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_ben	pbp_c_oon_out_mc_bendesc_cats	pbp_c_oon_out_nmc_bendesc_cats	pbp_c_oon_outpt_maxplan_yn	pbp_c_oon_outpt_maxplan_amt	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_coins_yn	pbp_c_oon_outpt_cs_coins_yn	pbp_c_oon_outpt_cs_coins_min	pbp_c_oon_outpt_coins_min_pct	pbp_c_oon_outpt_coins_max_pct	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
H0084	001	0	1	04	01	H0084_001_0	6	8	Group 8	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	7	Group 7	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	6	Group 6	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H0084	001	0	1	04	01	H0084_001_0	6	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000001010	2		1	25.00	25.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H0084	001	0	1	04	01	H0084_001_0	6	9	Group 9	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
H0084	001	0	1	04	01	H0084_001_0	6	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	12	Group 12	11	0000000000000000000000010001011100110	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	11	Group 11	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
H0084	001	0	1	04	01	H0084_001_0	6	10	Group 10	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	25.00	50.00
H0084	001	0	1	04	01	H0084_001_0	6	1	Group 1	11	0111000011011010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H0084	001	0	1	04	01	H0084_001_0	6	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
H0084	004	0	1	04	01	H0084_004_0	5	7	Group 7	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H0084	004	0	1	04	01	H0084_004_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	5	Group 5	11	0000001100001000000000000000000000000	000000000000000000100010	2		1	20.00	20.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	4	Group 4	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H0084	004	0	1	04	01	H0084_004_0	5	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	13	Group 13	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	12	Group 12	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
H0084	004	0	1	04	01	H0084_004_0	5	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H0084	004	0	1	04	01	H0084_004_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	20.00	50.00
H0084	014	0	1	04	01	H0084_014_0	6	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
H0084	014	0	1	04	01	H0084_014_0	6	2	Group 2	11	0000010000000000000000000000011100000	000001010100000010101110	2		1	0.00	0.00	2		2	2								
H0084	014	0	1	04	01	H0084_014_0	6	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
H0084	014	0	1	04	01	H0084_014_0	6	4	Group 4	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H0084	014	0	1	04	01	H0084_014_0	6	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
H0084	035	0	1	04	01	H0084_035_0	5	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
H0084	035	0	1	04	01	H0084_035_0	5	2	Group 2	11	0000010000000000000000000000011100000	000000010000000010011100	2		1	0.00	0.00	2		2	2								
H0084	035	0	1	04	01	H0084_035_0	5	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
H0084	035	0	1	04	01	H0084_035_0	5	4	Group 4	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
H0084	035	0	1	04	01	H0084_035_0	5	5	Group 5	10		000000000000000000100000	2		1	10.00	10.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	5	Group 5	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	6	Group 6	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	7	Group 7	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	8	Group 8	10		000000000000000000000001	2		1	340.00	390.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	10.00	10.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H0084	064	0	1	04	01	H0084_064_0	5	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	15	Group 15	01	0000000000000000000001000000000000000		2		1	270.00	270.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	14	Group 14	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H0084	064	0	1	04	01	H0084_064_0	5	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	12	Group 12	11	0000000000000000000000010001011100110	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	9	Group 9	01	0000000000000000000000000011100010000		2		2			2		2	1			20	20				
H0084	064	0	1	04	01	H0084_064_0	5	10	Group 10	01	0000000000000001111100000000000000000		2		1	14.00	15.00	2		1	1	2		20	20		1	10.00	30.00
H0084	064	0	1	04	01	H0084_064_0	5	1	Group 1	11	0111000011011010000000000000000001101	000001000000000000000000	2		1	30.00	30.00	2		2	2								
H0084	064	0	1	04	01	H0084_064_0	5	11	Group 11	01	0000000000000000000010000000000000000		2		1	14.00	270.00	2		2	1			20	20				
H0084	065	0	1	04	01	H0084_065_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	7	Group 7	01	0000000000000000000001000000000000000		2		1	270.00	270.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	8	Group 8	01	0000000000000000000000000010100010000		2		2			2		2	1			20	20				
H0084	065	0	1	04	01	H0084_065_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	10.00	30.00
H0084	065	0	1	04	01	H0084_065_0	5	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	30.00	30.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	10	Group 10	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	12	Group 12	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	13	Group 13	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H0084	065	0	1	04	01	H0084_065_0	5	14	Group 14	01	0000000000000000000010000000000000000		2		1	13.00	270.00	2		2	1			20	20				
H0084	065	0	1	04	01	H0084_065_0	5	15	Group 15	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	10.00	10.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H0084	065	0	1	04	01	H0084_065_0	5	4	Group 4	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0084	065	0	1	04	01	H0084_065_0	5	5	Group 5	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
H0104	010	1	1	04	01	H0104_010_1	4	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	010	1	1	04	01	H0104_010_1	4	1	Part B - General	11	0111111111111111111111110111111111111	000000100000000010101000	2		2			2		2	1			30	30				
H0104	010	2	1	04	01	H0104_010_2	4	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	010	2	1	04	01	H0104_010_2	4	1	Part B - General	11	0111111111111111111111110111111111111	000000100000000010101000	2		2			2		2	1			30	30				
H0104	010	3	1	04	01	H0104_010_3	4	1	Part B - General	11	0111111111111111111111110111111111111	000000100000000010101000	2		2			2		2	1			30	30				
H0104	010	3	1	04	01	H0104_010_3	4	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	010	4	1	04	01	H0104_010_4	4	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	010	4	1	04	01	H0104_010_4	4	1	Part B - General	11	0111111111111111111111110111111111111	000000100000000010101000	2		2			2		2	1			30	30				
H0104	010	5	1	04	01	H0104_010_5	4	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	010	5	1	04	01	H0104_010_5	4	1	Part B - General	11	0111111111111111111111110111111111111	000000100000000010101000	2		2			2		2	1			30	30				
