_001_0	8	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H0752	002	0	1	02	01	H0752_002_0	7	2	Group 2	01	000000000010010000000000000000000000		1	50	50	2			2			2								
H0752	002	0	1	02	01	H0752_002_0	7	3	Group 3	01	000000000000000000000000000010000000		1	0	30	2			2			2								
H0752	002	0	1	02	01	H0752_002_0	7	4	Group 4	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H0752	002	0	1	02	01	H0752_002_0	7	1	Group 1	11	000000110101100011000000000001110111	000001000001000100000000	1	30	30	2			2			2		2						
H0752	002	0	1	02	01	H0752_002_0	7	5	Group 5	10		000000000000000000001100	2			1	0.00	0.00	2			2								
H0755	807	0	1	02	01	H0755_807_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H0755	807	0	1	02	01	H0755_807_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H0755	807	0	1	02	01	H0755_807_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H0755	808	0	1	02	01	H0755_808_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H0755	808	0	1	02	01	H0755_808_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H0755	808	0	1	02	01	H0755_808_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H1032	002	0	1	02	01	H1032_002_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	025	0	1	02	01	H1032_025_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	035	0	1	02	01	H1032_035_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	061	0	1	02	01	H1032_061_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	073	0	1	02	01	H1032_073_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	091	0	1	02	01	H1032_091_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	101	0	1	02	01	H1032_101_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1032	177	0	1	02	01	H1032_177_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1035	002	0	1	02	01	H1035_002_0	9	1	Group 1	01	000001000000000111111000111000010000		1	20	20	2			2			2		2						
H1035	002	0	1	02	01	H1035_002_0	9	2	Group 2	01	011100111111011000000100000000001000		2			1	40.00	40.00	2			2								
H1035	007	0	1	02	01	H1035_007_0	4	2	Group 2	01	011100111111011000000100000000001000		2			1	40.00	40.00	2			2								
H1035	007	0	1	02	01	H1035_007_0	4	1	Group 1	01	000001000000000111111000111000010000		1	20	20	2			2			2		2						
H1036	137	0	1	02	01	H1036_137_0	6	2		11	000001000000000000000010000000000000	000000000000000000001000	2			1	0.00	0.00	2			2								
H1036	137	0	1	02	01	H1036_137_0	6	1		11	011110111111111011111100111001101101	000000000000000100000000	1	30	30	2			2			2		2						
H1036	137	0	1	02	01	H1036_137_0	6	3		01	000000000000000100000000000000000000		1	0	30	2			2			2		2						
H1036	137	0	1	02	01	H1036_137_0	6	5		01	000000000000000000000000000100010000		1	20	20	2			2			2								
H1036	137	0	1	02	01	H1036_137_0	6	6		10		000000100110000010000000	1	50	50	2			2			2								
H1036	137	0	1	02	01	H1036_137_0	6	7		01	000000000000000000000000000010000000		1	30	30	1	0.00	0.00	2			2								
H1036	137	0	1	02	01	H1036_137_0	6	4		01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1036	138	0	1	02	01	H1036_138_0	6	4		01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1036	138	0	1	02	01	H1036_138_0	6	7		01	000000000000000000000000000010000000		1	30	30	1	0.00	0.00	2			2								
H1036	138	0	1	02	01	H1036_138_0	6	6		10		000000000110000010000000	1	50	50	2			2			2								
H1036	138	0	1	02	01	H1036_138_0	6	5		01	000000000000000000000000000100000000		1	20	20	2			2			2								
H1036	138	0	1	02	01	H1036_138_0	6	3		01	000000000000000100000000000000000000		1	0	30	2			2			2		2						
H1036	138	0	1	02	01	H1036_138_0	6	2		11	000001000000000000000010000000000010	000000100000000000001000	2			1	0.00	0.00	2			2								
H1036	138	0	1	02	01	H1036_138_0	6	1		11	011110111111111011111100111001111101	000000000000000100000000	1	30	30	2			2			2		2						
H1036	149	0	1	02	01	H1036_149_0	8	1		11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H1036	149	0	1	02	01	H1036_149_0	8	4		11	011110111111111111111100011001111111	000000000000000100000000	1	30	30	2			2			2		2						
H1036	149	0	1	02	01	H1036_149_0	8	2		01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1036	149	0	1	02	01	H1036_149_0	8	3		01	000000000000000000000000000100000000		1	20	20	2			2			2								
H1036	149	0	1	02	01	H1036_149_0	8	6		01	000000000000000000000000000010000000		1	0	30	2			2			2								
H1036	149	0	1	02	01	H1036_149_0	8	5		10		000000000010000010000000	1	50	50	2			2			2								
H1045	001	0	1	02	01	H1045_001_0	4	1		01	010000000100000111110010000010000000		2			2			2			2		2						
H1045	012	0	1	02	01	H1045_012_0	3	1		01	010000000100000111110010000010000000		2			2			2			2		2						
H1080	004	0	1	02	01	H1080_004_0	7	1	Group 1	11	000000100000000000000000000000000000	000000000000000000100000	2			1	40.00	40.00	2			2								
H1080	004	0	1	02	01	H1080_004_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1080	004	0	1	02	01	H1080_004_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	40.00	45.00	2			2								
H1080	004	0	1	02	01	H1080_004_0	7	12	Group 12	01	000000000000000000000000000000010000		1	50	50	2			2			2								
H1080	004	0	1	02	01	H1080_004_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	45.00	45.00	2			2		2						
H1080	004	0	1	02	01	H1080_004_0	7	3	Group 3	11	000000000000000011011000011001100010	000000000001000100000000	1	30	30	2			2			2		2						
H1080	004	0	1	02	01	H1080_004_0	7	4	Group 4	01	000000000000000100000000000000000000		1	30	30	1	13.00	13.00	2			2		2						
H1080	004	0	1	02	01	H1080_004_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	30	2			2			2								
H1080	004	0	1	02	01	H1080_004_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H1080	004	0	1	02	01	H1080_004_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H1080	004	0	1	02	01	H1080_004_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H1080	004	0	1	02	01	H1080_004_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H1099	001	0	1	02	01	H1099_001_0	9	1		11	011111111111111111111111111011100101	000000000000000010000000	1	20	20	2			1	500000.00	3	2		2						
H1099	804	0	1	02	01	H1099_804_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H1099	804	0	1	02	01	H1099_804_0	5	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H1099	804	0	1	02	01	H1099_804_0	5	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H1112	027	0	1	02	01	H1112_027_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1216	001	0	1	02	01	H1216_001_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1264	004	0	1	02	01	H1264_004_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H1286	002	0	1	02	01	H1286_002_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H1286	002	0	1	02	01	H1286_002_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H1286	002	0	1	02	01	H1286_002_0	7	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	13.00	13.00	2			2		2						
H1286	002	0	1	02	01	H1286_002_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H1286	002	0	1	02	01	H1286_002_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H1286	002	0	1	02	01	H1286_002_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H1286	002	0	1	02	01	H1286_002_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H1286	002	0	1	02	01	H1286_002_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H1286	002	0	1	02	01	H1286_002_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1286	002	0	1	02	01	H1286_002_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H1286	002	0	1	02	01	H1286_002_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H1286	003	0	1	02	01	H1286_003_0	3	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H1286	003	0	1	02	01	H1286_003_0	3	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H1286	003	0	1	02	01	H1286_003_0	3	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1286	003	0	1	02	01	H1286_003_0	3	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H1286	003	0	1	02	01	H1286_003_0	3	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H1286	003	0	1	02	01	H1286_003_0	3	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	10.00	10.00	2			2		2						
H1286	003	0	1	02	01	H1286_003_0	3	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H1286	003	0	1	02	01	H1286_003_0	3	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H1286	003	0	1	02	01	H1286_003_0	3	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H1286	003	0	1	02	01	H1286_003_0	3	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H1286	003	0	1	02	01	H1286_003_0	3	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H1286	804	0	1	02	01	H1286_804_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H1286	804	0	1	02	01	H1286_804_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H1286	804	0	1	02	01	H1286_804_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H1406	022	0	1	02	01	H1406_022_0	7	1		10		000000000000000000000011	1	25	25	2			2			2								
H1406	022	0	1	02	01	H1406_022_0	7	2		11	011111111111111111111100111001111101	000001000110000110000000	1	50	50	2			2			2		2						
H1406	022	0	1	02	01	H1406_022_0	7	3		01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H1406	022	0	1	02	01	H1406_022_0	7	4		01	000000000000000000000000000100000000		1	20	20	2			2			2								
H1406	022	0	1	02	01	H1406_022_0	7	5		11	000000000000000000000010000000000010	000000100000000000001000	2			1	0.00	0.00	2			2								