H0104	011	1	1	04	01	H0104_011_1	4	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	011	1	1	04	01	H0104_011_1	4	1		11	0111111111111111111111110111111111111	000000100000000010001000	2		2			2		2	1			30	30				
H0104	011	2	1	04	01	H0104_011_2	4	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	011	2	1	04	01	H0104_011_2	4	1		11	0111111111111111111111110111111111111	000000100000000010001000	2		2			2		2	1			30	30				
H0104	011	3	1	04	01	H0104_011_3	4	1		11	0111111111111111111111110111111111111	000000100000000010001000	2		2			2		2	1			30	30				
H0104	011	3	1	04	01	H0104_011_3	4	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	011	4	1	04	01	H0104_011_4	4	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	011	4	1	04	01	H0104_011_4	4	1		11	0111111111111111111111110111111111111	000000100000000010001000	2		2			2		2	1			30	30				
H0104	011	5	1	04	01	H0104_011_5	4	1		11	0111111111111111111111110111111111111	000000100000000010001000	2		2			2		2	1			30	30				
H0104	011	5	1	04	01	H0104_011_5	4	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H0104	011	6	1	04	01	H0104_011_6	5	1		11	0111111111111111111111110111111111111	000000100000000010001000	2		2			2		2	1			30	30				
H0104	011	6	1	04	01	H0104_011_6	5	2	Ambulance	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0104	801	0	1	04	01	H0104_801_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H0104	801	0	1	04	01	H0104_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H0104	802	0	1	04	01	H0104_802_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H0104	802	0	1	04	01	H0104_802_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H0104	804	0	1	04	01	H0104_804_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H0104	804	0	1	04	01	H0104_804_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H0107	001	0	1	04	01	H0107_001_0	10	1		01	0000010000000000000000010000011000000		2		1	0.00	0.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	4		01	0000100000100100000000100000000000000		2		1	60.00	60.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	9		10		000000000000000000000100	2		1	25.00	25.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	8		10		000000000000000000001011	2		1	20.00	20.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	7		01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	6		01	0000000000000000000011000000000000000		2		1	350.00	350.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	5		11	0000000001011010000000000000000001111	000000000000000000000010	2		1	65.00	65.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	3		01	0000001100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H0107	001	0	1	04	01	H0107_001_0	10	2		11	0111000010000001111100000111100110000	000000000000000010000000	2		2			2		2	1			20	20				
H0107	002	0	1	04	01	H0107_002_0	11	1		01	0000010000000000000000010000011000000		2		1	0.00	0.00	2		2	2								
H0107	002	0	1	04	01	H0107_002_0	11	4		01	0000100001111110000000100000000001111		2		1	45.00	45.00	2		2	2								
H0107	002	0	1	04	01	H0107_002_0	11	5		01	0000000000000000000011000000000000000		2		1	275.00	275.00	2		2	2								
H0107	002	0	1	04	01	H0107_002_0	11	3		01	0000001100000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H0107	002	0	1	04	01	H0107_002_0	11	2		11	0111000010000001111100000111100110000	000000000000000010000000	2		2			2		2	1			20	20				
H0107	002	0	1	04	01	H0107_002_0	11	6		01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H0107	002	0	1	04	01	H0107_002_0	11	7		10		000000000000000000001011	2		1	20.00	20.00	2		2	2								
H0107	002	0	1	04	01	H0107_002_0	11	8		10		000000000000000000000100	2		1	25.00	25.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	8		01	0000000000000000000000000000000000100		2		1	20.00	20.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	4		01	0000100000100100000000100000000000000		2		1	60.00	60.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	3		01	0000001100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	2		01	0111000010000001111100000111101110000		2		2			2		2	1			20	20				
H0107	801	0	1	04	01	H0107_801_0	6	1		01	0000010000000000000000010000011000000		2		1	0.00	0.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	6		01	0000000000000000000011000000000000000		2		1	350.00	350.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	7		01	0000000000000000000000001000000000000		2		1	10.00	100.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	9		01	0000000000000000000000000000000000010		2		1	175.00	175.00	2		2	2								
H0107	801	0	1	04	01	H0107_801_0	6	5		01	0000000001011010000000000000000001001		2		1	65.00	65.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	5		01	0000000001011010000000000000000001001		2		1	65.00	65.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	4		01	0000100000100100000000100000000000000		2		1	60.00	60.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	3		01	0000001100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	2		01	0111000010000001111100000111101110000		2		2			2		2	1			20	20				
H0107	802	0	1	04	01	H0107_802_0	2	1		01	0000010000000000000000010000011000000		2		1	0.00	0.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	9		01	0000000000000000000000000000000000010		2		1	175.00	175.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	6		01	0000000000000000000011000000000000000		2		1	350.00	350.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	7		01	0000000000000000000000001000000000000		2		1	10.00	100.00	2		2	2								
H0107	802	0	1	04	01	H0107_802_0	2	8		01	0000000000000000000000000000000000100		2		1	20.00	20.00	2		2	2								
H0248	001	0	1	04	01	H0248_001_0	5	10		10		000000010110000010110000	2		2			2		2	1			50	50				
H0248	001	0	1	04	01	H0248_001_0	5	1		11	0000000000000000000000010000000000000	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H0248	001	0	1	04	01	H0248_001_0	5	9		01	0000000000000000000000000111000000000		2		2			2		2	1			40	40				
H0248	001	0	1	04	01	H0248_001_0	5	8		01	0000000000000001100100000000000000000		2		1	35.00	35.00	2		2	1			25	25				
H0248	001	0	1	04	01	H0248_001_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H0248	001	0	1	04	01	H0248_001_0	5	6		11	0111111110110110011001100000001111111	000000000000000100000000	2		2			2		2	1			25	25				
H0248	001	0	1	04	01	H0248_001_0	5	5		01	0000000000000000000010000000000000000		2		1	15.00	15.00	2		2	1			20	25				
H0248	001	0	1	04	01	H0248_001_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0248	001	0	1	04	01	H0248_001_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	25				
H0248	001	0	1	04	01	H0248_001_0	5	7		01	0000000001001000000000000000000000000		2		1	15.00	15.00	2		2	1			25	25				
H0294	002	0	1	04	01	H0294_002_0	6	7	Group 7	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