H1406	022	0	1	02	01	H1406_022_0	7	6		01	000000000000000000000000000010000000		1	0	50	2			2			2								
H1415	021	0	1	02	01	H1415_021_0	7	1		01	011111111111111111111110110000000000		1	30	30	2			2			2		2						
H1415	021	0	1	02	01	H1415_021_0	7	2	Air Ambulance	01	000000000000000000000001000000000000		1	20	20	2			2			2								
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H1463	008	0	1	02	01	H1463_008_0	3	1	All Services	01	011111111111111111111111111111110101		2			2			2			1	5000.00	2						
H1463	009	0	1	02	01	H1463_009_0	5	1	All Services	01	011111111111111111111111111111110101		2			2			2			1	5000.00	2						
H1903	022	0	1	02	01	H1903_022_0	6	1	Group 1	01	011101011101101111111011111001110000		1	30	30	2			2			2		2						
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H1961	802	0	1	02	01	H1961_802_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H1961	802	0	1	02	01	H1961_802_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
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H2012	006	0	1	02	01	H2012_006_0	6	2		11	000001000000000000000010000000000000	000000100000000000001000	2			1	0.00	0.00	2			2								
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H2012	030	0	1	02	01	H2012_030_0	10	5		01	000000000000000110100000000000110000		1	30	40	1	25.00	25.00	2			2		2						
H2012	030	0	1	02	01	H2012_030_0	10	4		01	011100001000001001000000000000000000		1	30	40	2			2			2		2						
H2012	030	0	1	02	01	H2012_030_0	10	2		11	000000100000000000000000000000000000	000000000000000100000000	2			1	25.00	25.00	2			2								
H2012	030	0	1	02	01	H2012_030_0	10	11		01	000000000000000000000000000001000000		1	30	30	1	25.00	25.00	2			2								
H2012	030	0	1	02	01	H2012_030_0	10	10		01	000000000000000000000000000010000000		1	30	40	1	0.00	25.00	2			2								
H2012	030	0	1	02	01	H2012_030_0	10	1		10		000000000110000010000000	1	50	50	2			2			2								
H2012	038	0	1	02	01	H2012_038_0	7	1		11	000000000000000000000010000000000000	000000100000000000001000	2			1	0.00	0.00	2			2								
H2012	038	0	1	02	01	H2012_038_0	7	5		10		000000000110000010000000	1	50	50	2			2			2								
H2012	038	0	1	02	01	H2012_038_0	7	4		11	011110111111111111111100011001111111	000000000000000100000000	1	30	30	2			2			2		2						
H2012	038	0	1	02	01	H2012_038_0	7	2		01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H2012	038	0	1	02	01	H2012_038_0	7	3		01	000000000000000000000000000100000000		1	20	20	2			2			2								
H2012	038	0	1	02	01	H2012_038_0	7	6		01	000000000000000000000000000010000000		1	0	30	2			2			2								
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H2012	046	0	1	02	01	H2012_046_0	6	7		01	000000000000000000000000000010000000		1	30	30	1	0.00	0.00	2			2								
H2012	046	0	1	02	01	H2012_046_0	6	3		01	000000000000000100000000000000000000		1	0	30	2			2			2		2						
H2012	046	0	1	02	01	H2012_046_0	6	5		01	000000000000000000000000000100010000		1	20	20	2			2			2								
H2012	046	0	1	02	01	H2012_046_0	6	2		11	000001000000000000000010000000000010	000000100000000000001000	2			1	0.00	0.00	2			2								
H2012	046	0	1	02	01	H2012_046_0	6	6		10		000000000000000010000000	1	50	50	2			2			2								
H2012	046	0	1	02	01	H2012_046_0	6	1		11	011110111111111011111100111001001101	000000000000000100000000	1	30	30	2			2			2		2						
H2165	011	0	1	02	01	H2165_011_0	6	2		01	000000000000000000000001000000000000		1	20	20	1	100.00	100.00	2			2								
H2165	011	0	1	02	01	H2165_011_0	6	1		01	011110111111111111111110110000010000		1	30	30	2			2			2		2						
H2165	015	0	1	02	01	H2165_015_0	6	1		01	011110111111111111111110110000010000		1	30	30	2			2			2		2						
H2165	015	0	1	02	01	H2165_015_0	6	2		01	000000000000000000000001000000000000		1	20	20	1	100.00	100.00	2			2								
H2165	805	0	1	02	01	H2165_805_0	2	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2165	805	0	1	02	01	H2165_805_0	2	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2165	805	0	1	02	01	H2165_805_0	2	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2165	806	0	1	02	01	H2165_806_0	2	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2165	806	0	1	02	01	H2165_806_0	2	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2165	806	0	1	02	01	H2165_806_0	2	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2165	809	0	1	02	01	H2165_809_0	2	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2165	809	0	1	02	01	H2165_809_0	2	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2165	809	0	1	02	01	H2165_809_0	2	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2165	810	0	1	02	01	H2165_810_0	2	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2165	810	0	1	02	01	H2165_810_0	2	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2165	810	0	1	02	01	H2165_810_0	2	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2182	001	0	1	02	01	H2182_001_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H2182	001	0	1	02	01	H2182_001_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H2182	001	0	1	02	01	H2182_001_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H2182	001	0	1	02	01	H2182_001_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H2182	001	0	1	02	01	H2182_001_0	7	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	13.00	13.00	2			2		2						
H2182	001	0	1	02	01	H2182_001_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H2182	001	0	1	02	01	H2182_001_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H2182	001	0	1	02	01	H2182_001_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H2182	001	0	1	02	01	H2182_001_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H2182	001	0	1	02	01	H2182_001_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H2182	001	0	1	02	01	H2182_001_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H2312	007	0	1	02	01	H2312_007_0	5	1		11	011101111101101111111011001011100111	000000100000000110001110	1	20	20	2			2			2		2						
H2312	010	0	1	02	01	H2312_010_0	5	1		11	011101111101101111111011001011111111	000000100000000110001010	1	20	20	2			2			2		2						
H2312	012	0	1	02	01	H2312_012_0	6	1		11	011101111101101111111011001011100111	000000100000000110001010	1	20	20	2			2			2		2						
H2312	805	0	1	02	01	H2312_805_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2312	805	0	1	02	01	H2312_805_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2312	805	0	1	02	01	H2312_805_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2312	807	0	1	02	01	H2312_807_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2312	807	0	1	02	01	H2312_807_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2312	807	0	1	02	01	H2312_807_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2320	007	0	1	02	01	H2320_007_0	9	1	30% Coinsurance	11	011100111111111111111110111111100111	000000000000000100000000	1	30	30	2			2			2		2						
H2320	007	0	1	02	01	H2320_007_0	9	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	007	0	1	02	01	H2320_007_0	9	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	007	0	1	02	01	H2320_007_0	9	3	$0 Copay	11	000001000000000000000000000000000000	000000100001000000100001	2			2			2			2								
H2320	008	0	1	02	01	H2320_008_0	7	1	30% Coinsurance	11	011100111111111111111110111111100111	000000000000000100000000	1	30	30	2			2			2		2						
H2320	008	0	1	02	01	H2320_008_0	7	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	008	0	1	02	01	H2320_008_0	7	4	40% Coinsuramce	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	008	0	1	02	01	H2320_008_0	7	3	$0 Copay	11	000001000000000000000000000000000000	000000100001000000100001	2			2			2			2								
H2320	011	0	1	02	01	H2320_011_0	9	3	$0 Copayment	11	000001000000000000000000000000000000	000000100001000000100000	2			2			2			2								
H2320	011	0	1	02	01	H2320_011_0	9	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	011	0	1	02	01	H2320_011_0	9	1	30% Coinsurance	11	011100111111111111111110111111100101	000000000000000100000000	1	30	30	2			2			2		2						
H2320	011	0	1	02	01	H2320_011_0	9	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	012	0	1	02	01	H2320_012_0	8	1	30% Coinsurance	11	011100111111111111111110111111100101	000000000000000100000000	1	30	30	2			2			2		2						
H2320	012	0	1	02	01	H2320_012_0	8	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	012	0	1	02	01	H2320_012_0	8	3	$0 Copayment	11	000001000000000000000000000000000000	000000100001000000100000	2			2			2			2								
H2320	012	0	1	02	01	H2320_012_0	8	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	013	0	1	02	01	H2320_013_0	7	3	$0 Copay	11	000001000000000000000000000000000000	000000100001000000100001	2			2			2			2								
H2320	013	0	1	02	01	H2320_013_0	7	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	013	0	1	02	01	H2320_013_0	7	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	013	0	1	02	01	H2320_013_0	7	1	30% Coinsurance	11	011100111111111111111110111111100111	000000000000000100000000	1	30	30	2			2			2		2						
H2320	015	0	1	02	01	H2320_015_0	7	1	30% Coinsurance	11	011100111111111111111110111111100101	000000000000000100000000	1	30	30	2			2			2		2						
H2320	015	0	1	02	01	H2320_015_0	7	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	015	0	1	02	01	H2320_015_0	7	3	$0 Copayment	11	000001000000000000000000000000000000	000000100001000000100000	2			2			2			2								