H0294	002	0	1	04	01	H0294_002_0	6	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H0294	002	0	1	04	01	H0294_002_0	6	4	Group 4	11	0000001100001000000000000000000000000	000000000000000000100010	2		1	20.00	20.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	3	Group 3	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	2	Group 2	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H0294	002	0	1	04	01	H0294_002_0	6	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	12	Group 12	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	20.00	50.00
H0294	002	0	1	04	01	H0294_002_0	6	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H0294	002	0	1	04	01	H0294_002_0	6	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
H0294	004	0	1	04	01	H0294_004_0	6	1	Group 1	11	0111000011011010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	10	Group 10	01	0000000000000000000010000000000000000		2		1	14.00	15.00	2		2	1			20	20				
H0294	004	0	1	04	01	H0294_004_0	6	11	Group 11	11	0000000000000000000000010001011100110	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	12	Group 12	10		000000000000000000000001	2		1	340.00	390.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	2	Group 2	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H0294	004	0	1	04	01	H0294_004_0	6	3	Group 3	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	4	Group 4	11	0000001100001000000000000000000000000	000000000000000000100010	2		1	20.00	20.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H0294	004	0	1	04	01	H0294_004_0	6	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	7	Group 7	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0294	004	0	1	04	01	H0294_004_0	6	8	Group 8	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
H0294	004	0	1	04	01	H0294_004_0	6	9	Group 9	01	0000000000000001111100000000000000000		2		1	14.00	15.00	2		1	1	2		20	20		1	20.00	50.00
H0294	006	0	1	04	01	H0294_006_0	6	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
H0294	006	0	1	04	01	H0294_006_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
H0294	006	0	1	04	01	H0294_006_0	6	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
H0294	006	0	1	04	01	H0294_006_0	6	2	Group 2	11	0000010000000000000000000000011100000	000000000100000010100000	2		1	0.00	0.00	2		2	2								
H0317	001	0	1	04	01	H0317_001_0	4	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H0317	001	0	1	04	01	H0317_001_0	4	1		11	0000000000000000000000010000000000000	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H0317	001	0	1	04	01	H0317_001_0	4	9		10		000000000110000010110000	2		2			2		2	1			50	50				
H0317	001	0	1	04	01	H0317_001_0	4	8		01	0000000000000001100100000000000000000		2		1	35.00	35.00	2		2	1			30	30				
H0317	001	0	1	04	01	H0317_001_0	4	7		01	0000000001001000000000000000000000000		2		1	15.00	15.00	2		2	1			30	30				
H0317	001	0	1	04	01	H0317_001_0	4	6		11	0111111110110110011001100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H0317	001	0	1	04	01	H0317_001_0	4	5		01	0000000000000000000010000000000000000		2		1	15.00	15.00	2		2	1			20	30				
H0317	001	0	1	04	01	H0317_001_0	4	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0317	001	0	1	04	01	H0317_001_0	4	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H0317	004	0	1	04	01	H0317_004_0	6	1		11	0000000000000000000000010000000000000	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H0317	004	0	1	04	01	H0317_004_0	6	8		01	0000000000000001100100000000000000000		2		1	35.00	35.00	2		2	1			30	30				
H0317	004	0	1	04	01	H0317_004_0	6	7		01	0000000001001000000000000000000000000		2		1	15.00	15.00	2		2	1			30	30				
H0317	004	0	1	04	01	H0317_004_0	6	6		11	0111111110110110011001100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H0317	004	0	1	04	01	H0317_004_0	6	9		10		000000000110000010110000	2		2			2		2	1			50	50				
H0317	004	0	1	04	01	H0317_004_0	6	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0317	004	0	1	04	01	H0317_004_0	6	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H0317	004	0	1	04	01	H0317_004_0	6	2		01	0000000000000000000000001000000000000		2		1	275.00	275.00	2		2	2								
H0317	004	0	1	04	01	H0317_004_0	6	5		01	0000000000000000000010000000000000000		2		1	15.00	15.00	2		2	1			20	30				
H0317	006	0	1	04	01	H0317_006_0	8	2		01	0000000000000000000000001000000000000		2		1	350.00	350.00	2		2	2								
H0317	006	0	1	04	01	H0317_006_0	8	1		11	0000000000000000000000010000000000000	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H0317	006	0	1	04	01	H0317_006_0	8	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H0317	006	0	1	04	01	H0317_006_0	8	9		10		000000000110000010110000	2		2			2		2	1			50	50				
H0317	006	0	1	04	01	H0317_006_0	8	8		01	0000000000000001100100000000000000000		2		1	40.00	40.00	2		2	1			30	30				
H0317	006	0	1	04	01	H0317_006_0	8	7		01	0000000001001000000000000000000000000		2		1	20.00	20.00	2		2	1			30	30				
H0317	006	0	1	04	01	H0317_006_0	8	6		11	0111111110110110011001100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H0317	006	0	1	04	01	H0317_006_0	8	5		01	0000000000000000000010000000000000000		2		1	20.00	20.00	2		2	1			20	30				
H0317	006	0	1	04	01	H0317_006_0	8	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0317	007	0	1	04	01	H0317_007_0	6	1		11	0000000000000000000000010000000000000	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H0317	007	0	1	04	01	H0317_007_0	6	2		01	0000000000000000000000001000000000000		2		1	350.00	350.00	2		2	2								
H0317	007	0	1	04	01	H0317_007_0	6	9		10		000000000110000010110000	2		2			2		2	1			50	50				
H0317	007	0	1	04	01	H0317_007_0	6	8		01	0000000000000001100100000000000000000		2		1	40.00	40.00	2		2	1			30	30				
H0317	007	0	1	04	01	H0317_007_0	6	7		01	0000000001001000000000000000000000000		2		1	20.00	20.00	2		2	1			30	30				
H0317	007	0	1	04	01	H0317_007_0	6	6		11	0111111110110110011001100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H0317	007	0	1	04	01	H0317_007_0	6	5		01	0000000000000000000010000000000000000		2		1	20.00	20.00	2		2	1			20	30				
H0317	007	0	1	04	01	H0317_007_0	6	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H0317	007	0	1	04	01	H0317_007_0	6	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0319	001	0	1	04	01	H0319_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000100000000110101	2		1	0.00	0.00	2		2	2								
H0319	001	0	1	04	01	H0319_001_0	5	3	Group 3	10		000000010000000000000000	2		2			2		2	1			75	75				
H0319	001	0	1	04	01	H0319_001_0	5	4	Group 4	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H0319	001	0	1	04	01	H0319_001_0	5	5	Group 5	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0319	001	0	1	04	01	H0319_001_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001010	2		2			2		2	1			30	30				
H0319	001	0	1	04	01	H0319_001_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H0620	002	0	1	04	01	H0620_002_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001010	2		2			2		2	1			30	30				
H0620	002	0	1	04	01	H0620_002_0	5	2	Group 2	11	0000000000000000000000000000100000010	000000000100000000110101	2		1	0.00	0.00	2		2	2								