H2320	015	0	1	02	01	H2320_015_0	7	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	016	0	1	02	01	H2320_016_0	7	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	016	0	1	02	01	H2320_016_0	7	3	$0 Copay	11	000001000000000000000000000000000000	000000100001000000100001	2			2			2			2								
H2320	016	0	1	02	01	H2320_016_0	7	1	30% Coinsurance	11	011100111111111111111110111111100111	000000000000000100000000	1	30	30	2			2			2		2						
H2320	016	0	1	02	01	H2320_016_0	7	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	018	0	1	02	01	H2320_018_0	8	1	30% Coinsurance	11	011100111111111111111110111111100101	000000000000000100000000	1	30	30	2			2			2		2						
H2320	018	0	1	02	01	H2320_018_0	8	3	$0 Copayment	11	000001000000000000000000000000000000	000000100001000000100000	2			2			2			2								
H2320	018	0	1	02	01	H2320_018_0	8	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	018	0	1	02	01	H2320_018_0	8	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	019	0	1	02	01	H2320_019_0	7	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	019	0	1	02	01	H2320_019_0	7	1	30% Coinsurance	11	011100111111111111111110111111100111	000000000000000100000000	1	30	30	2			2			2		2						
H2320	019	0	1	02	01	H2320_019_0	7	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	019	0	1	02	01	H2320_019_0	7	3	$0 Copay	11	000001000000000000000000000000000000	000000100001000000100001	2			2			2			2								
H2320	021	0	1	02	01	H2320_021_0	8	4	40% Coinsurance	01	000010000000000000000000000000000000		1	40	40	2			2			2								
H2320	021	0	1	02	01	H2320_021_0	8	3	$0 Copayment	11	000001000000000000000000000000000000	000000100001000000100000	2			2			2			2								
H2320	021	0	1	02	01	H2320_021_0	8	2	20% Coinsurance	01	000000000000000000000000000000010000		1	20	20	2			2			2								
H2320	021	0	1	02	01	H2320_021_0	8	1	30% Coinsurance	11	011100111111111111111110111111100101	000000000000000100000000	1	30	30	2			2			2		2						
H2320	802	0	1	02	01	H2320_802_0	4	1	20% - 40% Coinsurance	01	011111111111111111111111111011101111		1	20	40	2			2			2		2						
H2320	803	0	1	02	01	H2320_803_0	4	1	20% - 40% Coinsurance	01	011111111111111111111111111011101111		1	20	40	2			2			2		2						
H2354	001	0	1	02	01	H2354_001_0	17	2	Group 2 - $15 Copay	01	000000100000000000000000000000000000		2			1	15.00	15.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	1	Group 1 - $0 Copay	11	011001000000000000000010001010000000	000000000000000010000000	2			1	0.00	0.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	4	Group 4 - $35 Copay	01	000100001101101000000000000000000001		2			1	35.00	35.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	9	Group 9 - Office Visit Copay may apply	01	000000000000000111100000000000100100		2			1	0.00	0.00	2			2		1	2			1	15.00	35.00
H2354	001	0	1	02	01	H2354_001_0	17	6	Group 6 - $50 Copay	01	000000000000000000000001000000000000		2			1	50.00	50.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	7	Group 7 - $100 Copay	01	000000000000000000001000000000000000		2			1	100.00	100.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	8	Group 8 - $200 Copay	01	000000000000000000010000000000000000		2			1	200.00	200.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	3	Group 3 - $20 Copay	01	000000010000000000000000000000000000		2			1	20.00	20.00	2			2								
H2354	001	0	1	02	01	H2354_001_0	17	5	Group 5 - $0-$35	01	000000000000000000000000000000000100		2			1	0.00	35.00	2			2		1	2			1	15.00	35.00
H2354	013	0	1	02	01	H2354_013_0	18	1	Group 1 - $0 Copay	11	011001000000000000000010001010000000	000000000000000010000000	2			1	0.00	0.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	2	Group 2 - $10 Copay	01	000000100000000000000000000000000000		2			1	10.00	10.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	9	Group 9 - Office Visit Copay may apply	01	000000000000000111100000000000100100		2			1	0.00	0.00	2			2		1	2			1	10.00	25.00
H2354	013	0	1	02	01	H2354_013_0	18	8	Group 8 - $100 Copay	01	000000000000000000010000000000000000		2			1	100.00	100.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	7	Group 7 - $50 Copay	01	000000000000000000001000000000000000		2			1	50.00	50.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	6	Group 6 - $20 Copay	01	000000000000000000000001000000000000		2			1	25.00	25.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	3	Group 3 - $20 Copay	01	000000010000000000000000000000000000		2			1	20.00	20.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	4	Group 4 - $25 Copay	01	000100001101101000000000000000000001		2			1	25.00	25.00	2			2								
H2354	013	0	1	02	01	H2354_013_0	18	5	Group 5 - $0-$25	01	000000000000000000000000000000000100		2			1	0.00	25.00	2			2		1	2			1	10.00	25.00
H2354	015	0	1	02	01	H2354_015_0	20	4	Group 4 - $35 Copay	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H2354	015	0	1	02	01	H2354_015_0	20	3	Group 3 - $20 Copay	01	000000010000000000000000000000000000		2			1	20.00	20.00	2			2								
H2354	015	0	1	02	01	H2354_015_0	20	2	Group 2 - 20% Coinsurance	01	000100001001101000011001000000000001		1	20	20	2			2			2								
H2354	015	0	1	02	01	H2354_015_0	20	1	Group 1 - 0% Coinsurance	11	011001000000000000000010001010000000	000000000000000010000000	1	0	0	2			2			2								
H2354	015	0	1	02	01	H2354_015_0	20	6	Group 6 - 20% (Office Copay may apply)	01	000000000000000111100000000000000000		1	20	20	2			2			2		1	2			1	35.00	50.00
H2354	015	0	1	02	01	H2354_015_0	20	5	Group 5 - $50	01	000000000100000000000000000000000000		2			1	50.00	50.00	2			2								
H2425	002	0	1	02	01	H2425_002_0	11	1	Group 1	11	011111111111111111111111111001111111	000000000000000100001010	1	40	40	2			2			2		2						
H2425	002	0	1	02	01	H2425_002_0	11	2	Group 2	01	000000000000000000000000000110000000		1	0	40	2			2			2								
H2459	001	0	1	02	01	H2459_001_0	6	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H2459	001	0	1	02	01	H2459_001_0	6	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	1	0.00	25.00	2			2		1	1	20	20	2		
H2459	002	0	1	02	01	H2459_002_0	8	2	Non-Medicare-covered Preventive Dental	10		000000000000000000100000	2			2			2			2								
H2459	002	0	1	02	01	H2459_002_0	8	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H2459	002	0	1	02	01	H2459_002_0	8	3	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	2			2			2		1	1	20	20	2		
H2459	013	0	1	02	01	H2459_013_0	7	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	1	0.00	25.00	2			2		1	1	20	20	2		
H2459	013	0	1	02	01	H2459_013_0	7	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H2459	018	0	1	02	01	H2459_018_0	8	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	1	0.00	35.00	2			2		1	1	20	20	2		
H2459	018	0	1	02	01	H2459_018_0	8	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H2459	019	0	1	02	01	H2459_019_0	9	3	Non-Medicare-covered Dental	10		000000000000000000110000	2			2			2			2								
H2459	019	0	1	02	01	H2459_019_0	9	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H2459	019	0	1	02	01	H2459_019_0	9	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	10	20	2			2			2		1	1	20	20	2		
H2459	801	0	1	02	01	H2459_801_0	5	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2459	801	0	1	02	01	H2459_801_0	5	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2459	801	0	1	02	01	H2459_801_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2491	002	0	1	02	01	H2491_002_0	7	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H2491	004	0	1	02	01	H2491_004_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H2649	021	0	1	02	01	H2649_021_0	7	4		01	000000100100000000000000000000000000		2			1	0.00	250.00	2			2								
H2649	021	0	1	02	01	H2649_021_0	7	3		11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H2649	021	0	1	02	01	H2649_021_0	7	2		01	000000000000000000010000000000000000		1	20	30	1	300.00	300.00	2			2								
H2649	021	0	1	02	01	H2649_021_0	7	1		10		000000000110000010000000	1	50	50	2			2			2								
H2654	010	0	1	02	01	H2654_010_0	8	2	Group 2	01	000000000000000100000000000000000000		1	40	40	1	14.00	14.00	2			2		2						
H2654	010	0	1	02	01	H2654_010_0	8	3	Group 3	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H2654	010	0	1	02	01	H2654_010_0	8	4	Group 4	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H2654	010	0	1	02	01	H2654_010_0	8	1	Group 1	01	011100001000001011011000000000000000		1	40	40	2			2			2		2						
H2654	010	0	1	02	01	H2654_010_0	8	5	Group 5	10		000000000000000010000000	2			1	0.00	0.00	2			2								
H2654	013	0	1	02	01	H2654_013_0	7	5	Group 5	10		000000000000000010000000	2			1	0.00	0.00	2			2								
H2654	013	0	1	02	01	H2654_013_0	7	4	Group 4	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H2654	013	0	1	02	01	H2654_013_0	7	3	Group 3	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H2654	013	0	1	02	01	H2654_013_0	7	2	Group 2	01	000000000000000100000000000000000000		1	35	35	1	14.00	14.00	2			2		2						
H2654	013	0	1	02	01	H2654_013_0	7	1	Group 1	01	011100001000001011011000000000000000		1	35	35	2			2			2		2						
H2654	029	0	1	02	01	H2654_029_0	7	3	Group 3	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H2654	029	0	1	02	01	H2654_029_0	7	1	Group 1	01	011100001000001011011000000000000000		1	35	35	2			2			2		2						