H0620	002	0	1	04	01	H0620_002_0	5	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H0620	002	0	1	04	01	H0620_002_0	5	4	Group 4	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H0620	002	0	1	04	01	H0620_002_0	5	3	Group 3	10		000000010000000000000000	2		2			2		2	1			75	75				
H0710	001	0	1	04	01	H0710_001_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H0710	001	0	1	04	01	H0710_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000100000000010100	2		1	0.00	0.00	2		2	2								
H0710	001	0	1	04	01	H0710_001_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H0710	001	0	1	04	01	H0710_001_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H0710	001	0	1	04	01	H0710_001_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H0710	001	0	1	04	01	H0710_001_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H0840	001	0	1	04	01	H0840_001_0	16	13		01	0000000000000000000000000000000001101		2		1	35.00	35.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	14		01	0000000000000000000000000000000010000		2		2			2		2	1			20	20				
H0840	001	0	1	04	01	H0840_001_0	16	15		10		000000000000000000000100	1	100.00	1	0.00	100.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	2		11	0000100000000000000000000000000000000	000000000000000010000000	2		2			2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	3		01	0000010010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	4		10		000000000000000000001000	2		1	0.00	100.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	5		01	0000001101001100000000000000000000000		2		1	35.00	35.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	6		01	0000000000000001111100000000000000000		2		2			2		2	1			20	20				
H0840	001	0	1	04	01	H0840_001_0	16	7		01	0000000000110100000000110000100000000		2		1	35.00	35.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	8		01	0000000000000000000000000000000100000		2		1	25.00	25.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	9		01	0000000000000000000011000000000000000		2		1	300.00	300.00	2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	1		01	0111000000000000000000000100000000000		2		2			2		2	1			20	20				
H0840	001	0	1	04	01	H0840_001_0	16	10		01	0000000000000000000000000110000000010		2		2			2		2	1			20	20				
H0840	001	0	1	04	01	H0840_001_0	16	11		01	0000000000000000000000000001011000000		2		2			2		2	2								
H0840	001	0	1	04	01	H0840_001_0	16	12		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	10		01	0000000000000000000000000110000000010		2		2			2		2	1			20	20				
H0840	002	0	1	04	01	H0840_002_0	13	6		01	0000000000000001111100000000000000000		2		2			2		2	1			20	20				
H0840	002	0	1	04	01	H0840_002_0	13	12		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	13		01	0000000000000000000000000000000001101		2		1	35.00	35.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	14		01	0000000000000000000000000000000010000		2		2			2		2	1			20	20				
H0840	002	0	1	04	01	H0840_002_0	13	15		10		000000000000000000000100	1	100.00	1	0.00	100.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	2		11	0000100000000000000000000000000000000	000000000000000010000000	2		2			2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	3		01	0000010010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	4		10		000000000000000000001000	2		1	0.00	100.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	5		01	0000001101001100000000000000000000000		2		1	35.00	35.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	1		01	0111000000000000000000000100000000000		2		2			2		2	1			20	20				
H0840	002	0	1	04	01	H0840_002_0	13	9		01	0000000000000000000011000000000000000		2		1	300.00	300.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	8		01	0000000000000000000000000000000100000		2		1	25.00	25.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	7		01	0000000000110100000000110000100000000		2		1	35.00	35.00	2		2	2								
H0840	002	0	1	04	01	H0840_002_0	13	11		01	0000000000000000000000000001011000000		2		2			2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	9	OON Dental	10		000000000000000000100000	1	100.00	2			2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	8	Other	11	0000000000000000000000000000010001010	000000000010000000100000	2		2			2		2	1			0	0				
H0879	001	0	1	04	01	H0879_001_0	14	7	OP Blood	11	0000000000000000000000010000000000000	000000100000000000000000	2		2			2		2	1			30	30				
H0879	001	0	1	04	01	H0879_001_0	14	6	Part B Drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H0879	001	0	1	04	01	H0879_001_0	14	5	Diabetes/Kidney Disease	01	0000000000000000000000000000001100000		2		2			2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	4	Ambulance	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	3	Specialist/Healthcare Services	01	0000000001111100000000100000000000101		2		1	25.00	25.00	2		2	2								
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H0879	001	0	1	04	01	H0879_001_0	14	14		10		000000010000000000000000	2		2			2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	12		10		000000000000000010000000	2		2			2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	13		01	0000000000000001111100000000000000000		2		2			2		1	1	2		30	30		1	25.00	30.00
H0879	001	0	1	04	01	H0879_001_0	14	11	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			20	20				
H0879	001	0	1	04	01	H0879_001_0	14	10	OON Routine Eye Exam	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0879	001	0	1	04	01	H0879_001_0	14	1	Percentage Co-Pay	01	0111110110000010000011000110100000000		2		2			2		2	1			30	30				
H0879	002	0	1	04	01	H0879_002_0	14	3	Specialist/Healthcare Services	01	0000000001111100000000100000000000101		2		1	35.00	35.00	2		2	2								
H0879	002	0	1	04	01	H0879_002_0	14	4	Ambulance	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H0879	002	0	1	04	01	H0879_002_0	14	5	Diabetes/Kidney Disease	01	0000000000000000000000000000001100000		2		2			2		2	2								
H0879	002	0	1	04	01	H0879_002_0	14	6	Part B Drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H0879	002	0	1	04	01	H0879_002_0	14	7	OP Blood	11	0000000000000000000000010000000000000	000000100000000000000000	2		2			2		2	1			30	30				
H0879	002	0	1	04	01	H0879_002_0	14	8	Other	11	0000000000000000000000000000010001010	000000000010000000100000	2		2			2		2	1			0	0				
H0879	002	0	1	04	01	H0879_002_0	14	13		01	0000000000000001111100000000000000000		2		2			2		1	1	2		50	50		1	30.00	35.00
H0879	002	0	1	04	01	H0879_002_0	14	1	Percentage Co-Pay	01	0111110110000010000011000110100000000		2		2			2		2	1			50	50				
H0879	002	0	1	04	01	H0879_002_0	14	2	PCP	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H0879	002	0	1	04	01	H0879_002_0	14	10	OON Routine Eye Exam	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0879	002	0	1	04	01	H0879_002_0	14	11	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			20	20				
H0879	002	0	1	04	01	H0879_002_0	14	12		10		000000010000000010000000	2		2			2		2	2								