H2654	029	0	1	02	01	H2654_029_0	7	5	Group 5	10		000000000000000010000000	2			1	0.00	0.00	2			2								
H2654	029	0	1	02	01	H2654_029_0	7	2	Group 2	01	000000000000000100000000000000000000		1	35	35	1	14.00	14.00	2			2		2						
H2654	029	0	1	02	01	H2654_029_0	7	4	Group 4	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H2663	002	0	1	02	01	H2663_002_0	10	1	Out of Network--Other	01	011111111111111111111111111010111101		1	30	30	2			2			2		2						
H2663	015	0	1	02	01	H2663_015_0	8	2	Supplemental Education/Wellness Programs	10		000000000000000010000000	2			1	0.00	50.00	2			2								
H2663	015	0	1	02	01	H2663_015_0	8	1	Out of Network--Other	01	011111111111111111111111111011111101		1	30	30	2			2			2		2						
H2667	017	0	1	02	01	H2667_017_0	10	2		01	000000000000000111111000000000000000		1	40	40	2			1	10000.00	3	2		2						
H2667	017	0	1	02	01	H2667_017_0	10	1		01	000000000100000000000000000000000000		1	40	40	2			1	5000.00	3	2								
H2672	009	0	1	02	01	H2672_009_0	12	1		01	000000000100000000000000000000000000		1	40	40	2			1	5000.00	3	2								
H2672	009	0	1	02	01	H2672_009_0	12	2		01	000000000000000111111000000000000000		1	40	40	2			1	10000.00	3	2		2						
H2803	001	0	1	02	01	H2803_001_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H2803	001	0	1	02	01	H2803_001_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H2803	001	0	1	02	01	H2803_001_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H2803	001	0	1	02	01	H2803_001_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H2803	001	0	1	02	01	H2803_001_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H2803	001	0	1	02	01	H2803_001_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H2803	001	0	1	02	01	H2803_001_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H2803	001	0	1	02	01	H2803_001_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H2803	001	0	1	02	01	H2803_001_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H2803	001	0	1	02	01	H2803_001_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H2803	001	0	1	02	01	H2803_001_0	7	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	14.00	14.00	2			2		2						
H2803	002	0	1	02	01	H2803_002_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H2803	002	0	1	02	01	H2803_002_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	60.00	60.00	2			2		2						
H2803	002	0	1	02	01	H2803_002_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	60.00	2			2								
H2803	002	0	1	02	01	H2803_002_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H2803	002	0	1	02	01	H2803_002_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H2803	002	0	1	02	01	H2803_002_0	7	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	14.00	14.00	2			2		2						
H2803	002	0	1	02	01	H2803_002_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H2803	002	0	1	02	01	H2803_002_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H2803	002	0	1	02	01	H2803_002_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H2803	002	0	1	02	01	H2803_002_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H2803	002	0	1	02	01	H2803_002_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H2803	010	0	1	02	01	H2803_010_0	6	1	Group 1	11	011111111111111011111111111001111101	000001100000000000000000	1	30	30	2			2			2		2						
H2803	010	0	1	02	01	H2803_010_0	6	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H2803	010	0	1	02	01	H2803_010_0	6	3	Group 3	01	000000000000000000000000000000000010		2			1	0.00	0.00	2			2								
H2803	010	0	1	02	01	H2803_010_0	6	4	Group 4	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H2803	012	0	1	02	01	H2803_012_0	6	3	Group 3	01	000000000000000000000000000000000010		2			1	0.00	0.00	2			2								
H2803	012	0	1	02	01	H2803_012_0	6	1	Group 1	11	011111111111111011111111111001111101	000001100000000000000000	1	30	30	2			2			2		2						
H2803	012	0	1	02	01	H2803_012_0	6	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H2803	012	0	1	02	01	H2803_012_0	6	4	Group 4	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H2803	801	0	1	02	01	H2803_801_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H2803	801	0	1	02	01	H2803_801_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H2803	801	0	1	02	01	H2803_801_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H2931	002	0	1	02	01	H2931_002_0	10	1	Group 1	01	000000100000000000000000000000000000		2			1	40.00	40.00	2			2								
H2931	002	0	1	02	01	H2931_002_0	10	2	Group 2	11	011100011111011000000100000000001101	000000000000000000000010	2			1	50.00	50.00	2			2		2						
H2931	002	0	1	02	01	H2931_002_0	10	3	Group 3	11	000011000000000011111010011001110010	000000100001000100000000	1	40	40	2			2			2		2						
H2931	002	0	1	02	01	H2931_002_0	10	8	Group 8	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H2931	002	0	1	02	01	H2931_002_0	10	5	Group 5	01	000000000000000100000000000000000000		1	40	50	2			2			2		2						
H2931	002	0	1	02	01	H2931_002_0	10	6	Group 6	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H2931	002	0	1	02	01	H2931_002_0	10	7	Group 7	01	000000000000100000000000000000000000		2			1	40.00	50.00	2			2								
H2931	002	0	1	02	01	H2931_002_0	10	4	Group 4	01	000000000000000000000001000000000000		1	40	40	1	150.00	150.00	2			2								
H3107	807	0	1	02	01	H3107_807_0	2	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3107	807	0	1	02	01	H3107_807_0	2	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3107	807	0	1	02	01	H3107_807_0	2	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3154	005	0	1	02	01	H3154_005_0	6	1		11	011111111111111111111111111111111111	000000100001000000001010	1	35	35	2			2			2		2						
H3154	006	0	1	02	01	H3154_006_0	6	1		11	011111111111111111111111111111111111	000000100001000000001010	1	35	35	2			2			2		2						
H3154	012	0	1	02	01	H3154_012_0	7	1		11	011111111111111111111111111111111111	000000100001000000001010	1	35	35	2			2			2		2						
H3154	801	0	1	02	01	H3154_801_0	4	1		11	011111111111111111111111111111111111	000000100001000000001010	1	35	35	2			2			2		2						
H3154	802	0	1	02	01	H3154_802_0	4	1		11	011111111111111111111111111111111111	000000100001000000001010	1	35	35	2			2			2		2						
H3154	805	0	1	02	01	H3154_805_0	4	1		11	011111111111111111111111111111111111	000000100001000000001010	1	35	35	2			2			2		2						
H3251	021	0	1	02	01	H3251_021_0	9	3	Group 3 - $250	01	000000000000000000011000000000000000		2			1	250.00	250.00	2			2								
H3251	021	0	1	02	01	H3251_021_0	9	4	Group 4 - $75	01	000000000000000000000001000000000000		2			1	75.00	75.00	2			2								
H3251	021	0	1	02	01	H3251_021_0	9	2	Group 2 - $40	01	000000000111110000000100000000000000		2			1	40.00	40.00	2			2								
H3251	021	0	1	02	01	H3251_021_0	9	6	Group 6 - $0	01	000001000000000000000000000011100000		2			2			2			2		2						
H3251	021	0	1	02	01	H3251_021_0	9	1	Group 1 - 20%	01	011110001000001111100010111000000000		1	20	20	2			2			2		2						
H3251	021	0	1	02	01	H3251_021_0	9	5	Group 5 - $20	01	000000100000000000000000000000000000		2			1	20.00	20.00	2			2								
H3305	007	0	1	02	01	H3305_007_0	5	1	POS Benefit - 30% Coinsurance	01	011110111101001111111011110000000000		1	30	30	2			1	5000.00	3	2		2						
H3305	011	0	1	02	01	H3305_011_0	6	1	POS Benefit - 30% Coinsurance	01	011110111101001111111011110000000000		1	30	30	2			1	5000.00	3	2		2						
H3305	015	0	1	02	01	H3305_015_0	6	1	POS Benefit - 30% Coinsurance	01	011110111101001111111011110000000000		1	30	30	2			1	5000.00	3	2		2						
H3305	801	0	1	02	01	H3305_801_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3305	801	0	1	02	01	H3305_801_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3305	801	0	1	02	01	H3305_801_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3305	803	0	1	02	01	H3305_803_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3305	803	0	1	02	01	H3305_803_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3305	803	0	1	02	01	H3305_803_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3307	807	0	1	02	01	H3307_807_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3307	807	0	1	02	01	H3307_807_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3307	807	0	1	02	01	H3307_807_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3327	038	0	1	02	01	H3327_038_0	7	1		11	011111111111111111111111111011100101	000001100000000010001010	1	20	20	2			2			2		2						
H3327	039	0	1	02	01	H3327_039_0	5	1		11	011111111111111111111111111011100101	000001100000000010001010	1	20	20	2			2			2		2						
H3327	805	0	1	02	01	H3327_805_0	6	1		01	011111111111111111111111111011100101		1	20	20	2			2			2		2						
H3327	806	0	1	02	01	H3327_806_0	6	1		01	011111111111111111111111111011100101		1	20	20	2			2			2		2						
H3327	807	0	1	02	01	H3327_807_0	6	1		01	011111111111111111111111111011100101		1	20	20	2			2			2		2						
H3328	001	0	1	02	01	H3328_001_0	5	3	Outpatient Diagnostic	01	000000000000000100000000000000000000		1	0	50	2			2			2		1	1	50	50	2		
H3328	001	0	1	02	01	H3328_001_0	5	2	Specialty Services  ASC  Outpatient SA	01	011110011111111000001100000000000000		1	50	50	2			2			2								
H3328	001	0	1	02	01	H3328_001_0	5	1	Preventive Services	01	000000000000000000000010000011100000		2			2			2			2		2						
H3328	003	0	1	02	01	H3328_003_0	6	2	Specialty Services  ASC Surgery	01	011110011111111000001100000000000000		1	50	50	2			2			2								
H3328	003	0	1	02	01	H3328_003_0	6	3	Outpatient Testing	01	000000000000000100000000000000000000		1	0	50	2			2			2		2						
H3328	003	0	1	02	01	H3328_003_0	6	1	Preventive  Training	01	000000000000000000000010000011100000		2			2			2			2		2						
H3328	801	0	1	02	01	H3328_801_0	2	2	Mental Health and Psychiatry	01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3328	801	0	1	02	01	H3328_801_0	2	1		01	011111111101101111111111111011100101		1	20	20	2			2			2		2						
H3328	802	0	1	02	01	H3328_802_0	1	1		01	011111111101101111111111111011100101		1	20	20	2			2			2		2						
H3328	802	0	1	02	01	H3328_802_0	1	2	Mental Health and Psychiatry	01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3328	803	0	1	02	01	H3328_803_0	1	2	Mental Health and Psychiatry	01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3328	803	0	1	02	01	H3328_803_0	1	1		01	011111111101101111111111111011100101		1	20	20	2			2			2		2						
H3351	001	0	1	02	01	H3351_001_0	5	1	POS Group #1	01	011101111101101111111011111011110101		1	30	30	2			2			2		2						
H3351	002	0	1	02	01	H3351_002_0	8	1	POS Group #1	01	011101111101101111111011111011110101		1	30	30	2			2			2		2						
H3351	006	0	1	02	01	H3351_006_0	7	1	POS Group #1	01	011101111101101111111011111011110101		1	30	30	2			2			2		2						
H3351	007	0	1	02	01	H3351_007_0	5	1	POS Group #1	01	011101111101101111111011111011110101		1	30	30	2			2			2		2						
H3351	801	0	1	02	01	H3351_801_0	4	1	POS Group #1	01	011101111101101111111011111011110101		1	20	20	2			1	5000.00	3	2		2						
H3351	802	0	1	02	01	H3351_802_0	4	1	POS Group #1	01	011101111101101111111011111011110101		1	20	20	2			1	5000.00	3	2		2						
H3351	803	0	1	02	01	H3351_803_0	4	1	POS Group #1	01	011101111101101111111011111011110101		1	20	20	2			1	5000.00	3	2		2						
H3351	804	0	1	02	01	H3351_804_0	4	1	POS Group #1	01	011101111101101111111011111011110101		1	20	20	2			1	5000.00	3	2		2						
H3351	805	0	1	02	01	H3351_805_0	4	1	POS Group #1	01	011101111101101111111011111011110101		1	20	20	2			1	5000.00	3	2		2						
H3351	806	0	1	02	01	H3351_806_0	4	1	POS Group #1	01	011101111101101111111011111011110101		1	20	20	2			1	5000.00	3	2		2						
H3361	099	0	1	02	01	H3361_099_0	8	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H3361	106	0	1	02	01	H3361_106_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H3361	129	0	1	02	01	H3361_129_0	6	1	Group 1	01	011101011101101111111011111001110000		1	20	20	2			2			2		2						
H3362	026	0	1	02	01	H3362_026_0	11	1	$45	01	000000100100100000000000000000000000		2			1	45.00	45.00	1	1500.00	3	2								
H3362	807	0	1	02	01	H3362_807_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3362	807	0	1	02	01	H3362_807_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3362	807	0	1	02	01	H3362_807_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
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H3362	819	0	1	02	01	H3362_819_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3456	023	0	1	02	01	H3456_023_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
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H3456	023	0	1	02	01	H3456_023_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
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H3456	023	0	1	02	01	H3456_023_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H3456	023	0	1	02	01	H3456_023_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
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H3456	023	0	1	02	01	H3456_023_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H3456	023	0	1	02	01	H3456_023_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H3456	023	0	1	02	01	H3456_023_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H3456	023	0	1	02	01	H3456_023_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H3456	025	0	1	02	01	H3456_025_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H3456	025	0	1	02	01	H3456_025_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H3456	025	0	1	02	01	H3456_025_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
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H3456	025	0	1	02	01	H3456_025_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
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H3456	025	0	1	02	01	H3456_025_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H3456	025	0	1	02	01	H3456_025_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H3456	025	0	1	02	01	H3456_025_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
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H3528	006	0	1	02	01	H3528_006_0	11	2	$0	11	011100000000000000000010000010000000	000000100000000100000000	2			2			2			2								
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H3528	006	0	1	02	01	H3528_006_0	11	4	$175	01	000000000000000000000001000000000000		2			1	175.00	175.00	2			2								
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H3528	008	0	1	02	01	H3528_008_0	10	3	$200	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
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H3528	806	0	1	02	01	H3528_806_0	5	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3528	806	0	1	02	01	H3528_806_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3528	807	0	1	02	01	H3528_807_0	5	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3528	807	0	1	02	01	H3528_807_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3528	807	0	1	02	01	H3528_807_0	5	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3659	001	0	1	02	01	H3659_001_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
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H3659	001	0	1	02	01	H3659_001_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
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H3659	807	0	1	02	01	H3659_807_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
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H3660	028	0	1	02	01	H3660_028_0	8	5	Group 5 30% Coinsurance	01	000000000000000000000000111000000000		1	30	30	2			2			2								
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H3660	028	0	1	02	01	H3660_028_0	8	1	Group 1 20% Coinsurance	01	000001000000000111111010000100010000		1	20	20	2			2			2		2						
H3660	029	0	1	02	01	H3660_029_0	7	5	Group 5 $250 Copayment	01	000000000000000000000001000000000000		2			1	250.00	250.00	2			2								
H3660	029	0	1	02	01	H3660_029_0	7	4	Group 4 30% Coinsurance	01	000000000000000000000000111000000000		1	30	30	2			2			2								
H3660	029	0	1	02	01	H3660_029_0	7	3	Group 3 $50 Copayment	01	011110011111111000000100000000001110		2			1	50.00	50.00	2			2		2						
H3660	029	0	1	02	01	H3660_029_0	7	2	Group 2 $15 Copayment	01	000000100000000000000000000011100000		2			1	15.00	15.00	2			2		2						
H3660	029	0	1	02	01	H3660_029_0	7	1	Group 1 20% Coinsurance	01	000001000000000111111010000100010000		1	20	20	2			2			2		2						
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H3660	805	0	1	02	01	H3660_805_0	5	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
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H3660	806	0	1	02	01	H3660_806_0	5	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3660	806	0	1	02	01	H3660_806_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3664	014	0	1	02	01	H3664_014_0	7	1	Fitness Partners	10		000000000000000010000000	2			2			1	120.00	3	2								
H3664	017	0	1	02	01	H3664_017_0	6	1	Fitness Partners	10		000000000000000010000000	2			2			1	120.00	3	2								
H3664	018	0	1	02	01	H3664_018_0	6	1	Fitness Partners	10		000000000000000010000000	2			2			1	120.00	3	2								
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H3664	802	0	1	02	01	H3664_802_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3664	802	0	1	02	01	H3664_802_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3664	802	0	1	02	01	H3664_802_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3664	803	0	1	02	01	H3664_803_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3664	803	0	1	02	01	H3664_803_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3664	803	0	1	02	01	H3664_803_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3664	805	0	2	02	01	H3664_805_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3664	805	0	2	02	01	H3664_805_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3664	805	0	2	02	01	H3664_805_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3664	806	0	2	02	01	H3664_806_0	1	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H3664	806	0	2	02	01	H3664_806_0	1	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H3664	806	0	2	02	01	H3664_806_0	1	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H3810	004	0	1	02	01	H3810_004_0	8	1	POS Benefit	01	000000100101010110100000000000000000		1	20	20	2			1	5000.00	3	2		2						
H3810	005	0	1	02	01	H3810_005_0	10	1	POS Benefit	01	000000100101010110100000000000000000		1	20	20	2			1	5000.00	3	2		2						
H3887	001	0	1	02	01	H3887_001_0	6	4	Group 4	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H3887	001	0	1	02	01	H3887_001_0	6	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H3887	001	0	1	02	01	H3887_001_0	6	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