H0879	002	0	1	04	01	H0879_002_0	14	9	OON Dental	10		000000000000000000100000	1	100.00	2			2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	1	Percentage Co-Pay	01	0111110110000010000011000110100000000		2		2			2		2	1			50	50				
H0879	004	0	1	04	01	H0879_004_0	6	9	OON Dental	10		000000000000000000100000	1	100.00	2			2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	8	Other	11	0000000000000000000000000000010001010	000000000010000000100000	2		2			2		2	1			0	0				
H0879	004	0	1	04	01	H0879_004_0	6	7	OP Blood	11	0000000000000000000000010000000000000	000000100000000000000000	2		2			2		2	1			30	30				
H0879	004	0	1	04	01	H0879_004_0	6	6	Part B Drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H0879	004	0	1	04	01	H0879_004_0	6	5	Diabetes/Kidney Disease	01	0000000000000000000000000000001100000		2		2			2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	4	Ambulance	01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	10	OON Routine Eye Exam	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	2	PCP	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	3	Specialist/Healthcare Services	01	0000000001111100000000100000000000101		2		1	35.00	35.00	2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	11	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			20	20				
H0879	004	0	1	04	01	H0879_004_0	6	12		10		000000010000000010000000	2		2			2		2	2								
H0879	004	0	1	04	01	H0879_004_0	6	13		01	0000000000000001111100000000000000000		2		2			2		1	1	2		30	30		1	35.00	35.00
H0879	801	0	1	04	01	H0879_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H0879	801	0	1	04	01	H0879_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H0879	802	0	1	04	01	H0879_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H0879	802	0	1	04	01	H0879_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H0879	803	0	1	04	01	H0879_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H0879	803	0	1	04	01	H0879_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1019	014	0	1	01	01	H1019_014_0	6	1																					
H1019	027	0	1	01	01	H1019_027_0	5	1																					
H1019	043	0	1	01	01	H1019_043_0	7	1																					
H1019	057	0	1	01	01	H1019_057_0	5	1																					
H1019	060	0	1	01	01	H1019_060_0	6	1																					
H1019	065	0	1	01	01	H1019_065_0	6	1																					
H1108	001	0	1	04	01	H1108_001_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H1108	001	0	1	04	01	H1108_001_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H1108	001	0	1	04	01	H1108_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000100000000000101	2		1	0.00	0.00	2		2	2								
H1108	001	0	1	04	01	H1108_001_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1108	001	0	1	04	01	H1108_001_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001010	2		2			2		2	1			30	30				
H1108	001	0	1	04	01	H1108_001_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H1108	002	0	1	04	01	H1108_002_0	8	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H1108	002	0	1	04	01	H1108_002_0	8	2	Group 2	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H1108	002	0	1	04	01	H1108_002_0	8	3	Group 3	10		000000010000000000000000	2		2			2		2	1			75	75				
H1108	002	0	1	04	01	H1108_002_0	8	5	Group 5	11	0000000000000000000000000000000000010	000000000100000010110100	2		1	0.00	0.00	2		2	2								
H1108	002	0	1	04	01	H1108_002_0	8	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H1108	002	0	1	04	01	H1108_002_0	8	4	Group 4	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1110	001	0	1	04	01	H1110_001_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H1110	001	0	1	04	01	H1110_001_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1110	001	0	1	04	01	H1110_001_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			35	35				
H1110	001	0	1	04	01	H1110_001_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H1110	801	0	1	04	01	H1110_801_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1110	801	0	1	04	01	H1110_801_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1110	802	0	1	04	01	H1110_802_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1110	802	0	1	04	01	H1110_802_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1110	805	0	2	04	01	H1110_805_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1110	805	0	2	04	01	H1110_805_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1110	806	0	2	04	01	H1110_806_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1110	806	0	2	04	01	H1110_806_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1291	001	0	1	09	04	H1291_001_0	4	1		11	0000010000000000000000010000011100000	000000100000000100001000	2		1	0.00	0.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	10		01	0000000000000000000010000000000000000		2		1	40.00	250.00	2		2	1			20	20				
H1291	001	0	1	09	04	H1291_001_0	4	11		10		000000000110000010110000	2		2			2		2	1			50	50				
H1291	001	0	1	09	04	H1291_001_0	4	2		01	0000000000000001100000000000000000100		2		1	0.00	40.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	3		01	0000001100000000000000000000000000000		2		1	15.00	15.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	9		01	0000000000000000001000000111100010000		2		2			2		2	1			20	20				
H1291	001	0	1	09	04	H1291_001_0	4	5		01	0000000000000000000100000000000000000		2		1	15.00	40.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	6		01	0000000000000000000001001000000000000		2		1	200.00	200.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	7		01	0000000000000000000000000000000000010		2		1	25.00	25.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	8		01	0111100011111110000000100000000001001		2		1	40.00	40.00	2		2	2								
H1291	001	0	1	09	04	H1291_001_0	4	4		01	0000000000000000010000000000000000000		2		1	15.00	250.00	2		1	2	2					1	15.00	40.00
H1302	001	0	1	04	01	H1302_001_0	5	3	Ambulance $150 Copayment	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1302	001	0	1	04	01	H1302_001_0	5	2	$40 Copay	11	0111001111011010000000000000000000101	000000000000000000001000	2		1	40.00	40.00	2		2	2								
H1302	001	0	1	04	01	H1302_001_0	5	1	No Cost Share	01	0000000000000000000000000000011100010		2		2			2		2	1			0	0				
H1302	001	0	1	04	01	H1302_001_0	5	4	30% Coinsurance	11	0000110000100101111111110111100011000	000000100000000000000000	2		2			2		2	1			30	30				
H1302	001	0	1	04	01	H1302_001_0	5	5	$100 Vision Eyewear Manimum	10		000000000000000000000100	2		2			2		2	2								
H1302	001	0	1	04	01	H1302_001_0	5	6	$0 to $10 Copayment	10		000000000000000010000000	2		1	0.00	10.00	2		2	2								
H1302	004	0	1	04	01	H1302_004_0	3	3	Ambulance $150 Copayment	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1302	004	0	1	04	01	H1302_004_0	3	2	$30 Copay	11	0111001111011010000000000000000000101	000000000000000000001000	2		1	30.00	30.00	2		2	2								
H1302	004	0	1	04	01	H1302_004_0	3	1	No Cost Share	01	0000000000000000000000000000011100010		2		2			2		2	2								