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H3887	003	0	1	02	01	H3887_003_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
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H3887	003	0	1	02	01	H3887_003_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H3887	003	0	1	02	01	H3887_003_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
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H3887	003	0	1	02	01	H3887_003_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H3887	003	0	1	02	01	H3887_003_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H3887	003	0	1	02	01	H3887_003_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H3887	003	0	1	02	01	H3887_003_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H3887	003	0	1	02	01	H3887_003_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
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H4123	004	0	1	02	01	H4123_004_0	6	2	Specialty Services	01	000000010111110000000000000000000000		2			1	25.00	25.00	2			2								
H4123	004	0	1	02	01	H4123_004_0	6	3	Outpatient X-Rays and Lab Tests	01	000000000000000100100000000000000000		1	10	10	2			2			2		2						
H4123	004	0	1	02	01	H4123_004_0	6	4	Outpatient Hospital and ASC Services	01	000000000000000000011000000000000000		2			1	150.00	150.00	2			2								
H4123	004	0	1	02	01	H4123_004_0	6	9	Primary Care Services	01	000000100000000000000000000000000000		2			1	25.00	25.00	2			2								
H4123	004	0	1	02	01	H4123_004_0	6	6	Outpatient Therapy Services	01	000000001000001000000000000000000000		2			1	25.00	25.00	2			2								
H4123	004	0	1	02	01	H4123_004_0	6	5	CAT Scans, MRI and PET Scans	01	000000000000000010000000000000000000		2			1	100.00	100.00	2			2		1	2			1	25.00	25.00
H4123	004	0	1	02	01	H4123_004_0	6	7	Home Health Services	01	000001000000000000000000000000000000		2			2			2			2								
H4123	004	0	1	02	01	H4123_004_0	6	8	Diabetic Supplies and Services	01	000000000000000000000000001000000000		1	20	20	2			2			2								
H4152	007	0	1	02	01	H4152_007_0	6	1		11	011101111111111111111110111011110101	000000000000000010001010	1	20	20	2			2			2		2						
H4152	016	0	1	02	01	H4152_016_0	6	1		11	011101111111111111111110111011110101	000000000000000010001010	1	20	20	2			2			2		2						
H4152	815	0	1	02	01	H4152_815_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4152	815	0	1	02	01	H4152_815_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4152	815	0	1	02	01	H4152_815_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4270	001	0	1	02	01	H4270_001_0	7	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	1	0.00	25.00	2			2		1	1	20	20	2		
H4270	001	0	1	02	01	H4270_001_0	7	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H4270	003	0	1	02	01	H4270_003_0	7	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H4270	003	0	1	02	01	H4270_003_0	7	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	1	0.00	25.00	2			2		1	1	20	20	2		
H4270	004	0	1	02	01	H4270_004_0	8	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	0	20	1	0.00	35.00	2			2		1	1	20	20	2		
H4270	004	0	1	02	01	H4270_004_0	8	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H4270	005	0	1	02	01	H4270_005_0	8	3	Non-Medicare-covered Dental	10		000000000000000000110000	2			2			2			2								
H4270	005	0	1	02	01	H4270_005_0	8	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H4270	005	0	1	02	01	H4270_005_0	8	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	10	20	2			2			2		1	1	20	20	2		
H4270	006	0	1	02	01	H4270_006_0	9	2	Outpatient Diag/Tests/Lab Services	01	000000000000000100000000000000000000		1	10	20	2			2			2		1	1	20	20	2		
H4270	006	0	1	02	01	H4270_006_0	9	1	All other Medicare-covered POS	01	011111101111111011111111111111111101		1	20	20	2			1	100000.00	3	2		2						
H4270	006	0	1	02	01	H4270_006_0	9	3	Non-Medicare-covered Dental	10		000000000000000000110000	2			2			2			2								
H4270	801	0	1	02	01	H4270_801_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4270	801	0	1	02	01	H4270_801_0	5	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4270	801	0	1	02	01	H4270_801_0	5	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4407	022	0	1	02	01	H4407_022_0	7	2		01	000000000000000000000001000000000000		1	20	20	1	100.00	100.00	2			2								
H4407	022	0	1	02	01	H4407_022_0	7	1		01	011110111111111111111110110000010000		1	30	30	2			2			2		2						
H4407	023	0	1	02	01	H4407_023_0	8	1	30% Coinsurance	01	011111111111111111111110110111111101		1	30	30	2			2			2		2						
H4407	023	0	1	02	01	H4407_023_0	8	2	Ambulance	01	000000000000000000000001000000000000		1	20	20	1	100.00	100.00	2			2								
H4454	030	0	1	02	01	H4454_030_0	6	1		01	011110111111111111111110110000010000		1	30	30	2			2			2		2						
H4454	030	0	1	02	01	H4454_030_0	6	2		01	000000000000000000000001000000000000		1	20	20	1	100.00	100.00	2			2								
H4454	032	0	1	02	01	H4454_032_0	6	2		01	000000000000000000000001000000000000		1	20	20	1	100.00	100.00	2			2								
H4454	032	0	1	02	01	H4454_032_0	6	1		01	011110111111111111111110110000010000		1	30	30	2			2			2		2						
H4454	808	0	1	02	01	H4454_808_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4454	808	0	1	02	01	H4454_808_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4454	808	0	1	02	01	H4454_808_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4454	809	0	1	02	01	H4454_809_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4454	809	0	1	02	01	H4454_809_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4454	809	0	1	02	01	H4454_809_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4454	812	0	1	02	01	H4454_812_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4454	812	0	1	02	01	H4454_812_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4454	812	0	1	02	01	H4454_812_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4454	813	0	1	02	01	H4454_813_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4454	813	0	1	02	01	H4454_813_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4454	813	0	1	02	01	H4454_813_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4456	013	0	1	02	01	H4456_013_0	8	9	Group 9	11	000000000000000000000010000000000000	000000100000000000000000	2			1	0.00	0.00	2			2								
H4456	013	0	1	02	01	H4456_013_0	8	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H4456	013	0	1	02	01	H4456_013_0	8	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H4456	013	0	1	02	01	H4456_013_0	8	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H4456	013	0	1	02	01	H4456_013_0	8	4	Group 4	01	000000000000000100000000000000000000		1	30	30	1	12.00	12.00	2			2		2						
H4456	013	0	1	02	01	H4456_013_0	8	3	Group 3	01	000000000000000011011000011001110010		1	30	30	2			2			2		2						
H4456	013	0	1	02	01	H4456_013_0	8	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	35.00	35.00	2			2		2						
H4456	013	0	1	02	01	H4456_013_0	8	11	Group 11	01	000000000000100000000000000000000000		2			1	15.00	35.00	2			2								
H4456	013	0	1	02	01	H4456_013_0	8	10	Group 10	01	000000000000000000000000000010000000		2			1	0.00	15.00	2			2								
H4456	013	0	1	02	01	H4456_013_0	8	1	Group 1	11	000000100000000000000000000000000000	000000000001000100000000	2			1	15.00	15.00	2			2								
H4456	013	0	1	02	01	H4456_013_0	8	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H4513	807	0	1	02	01	H4513_807_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4513	807	0	1	02	01	H4513_807_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4513	807	0	1	02	01	H4513_807_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4513	808	0	1	02	01	H4513_808_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4513	808	0	1	02	01	H4513_808_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4513	808	0	1	02	01	H4513_808_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4513	811	0	1	02	01	H4513_811_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4513	811	0	1	02	01	H4513_811_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4513	811	0	1	02	01	H4513_811_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4513	812	0	1	02	01	H4513_812_0	3	1		01	000001000000000000000000000010000000		1	0	0	2			2			2								
H4513	812	0	1	02	01	H4513_812_0	3	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
H4513	812	0	1	02	01	H4513_812_0	3	2		01	000000000010010000000000000000000000		1	35	35	2			2			2								
H4514	007	0	1	02	01	H4514_007_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H4514	007	0	1	02	01	H4514_007_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H4514	007	0	1	02	01	H4514_007_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H4514	007	0	1	02	01	H4514_007_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H4514	007	0	1	02	01	H4514_007_0	7	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	12.00	12.00	2			2		2						