H1302	004	0	1	04	01	H1302_004_0	3	4	30% Coinsurance	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H1302	004	0	1	04	01	H1302_004_0	3	8	$0 to $10 Copayment	10		000000000000000010000000	2		1	0.00	10.00	2		2	2								
H1302	004	0	1	04	01	H1302_004_0	3	7	$100 Vision Eyewear Maximum	10		000000000000000000000100	2		2			2		2	2								
H1302	004	0	1	04	01	H1302_004_0	3	6	25% Coinsurance	11	0000100000100101111100110000000001000	000000100000000000000000	2		2			2		2	1			25	25				
H1302	004	0	1	04	01	H1302_004_0	3	5	20% Coinsurance	01	0000010000000000000011000111100000000		2		2			2		2	1			20	20				
H1302	006	0	1	04	01	H1302_006_0	5	1	No Cost Share	01	0000000000000000000000000000011100010		2		2			2		2	1			0	0				
H1302	006	0	1	04	01	H1302_006_0	5	5	$100 Vision Eyewear Maximum	10		000000000000000000000100	2		2			2		2	2								
H1302	006	0	1	04	01	H1302_006_0	5	4	30% Coinsurance	11	0000110000100101111111110111100011000	000000100000000000000000	2		2			2		2	1			30	30				
H1302	006	0	1	04	01	H1302_006_0	5	3	Ambulance $150 Copayment	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1302	006	0	1	04	01	H1302_006_0	5	2	$40 Copay	11	0111001111011010000000000000000000101	000000000000000000001000	2		1	40.00	40.00	2		2	2								
H1302	006	0	1	04	01	H1302_006_0	5	6	$0 to $10 Copayment	10		000000000000000010000000	2		1	0.00	10.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1303	001	0	1	04	01	H1303_001_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H1303	001	0	1	04	01	H1303_001_0	6	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	65.00	65.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			30	30				
H1303	001	0	1	04	01	H1303_001_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		30	30		1	35.00	65.00
H1303	001	0	1	04	01	H1303_001_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			30	30				
H1303	001	0	1	04	01	H1303_001_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1303	001	0	1	04	01	H1303_001_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	65.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1303	001	0	1	04	01	H1303_001_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1303	007	0	1	04	01	H1303_007_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	25.00	25.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	15	Group 15	10		000000000000000000100000	2		1	40.00	40.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	60.00	60.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			30	30				
H1303	007	0	1	04	01	H1303_007_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		30	30		1	25.00	60.00
H1303	007	0	1	04	01	H1303_007_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			30	30				
H1303	007	0	1	04	01	H1303_007_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1303	007	0	1	04	01	H1303_007_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H1303	007	0	1	04	01	H1303_007_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1303	007	0	1	04	01	H1303_007_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	25.00	60.00	2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H1304	001	0	1	04	01	H1304_001_0	8	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H1304	001	0	1	04	01	H1304_001_0	8	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H1304	001	0	1	04	01	H1304_001_0	8	6	$100 maximum	10		000000000000000000000100	1	100.00	2			2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	5	$0 to $275 copay	01	0000000000000000000010000000000000000		2		1	0.00	275.00	2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	1	$40 copay	01	0111001111111110000000100000000001101		2		1	40.00	40.00	2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	3	$150 copay	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H1304	001	0	1	04	01	H1304_001_0	8	11	0 - Zero Cost Share	11	0000100000000001100000010001011100010	000000100000000110000000	2		2			2		2	2								
H1304	001	0	1	04	01	H1304_001_0	8	10	30%	01	0000000000000000010000000110000000000		2		2			2		2	1			30	30				
H1304	001	0	1	04	01	H1304_001_0	8	4	$0 to $225 copay	01	0000000000000000000001000000000000000		2		1	0.00	225.00	2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H1304	002	0	1	04	01	H1304_002_0	15	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H1304	002	0	1	04	01	H1304_002_0	15	6	$50 maximum	10		000000000000000000000100	1	50.00	2			2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	5	$0 to $275 copay	01	0000000000000000000010000000000000000		2		1	0.00	275.00	2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	4	$0 to $225 copay	01	0000000000000000000001000000000000000		2		1	0.00	225.00	2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	3	$150 copay	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	13	$5 coapy	01	0000000000000000100000000000000000000		2		1	5.00	5.00	2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H1304	002	0	1	04	01	H1304_002_0	15	11	$0  Cost Share	11	0000100000000001100000010001011100010	000000100000000111000000	2		2			2		2	2								
H1304	002	0	1	04	01	H1304_002_0	15	10	30%	01	0000000000000000010000000110000000000		2		2			2		2	1			30	30				
H1304	002	0	1	04	01	H1304_002_0	15	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H1304	002	0	1	04	01	H1304_002_0	15	1	$40 copay	01	0111001111111110000000100000000001101		2		1	40.00	40.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	1	$30 copay	01	0111001111111110000000100000000001101		2		1	30.00	30.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	10	30%	01	0000000000000000010000000000000000000		2		2			2		2	1			30	30				
H1304	004	0	1	04	01	H1304_004_0	12	11	$0 to $150 copay	01	0000000000000000000001000000000000000		2		1	0.00	150.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	12	0% to 10%	01	0000000000000000000000000000000010000		2		2			2		2	1			0	10				
H1304	004	0	1	04	01	H1304_004_0	12	13	$5	01	0000000000000000100000000000000000000		2		1	5.00	5.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	2	$25 copay	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	3	$150 copay	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	4	$100 maximum	10		000000000000000000000100	1	100.00	2			2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	5	$0 to $250 copay	01	0000000000000000000010000000000000000		2		1	0.00	250.00	2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	6	$0  Cost Share	11	0000100000000001100000010001011100010	000000100000000111000000	2		2			2		2	2								
H1304	004	0	1	04	01	H1304_004_0	12	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H1304	004	0	1	04	01	H1304_004_0	12	8	10%	01	0000010000000000010100000000100000000		2		2			2		2	1			10	10				
H1304	004	0	1	04	01	H1304_004_0	12	9	20%	01	0000000000000000001000000110000000000		2		2			2		2	1			20	20				
H1304	008	0	1	04	01	H1304_008_0	8	5	$0 to $275 copay	01	0000000000000000000010000000000000000		2		1	0.00	275.00	2		2	2								
H1304	008	0	1	04	01	H1304_008_0	8	4	$0 to $225 copay	01	0000000000000000000001000000000000000		2		1	0.00	225.00	2		2	2								