H4514	007	0	1	02	01	H4514_007_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H4514	007	0	1	02	01	H4514_007_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H4514	007	0	1	02	01	H4514_007_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H4514	007	0	1	02	01	H4514_007_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H4514	007	0	1	02	01	H4514_007_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H4514	007	0	1	02	01	H4514_007_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H5211	001	0	1	02	01	H5211_001_0	5	1	OOP-Hospital Inpatient and SNF Inclusive	11	011111111111111111111110101001110101	000000100100000000001010	1	20	20	2			2			1	1500.00	2						
H5211	002	0	1	02	01	H5211_002_0	6	1	OOP-Hospital Inpatient and SNF Inclusive	11	011111111111111111111110111001110101	000000100100000001001010	1	20	20	2			2			1	1500.00	2						
H5211	003	0	1	02	01	H5211_003_0	4	1	OOP-Hospital Inpatient and SNF Inclusive	11	011111111111111111111110111001110101	000000100100000000001010	1	20	20	2			2			1	1500.00	2						
H5211	004	0	1	02	01	H5211_004_0	6	1	OOP-Hospital Inpatient and SNF Inclusive	11	011111111111111111111110111001110101	000000100100000001001010	1	20	20	2			2			1	1500.00	2						
H5211	005	0	1	02	01	H5211_005_0	8	1	OOP-Hospital Inpatient and SNF Inclusive	11	011111111111111111111110111001110101	000000100100000001001010	1	20	20	2			2			1	1500.00	2						
H5211	006	0	1	02	01	H5211_006_0	5	1	OOP-Hospital Inpatient and SNF Inclusive	11	011111111111111111111110111001110101	000000100100000000001010	1	20	20	2			2			1	1500.00	2						
H5253	004	0	1	02	01	H5253_004_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	25.00	25.00	2			2								
H5253	004	0	1	02	01	H5253_004_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	30	2			2			2								
H5253	004	0	1	02	01	H5253_004_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	25.00	50.00	2			2								
H5253	004	0	1	02	01	H5253_004_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H5253	004	0	1	02	01	H5253_004_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H5253	004	0	1	02	01	H5253_004_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H5253	004	0	1	02	01	H5253_004_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H5253	004	0	1	02	01	H5253_004_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H5253	004	0	1	02	01	H5253_004_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H5253	004	0	1	02	01	H5253_004_0	7	4	Group 4	01	000000000000000100000000000000000000		1	30	30	1	13.00	13.00	2			2		2						
H5253	004	0	1	02	01	H5253_004_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	30	30	2			2			2		2						
H5253	007	0	1	02	01	H5253_007_0	6	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H5253	007	0	1	02	01	H5253_007_0	6	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H5253	007	0	1	02	01	H5253_007_0	6	4	Group 4	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H5253	007	0	1	02	01	H5253_007_0	6	1	Group 1	11	011111111111111011111111111001111101	000001100000000000001000	1	30	30	2			2			2		2						
H5253	011	0	1	02	01	H5253_011_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H5253	011	0	1	02	01	H5253_011_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	280.00	280.00	2			2								
H5253	011	0	1	02	01	H5253_011_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H5253	011	0	1	02	01	H5253_011_0	7	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H5253	011	0	1	02	01	H5253_011_0	7	4	Group 4	01	000000000000000100000000000000000000		1	40	40	1	13.00	13.00	2			2		2						
H5253	011	0	1	02	01	H5253_011_0	7	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	40	40	2			2			2		2						
H5253	011	0	1	02	01	H5253_011_0	7	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H5253	011	0	1	02	01	H5253_011_0	7	11	Group 11	01	000000000000100000000000000000000000		2			1	35.00	50.00	2			2								
H5253	011	0	1	02	01	H5253_011_0	7	10	Group 10	01	000000000000000000000000000010000000		1	0	40	2			2			2								
H5253	011	0	1	02	01	H5253_011_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	35.00	35.00	2			2								
H5253	011	0	1	02	01	H5253_011_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H5253	021	0	1	02	01	H5253_021_0	3	10	Group 10	01	000000000000000000000000000010000000		1	0	30	2			2			2								
H5253	021	0	1	02	01	H5253_021_0	3	11	Group 11	01	000000000000100000000000000000000000		2			1	25.00	50.00	2			2								
H5253	021	0	1	02	01	H5253_021_0	3	2	Group 2	11	011100011101001000000000000000000101	000001000000000000001010	2			1	50.00	50.00	2			2		2						
H5253	021	0	1	02	01	H5253_021_0	3	3	Group 3	11	000000000000000011011000011001110010	000000000001000100000000	1	30	30	2			2			2		2						
H5253	021	0	1	02	01	H5253_021_0	3	4	Group 4	01	000000000000000100000000000000000000		1	30	30	1	10.00	10.00	2			2		2						
H5253	021	0	1	02	01	H5253_021_0	3	5	Group 5	01	000000000000000000100000000000000000		2			1	21.00	21.00	2			2		2						
H5253	021	0	1	02	01	H5253_021_0	3	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H5253	021	0	1	02	01	H5253_021_0	3	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H5253	021	0	1	02	01	H5253_021_0	3	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H5253	021	0	1	02	01	H5253_021_0	3	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H5253	021	0	1	02	01	H5253_021_0	3	1	Group 1	01	000000100000000000000000000000000000		2			1	25.00	25.00	2			2								
H5253	028	0	1	02	01	H5253_028_0	7	7	Group 7	01	000000000000000000000001000000000000		2			1	200.00	200.00	2			2								
H5253	028	0	1	02	01	H5253_028_0	7	8	Group 8	01	000000000010010000000100000000000000		2			1	35.00	45.00	2			2								
H5253	028	0	1	02	01	H5253_028_0	7	9	Group 9	11	000000000000000000000010000000000000	000000100000000010000000	2			1	0.00	0.00	2			2								
H5253	028	0	1	02	01	H5253_028_0	7	6	Group 6	01	000010000000000000000000000000000000		2			1	75.00	75.00	2			2								
H5253	028	0	1	02	01	H5253_028_0	7	4	Group 4	01	000000000000000100000000000000000000		1	30	30	1	13.00	13.00	2			2		2						
H5253	028	0	1	02	01	H5253_028_0	7	1	Group 1	01	000000100000000000000000000000000000		2			1	15.00	15.00	2			2								
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H5302	003	0	1	02	01	H5302_003_0	13	1	20%	01	000001000000000000100000000001100000		1	20	20	2			2			2		2						
H5302	003	0	1	02	01	H5302_003_0	13	2	100% coverage	11	000000000000000000000000000010000000	000000000001000100000000	2			2			2			2								
H5302	003	0	1	02	01	H5302_003_0	13	3	$50 copay	01	000000011111111000000100000000000000		2			1	50.00	50.00	2			2								
H5302	006	0	1	02	01	H5302_006_0	13	4	100% COVERAGE NO DEDUCTIBLE	11	000001000000000000000010000011100000	000000000001000100000000	2			2			2			2		2						
H5302	006	0	1	02	01	H5302_006_0	13	7	$50	01	000000000000000001000000000000000000		2			1	50.00	50.00	2			2		2						
H5302	006	0	1	02	01	H5302_006_0	13	6	OUPATIENT SURGERY	01	000000000000000000011000000000000000		2			1	275.00	275.00	2			2								
H5302	006	0	1	02	01	H5302_006_0	13	5	MRI, CT, AND PET	01	000000000000000010000000000000000000		2			1	250.00	325.00	2			2		2						
H5302	006	0	1	02	01	H5302_006_0	13	3	$40 COPAY	01	011100011111111110100100000000000101		2			1	40.00	40.00	2			2		2						
H5302	006	0	1	02	01	H5302_006_0	13	2	$100.00 copay	01	000010000000000000000000000000000000		2			1	100.00	100.00	2			2								
H5302	006	0	1	02	01	H5302_006_0	13	1	20% COINSURANCE CATEGORIES	01	000000000000000000000000000000010000		1	20	20	2			2			2								
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H5302	809	0	1	02	01	H5302_809_0	5	3		01	011110111101101111111111111101111111		1	20	20	2			2			2		2						
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H5410	012	0	1	02	01	H5410_012_0	7	1	30% Coinsurance	01	011111111111111111111110110111111101		1	30	30	2			2			2		2						
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H5410	018	0	1	02	01	H5410_018_0	6	1	30% Coinsurance	01	011111111111111111111110110111111101		1	30	30	2			2			2		2						
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H5471	015	0	1	02	01	H5471_015_0	6	1	$0 Co-pay	01	000000000100000000000000000000000000		2			2			2			2								
H5576	006	0	1	02	01	H5576_006_0	15	4	Non Medicare Eye Wear	10		000000000000000000000100	1	20	20	2			1	100.00	3	2								
H5576	006	0	1	02	01	H5576_006_0	15	3	Non Medicare Eye Exams	10		000000000000000000001000	2			2			1	50.00	3	2								
H5576	006	0	1	02	01	H5576_006_0	15	2	Non Medicare Preventive Dental	10		000000000000000000100000	1	20	20	2			1	125.00	4	2								
H5576	006	0	1	02	01	H5576_006_0	15	1	40% coinsurance	01	011111111111111111111111111011111111		1	40	40	2			1	5000.00	3	1	250.00	2						
H5576	006	0	1	02	01	H5576_006_0	15	6	ESRD	01	000000000000000000000000000100000000		1	20	20	2			1	5000.00	3	2								
H5576	006	0	1	02	01	H5576_006_0	15	5	Non Medicare Hearing Exams	10		000000000000000000000010	2			2			1	30.00	3	2								
H5576	007	0	1	02	01	H5576_007_0	14	1	40% coinsurance	01	011111111111111111111111111011111111		1	40	40	2			1	5000.00	3	1	250.00	2						
H5576	007	0	1	02	01	H5576_007_0	14	5	Non Medicare Hearing Exams	10		000000000000000000000010	2			2			1	30.00	3	2								
H5576	007	0	1	02	01	H5576_007_0	14	2	Non Medicare Preventive Dental	10		000000000000000000100000	1	20	20	2			1	100.00	4	2								
H5576	007	0	1	02	01	H5576_007_0	14	3	Non Medicare Eye Exams	10		000000000000000000001000	2			2			1	50.00	3	2								
H5576	007	0	1	02	01	H5576_007_0	14	4	Non Medicare Eye Wear	10		000000000000000000000100	1	20	20	2			1	100.00	3	2								