H1304	008	0	1	04	01	H1304_008_0	8	3	$150 copay	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1304	008	0	1	04	01	H1304_008_0	8	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H1304	008	0	1	04	01	H1304_008_0	8	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H1304	008	0	1	04	01	H1304_008_0	8	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H1304	008	0	1	04	01	H1304_008_0	8	10	30%	01	0000000000000000010000000110000000000		2		2			2		2	1			30	30				
H1304	008	0	1	04	01	H1304_008_0	8	1	$40 copay	01	0111001111111110000000100000000001101		2		1	40.00	40.00	2		2	2								
H1304	008	0	1	04	01	H1304_008_0	8	6	$100 maximum	10		000000000000000000000100	1	100.00	2			2		2	2								
H1304	008	0	1	04	01	H1304_008_0	8	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H1304	008	0	1	04	01	H1304_008_0	8	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H1304	008	0	1	04	01	H1304_008_0	8	11	0 - Zero Cost Share	11	0000100000000001100000010001011100010	000000100000000110000000	2		2			2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	4	$0 to $225 copay	01	0000000000000000000001000000000000000		2		1	0.00	225.00	2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	3	$150 copay	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	13	$5 Coapy	01	0000000000000000100000000000000000000		2		1	5.00	5.00	2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H1304	009	0	1	04	01	H1304_009_0	12	11	$0  Cost Share	11	0000100000000001000000010001011100010	000000100000000111000000	2		2			2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	10	30%	01	0000000000000000010000000110000000000		2		2			2		2	1			30	30				
H1304	009	0	1	04	01	H1304_009_0	12	1	$40 copay	01	0111001111111110000000100000000001101		2		1	40.00	40.00	2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	5	$0 to $275 copay	01	0000000000000000000010000000000000000		2		1	0.00	275.00	2		2	2								
H1304	009	0	1	04	01	H1304_009_0	12	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H1304	009	0	1	04	01	H1304_009_0	12	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H1304	009	0	1	04	01	H1304_009_0	12	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H1304	009	0	1	04	01	H1304_009_0	12	6	$50 maximum	10		000000000000000000000100	1	50.00	2			2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	1	$30 copay	01	0111001111111110000000100000000001101		2		1	30.00	30.00	2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	10	30%	01	0000000000000000010000000000000000000		2		2			2		2	1			30	30				
H1304	010	0	1	04	01	H1304_010_0	12	9	20%	01	0000000000000000001000000110000000000		2		2			2		2	1			20	20				
H1304	010	0	1	04	01	H1304_010_0	12	8	10%	01	0000010000000000010100000000100000000		2		2			2		2	1			10	10				
H1304	010	0	1	04	01	H1304_010_0	12	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H1304	010	0	1	04	01	H1304_010_0	12	11	$0 to $150 copay	01	0000000000000000000001000000000000000		2		1	0.00	150.00	2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	12	0% to 10%	01	0000000000000000000000000000000010000		2		2			2		2	1			0	10				
H1304	010	0	1	04	01	H1304_010_0	12	13	$5 coapy	01	0000000000000000100000000000000000000		2		1	5.00	5.00	2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	2	$25 copay	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	3	$150 copay	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	4	$100 maximum	10		000000000000000000000100	1	100.00	2			2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	5	$0 to $250 copay	01	0000000000000000000010000000000000000		2		1	0.00	250.00	2		2	2								
H1304	010	0	1	04	01	H1304_010_0	12	6	$0  Cost Share	11	0000100000000001100000010001011100010	000000100000000111000000	2		2			2		2	2								
H1304	803	0	1	04	01	H1304_803_0	4	2	20%	01	0111101111111111011111111111101111111		2		2			2		2	1			20	20				
H1304	803	0	1	04	01	H1304_803_0	4	1	$0	01	0000010000000000100000000000010000010		2		2			2		2	2								
H1304	804	0	1	04	01	H1304_804_0	4	1	$0	01	0000010000000000100000000000010000010		2		2			2		2	2								
H1304	804	0	1	04	01	H1304_804_0	4	2	20%	01	0111101111111111011111111111101111111		2		2			2		2	1			20	20				
H1365	001	0	1	04	01	H1365_001_0	11	5	Group 5	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H1365	001	0	1	04	01	H1365_001_0	11	4	Group 4	11	0000000000000000100000000000001100000	000000000001000000000000	2		2			2		2	2								
H1365	001	0	1	04	01	H1365_001_0	11	3	Group 3	01	0000000000000001000000000000000000000		2		1	0.00	75.00	2		2	2								
H1365	001	0	1	04	01	H1365_001_0	11	2	Group 2	01	0000010000000000000000000001100010000		2		2			2		2	1			20	20				
H1365	001	0	1	04	01	H1365_001_0	11	1	Group 1	11	0111100111111110011011110110010001111	000000100000000100001000	2		2			2		2	1			30	30				
H1365	001	0	1	04	01	H1365_001_0	11	6	Group 6	01	0000001000000000000000000000000000000		2		1	25.00	25.00	2		2	2								
H1365	001	0	1	04	01	H1365_001_0	11	7	Group 7	01	0000000000000000000100000000000000000		2		1	0.00	15.00	2		2	2								
H1365	002	0	1	04	01	H1365_002_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H1365	002	0	1	04	01	H1365_002_0	8	4	Group 4	11	0000000000000000100000000000001100000	000000000001000000000000	2		2			2		2	2								
H1365	002	0	1	04	01	H1365_002_0	8	3	Group 3	01	0000000000000001000000000000000000000		2		1	0.00	75.00	2		2	2								
H1365	002	0	1	04	01	H1365_002_0	8	2	Group 2	01	0000010000000000000000000001100010000		2		2			2		2	1			20	20				
H1365	002	0	1	04	01	H1365_002_0	8	1	Group 1	11	0111100111111110011011110110010001111	000000100000000100001000	2		2			2		2	1			30	30				
H1365	002	0	1	04	01	H1365_002_0	8	6	Group 6	01	0000001000000000000000000000000000000		2		1	25.00	25.00	2		2	2								
H1365	002	0	1	04	01	H1365_002_0	8	7	Group 7	01	0000000000000000000100000000000000000		2		1	0.00	15.00	2		2	2								
H1365	003	0	1	04	01	H1365_003_0	10	1	Group 1	11	0111100111111110011011110110010001111	000000100000000100001000	2		2			2		2	1			30	30				
H1365	003	0	1	04	01	H1365_003_0	10	2	Group 2	01	0000010000000000000000000001100010000		2		2			2		2	1			20	20				
H1365	003	0	1	04	01	H1365_003_0	10	3	Group 3	01	0000000000000001000000000000000000000		2		1	0.00	75.00	2		2	2								
H1365	003	0	1	04	01	H1365_003_0	10	4	Group 4	11	0000000000000000100000000000001100000	000000000001000000000000	2		2			2		2	2								
H1365	003	0	1	04	01	H1365_003_0	10	5	Group 5	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H1365	003	0	1	04	01	H1365_003_0	10	6	Group 6	01	0000001000000000000000000000000000000		2		1	25.00	25.00	2		2	2								
H1365	003	0	1	04	01	H1365_003_0	10	7	Group 7	01	0000000000000000000100000000000000000		2		1	0.00	15.00	2		2	2								
H1365	802	0	1	04	01	H1365_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1365	802	0	1	04	01	H1365_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1365	803	0	1	04	01	H1365_803_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1365	803	0	1	04	01	H1365_803_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1417	001	0	1	04	01	H1417_001_0	7	5	ASC	01	0000000000000000000011000000000000000		2		1	200.00	200.00	2		2	2								