H5576	007	0	1	02	01	H5576_007_0	14	6	ESRD	01	000000000000000000000000000100000000		1	20	20	2			1	5000.00	3	2								
H5576	009	0	1	02	01	H5576_009_0	15	6	ESRD	01	000000000000000000000000000100000000		1	20	20	2			1	5000.00	3	2								
H5576	009	0	1	02	01	H5576_009_0	15	3	Non Medicare Eye Exams	10		000000000000000000001000	2			2			1	50.00	3	2								
H5576	009	0	1	02	01	H5576_009_0	15	2	Non Medicare Preventive Dental	10		000000000000000000100000	1	20	20	2			1	125.00	4	2								
H5576	009	0	1	02	01	H5576_009_0	15	5	Non Medicare Hearing Exams	10		000000000000000000000010	2			2			1	30.00	3	2								
H5576	009	0	1	02	01	H5576_009_0	15	4	Non Medicare Eye Wear	10		000000000000000000000100	1	20	20	2			1	100.00	3	2								
H5576	009	0	1	02	01	H5576_009_0	15	1	40% coinsurance	01	011111111111111111111111111011111111		1	40	40	2			1	5000.00	3	1	250.00	2						
H5576	012	0	1	02	01	H5576_012_0	14	2	Non Medicare Preventive Dental	10		000000000000000000100000	1	20	20	2			1	100.00	4	2								
H5576	012	0	1	02	01	H5576_012_0	14	3	Non Medicare Eye Exams	10		000000000000000000001000	2			2			1	50.00	3	2								
H5576	012	0	1	02	01	H5576_012_0	14	4	Non Medicare Eye Wear	10		000000000000000000000100	1	20	20	2			1	100.00	3	2								
H5576	012	0	1	02	01	H5576_012_0	14	5	Non Medicare Hearing Exams	10		000000000000000000000010	2			2			1	30.00	3	2								
H5576	012	0	1	02	01	H5576_012_0	14	1	40% coinsurance	01	011111111111111111111111111011111111		1	40	40	2			1	5000.00	3	1	250.00	2						
H5576	012	0	1	02	01	H5576_012_0	14	6	ESRD	01	000000000000000000000000000100000000		1	20	20	2			1	5000.00	3	2								
H5576	801	0	1	02	01	H5576_801_0	11	2	50% coinsurance	01	000010000010010000000000000000000000		1	50	50	2			2			2								
H5576	801	0	1	02	01	H5576_801_0	11	1	40% coinsurance	01	011100011101001111111101111101111111		1	40	40	2			2			2		2						
H5576	801	0	1	02	01	H5576_801_0	11	4	20% to 40% coinsurance	01	000000000000100000000000000000000000		1	20	40	2			2			2								
H5576	801	0	1	02	01	H5576_801_0	11	3	20% coinsurance	01	000001100000000100000000000010000000		1	20	20	2			2			2		2						
H5576	802	0	1	02	01	H5576_802_0	11	1	40% coinsurance	01	011100011101001111111101111101111111		1	40	40	2			2			2		2						
H5576	802	0	1	02	01	H5576_802_0	11	2	50% coinsurance	01	000010000010010000000000000000000000		1	50	50	2			2			2								
H5576	802	0	1	02	01	H5576_802_0	11	3	20% coinsurance	01	000001100000000100000000000010000000		1	20	20	2			2			2		2						
H5576	802	0	1	02	01	H5576_802_0	11	4	20% to 40% coinsurance	01	000000000000100000000000000000000000		1	20	40	2			2			2								
H5576	803	0	1	02	01	H5576_803_0	11	2	50% coinsurance	01	000010000010010000000000000000000000		1	50	50	2			2			2								
H5576	803	0	1	02	01	H5576_803_0	11	3	20% coinsurance	01	000001100000000100000000000010000000		1	20	20	2			2			2		2						
H5576	803	0	1	02	01	H5576_803_0	11	4	20% to 40% coinsurance	01	000000000000100000000000000000000000		1	20	40	2			2			2								
H5576	803	0	1	02	01	H5576_803_0	11	1	40% coinsurance	01	011100011101001111111101111101111111		1	40	40	2			2			2		2						
H5577	008	0	1	02	01	H5577_008_0	7	1		11	011111111111111111111110001010000101	000000000000000000110100	1	0	20	2			2			2		2						
H5577	012	0	1	02	01	H5577_012_0	8	1		11	011111111111111111111110001010000101	000000000000000000110101	1	0	25	2			2			2		2						
H5591	001	0	1	02	01	H5591_001_0	6	3	Group 3	01	000000000000000000001000000000000000		2			1	200.00	200.00	2			2								
H5591	001	0	1	02	01	H5591_001_0	6	1	Group 1	11	000000111111111000000100000000000101	000000000000000000001000	2			1	25.00	40.00	2			2		2						
H5591	001	0	1	02	01	H5591_001_0	6	2	Group 2	01	000000000000000000010000000000000000		2			1	0.00	325.00	2			2								
H5591	001	0	1	02	01	H5591_001_0	6	4	Group 4	01	000000000000000000000000001100010010		1	20	20	2			2			2								
H5591	001	0	1	02	01	H5591_001_0	6	5		11	000000000000000100100010000001100000	000000100001000000000000	1	0	0	2			2			2		2						
H5591	001	0	1	02	01	H5591_001_0	6	6	Group 6	01	000000000000000011000000110000000000		1	30	30	2			2			2		2						
H5591	004	0	1	02	01	H5591_004_0	6	2	Group 2	01	000000000000000000010000000000000000		2			1	0.00	325.00	2			2								
H5591	004	0	1	02	01	H5591_004_0	6	4	Group 4	01	000000000000000000000000001100010010		1	20	20	2			2			2								
H5591	004	0	1	02	01	H5591_004_0	6	1	Group 1	11	000000111111111000000100000000000101	000000000000000000001000	2			1	25.00	40.00	2			2		2						
H5591	004	0	1	02	01	H5591_004_0	6	6	Group 6	01	000000000000000011000000110000000000		1	30	30	2			2			2		2						
H5591	004	0	1	02	01	H5591_004_0	6	3	Group 3	01	000000000000000000001000000000000000		2			1	200.00	200.00	2			2								
H5591	004	0	1	02	01	H5591_004_0	6	5		11	000000000000000100100010000001100000	000000100001000000000000	1	0	0	2			2			2		2						
H5591	005	0	1	02	01	H5591_005_0	6	5		11	000000000000000100100010000001100000	000000100001000000000000	1	0	0	2			2			2		2						
H5591	005	0	1	02	01	H5591_005_0	6	6	Group 6	01	000000000000000011000000110000000000		1	30	30	2			2			2		2						
H5591	005	0	1	02	01	H5591_005_0	6	1	Group 1	11	000000111111111000000100000000000101	000000000000000000001000	2			1	25.00	40.00	2			2		2						
H5591	005	0	1	02	01	H5591_005_0	6	2	Group 2	01	000000000000000000010000000000000000		2			1	0.00	325.00	2			2								
H5591	005	0	1	02	01	H5591_005_0	6	3	Group 3	01	000000000000000000001000000000000000		2			1	200.00	200.00	2			2								
H5591	005	0	1	02	01	H5591_005_0	6	4	Group 4	01	000000000000000000000000001100010010		1	20	20	2			2			2								
H5594	001	0	1	02	01	H5594_001_0	5	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	002	0	1	02	01	H5594_002_0	6	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	006	0	1	02	01	H5594_006_0	8	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	018	0	1	02	01	H5594_018_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	019	0	1	02	01	H5594_019_0	5	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	022	0	1	02	01	H5594_022_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	023	0	1	02	01	H5594_023_0	6	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	026	0	1	02	01	H5594_026_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	027	0	1	02	01	H5594_027_0	6	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	028	0	1	02	01	H5594_028_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	029	0	1	02	01	H5594_029_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	030	0	1	02	01	H5594_030_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5594	031	0	1	02	01	H5594_031_0	7	1	Physician Specialist Services	01	000000000100000000000000000000000000		1	30	30	2			2			2								
H5652	001	0	1	02	01	H5652_001_0	7	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H5652	001	0	1	02	01	H5652_001_0	7	5	Group 5	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H5652	001	0	1	02	01	H5652_001_0	7	4	Group 4	01	000000010000000000000000000000000000		1	50	50	2			2			2								
H5652	001	0	1	02	01	H5652_001_0	7	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H5652	001	0	1	02	01	H5652_001_0	7	1	Group 1	11	011111101111111011111111111001111101	000001100000000100001010	1	30	30	2			2			2		2						
H5652	002	0	1	02	01	H5652_002_0	3	5	Group 5	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H5652	002	0	1	02	01	H5652_002_0	3	4	Group 4	01	000000010000000000000000000000000000		1	50	50	2			2			2								
H5652	002	0	1	02	01	H5652_002_0	3	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H5652	002	0	1	02	01	H5652_002_0	3	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H5652	002	0	1	02	01	H5652_002_0	3	1	Group 1	11	011111101111111011111111111001111101	000001100000000100001010	1	30	30	2			2			2		2						
H5652	003	0	1	02	01	H5652_003_0	7	3	Group 3	11	000000000000000000000000000100000010	000000000000000000000101	2			1	0.00	0.00	2			2								
H5652	003	0	1	02	01	H5652_003_0	7	1	Group 1	11	011111111111111011111111111001111101	000001100000000000001010	1	30	30	2			2			2		2						
H5652	003	0	1	02	01	H5652_003_0	7	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H5652	004	0	1	02	01	H5652_004_0	7	4	Group 4	01	000000010000000000000000000000000000		1	50	50	2			2			2								
H5652	004	0	1	02	01	H5652_004_0	7	5	Group 5	01	000000000000000000000000000100000000		1	20	20	2			2			2								
H5652	004	0	1	02	01	H5652_004_0	7	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H5652	004	0	1	02	01	H5652_004_0	7	2	Group 2	01	000000000000000100000000000010000000		1	0	30	2			2			2		2						
H5652	004	0	1	02	01	H5652_004_0	7	1	Group 1	11	011111101111111011111111111001111101	000001100000000000001010	1	30	30	2			2			2		2						
H5652	006	0	1	02	01	H5652_006_0	7	1	Group 1	11	011111101111111011111111111001111101	000001100000000100001010	1	30	30	2			2			2		2						
H5652	006	0	1	02	01	H5652_006_0	7	2	Group 2	01	000000000000000100000000000000000000		1	30	30	1	10.00	10.00	2			2		2						
H5652	006	0	1	02	01	H5652_006_0	7	3	Group 3	11	000000000000000000000000000000000010	000000000000000000000100	2			1	0.00	0.00	2			2								
H5652	006	0	1	02	01	H5652_006_0	7	6	Group 6	01	000000000000000000000000000010000000		1	0	30	2			2			2								
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