H1417	001	0	1	04	01	H1417_001_0	7	4	DME	01	0000000000000000000000000111000000000		2		2			2		2	1			20	20				
H1417	001	0	1	04	01	H1417_001_0	7	3	Ambulance	01	0000000000000000000000001000000000000		2		1	50.00	50.00	2		2	2								
H1417	001	0	1	04	01	H1417_001_0	7	2	Renal Dialysis	11	0000000000000000000000010000100000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H1417	001	0	1	04	01	H1417_001_0	7	1	Office Visits	11	0111111111111111111100100000011111101	000000000001010110101010	2		1	30.00	30.00	2		2	2								
H1417	001	0	1	04	01	H1417_001_0	7	6	Eye Wear	01	0000000000000000000000000000000000010		2		1	0.00	0.00	2		2	2								
H1417	002	0	1	04	01	H1417_002_0	11	5	ASC	01	0000000000000000000011000000000000000		2		1	200.00	200.00	2		2	2								
H1417	002	0	1	04	01	H1417_002_0	11	4	DME	01	0000000000000000000000000111000000000		2		2			2		2	1			20	20				
H1417	002	0	1	04	01	H1417_002_0	11	3	Ambulance	01	0000000000000000000000001000000000000		2		1	50.00	50.00	2		2	2								
H1417	002	0	1	04	01	H1417_002_0	11	2	Renal Dialysis	11	0000000000000000000000010000100000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H1417	002	0	1	04	01	H1417_002_0	11	1	Office Visits	11	0111111111111111111100100000011111101	000000000001010110101010	2		1	30.00	30.00	2		2	2								
H1417	002	0	1	04	01	H1417_002_0	11	6	Eye Wear	01	0000000000000000000000000000000000010		2		1	0.00	0.00	2		2	2								
H1417	003	0	1	04	01	H1417_003_0	7	1	Office Visits	11	0111111111111111111100100000011111101	000000000001010110101000	2		1	50.00	50.00	2		2	2								
H1417	003	0	1	04	01	H1417_003_0	7	2	Renal Dialysis	11	0000000000000000000000010000100000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H1417	003	0	1	04	01	H1417_003_0	7	3	Ambulance	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H1417	003	0	1	04	01	H1417_003_0	7	4	DME	01	0000000000000000000000000111000000000		2		2			2		2	1			20	20				
H1417	003	0	1	04	01	H1417_003_0	7	5	ASC	01	0000000000000000000011000000000000000		2		1	200.00	200.00	2		2	2								
H1417	003	0	1	04	01	H1417_003_0	7	6	Eye Wear	01	0000000000000000000000000000000000010		2		1	0.00	0.00	2		2	2								
H1417	004	0	1	04	01	H1417_004_0	11	1	Office Visits	11	0111111111111111111100100000011111101	000000000001010110101000	2		1	50.00	50.00	2		2	2								
H1417	004	0	1	04	01	H1417_004_0	11	2	Renal Dialysis	11	0000000000000000000000010000100000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H1417	004	0	1	04	01	H1417_004_0	11	3	Ambulance	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H1417	004	0	1	04	01	H1417_004_0	11	4	DME	01	0000000000000000000000000111000000000		2		2			2		2	1			20	20				
H1417	004	0	1	04	01	H1417_004_0	11	5	ASC	01	0000000000000000000011000000000000000		2		1	200.00	200.00	2		2	2								
H1417	004	0	1	04	01	H1417_004_0	11	6	Eye Wear	01	0000000000000000000000000000000000010		2		1	0.00	0.00	2		2	2								
H1417	801	0	1	04	01	H1417_801_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1417	801	0	1	04	01	H1417_801_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1417	802	0	1	04	01	H1417_802_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1417	802	0	1	04	01	H1417_802_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1417	810	0	1	04	01	H1417_810_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1417	810	0	1	04	01	H1417_810_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1418	002	0	1	04	01	H1418_002_0	7	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	50				
H1418	002	0	1	04	01	H1418_002_0	7	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1418	002	0	1	04	01	H1418_002_0	7	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H1418	002	0	1	04	01	H1418_002_0	7	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H1418	002	0	1	04	01	H1418_002_0	7	6		11	0111111111111111111101100111001111101	000000000110000110110000	2		2			2		2	1			50	50				
H1418	002	0	1	04	01	H1418_002_0	7	1		11	0000000000000000000000010000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H1418	007	0	1	04	01	H1418_007_0	7	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H1418	007	0	1	04	01	H1418_007_0	7	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H1418	007	0	1	04	01	H1418_007_0	7	3		10		000000000000000000000010	2		1	35.00	35.00	2		2	2								
H1418	007	0	1	04	01	H1418_007_0	7	8		10		000000000110000010110000	2		2			2		2	1			50	50				
H1418	007	0	1	04	01	H1418_007_0	7	7		11	0111111111111111111101100111001111101	000001000000000100000000	2		2			2		2	1			30	30				
H1418	007	0	1	04	01	H1418_007_0	7	6		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H1418	007	0	1	04	01	H1418_007_0	7	5		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1418	007	0	1	04	01	H1418_007_0	7	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H1418	008	0	1	04	01	H1418_008_0	4	1		11	0000000000000000000000010000000000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H1418	008	0	1	04	01	H1418_008_0	4	6		11	0111111111111111111101100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H1418	008	0	1	04	01	H1418_008_0	4	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H1418	008	0	1	04	01	H1418_008_0	4	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1418	008	0	1	04	01	H1418_008_0	4	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H1418	008	0	1	04	01	H1418_008_0	4	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H1418	008	0	1	04	01	H1418_008_0	4	7		10		000000000100000010000000	2		2			2		2	1			50	50				
H1509	001	0	1	04	01	H1509_001_0	4	1	Group 1	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1509	001	0	1	04	01	H1509_001_0	4	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
H1509	001	0	1	04	01	H1509_001_0	4	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	30.00	60.00
H1509	001	0	1	04	01	H1509_001_0	4	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H1509	001	0	1	04	01	H1509_001_0	4	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	60.00	60.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	30.00	60.00	2		2	2								
H1509	001	0	1	04	01	H1509_001_0	4	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1509	001	0	1	04	01	H1509_001_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H1509	007	0	1	04	01	H1509_007_0	4	1	Group 1	01	0000001000000000000000000000000000000		2		1	25.00	25.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
H1509	007	0	1	04	01	H1509_007_0	4	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	25.00	55.00
H1509	007	0	1	04	01	H1509_007_0	4	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1509	007	0	1	04	01	H1509_007_0	4	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	55.00	55.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	25.00	55.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1509	007	0	1	04	01	H1509_007_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H1509	007	0	1	04	01	H1509_007_0	4	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1509	007	0	1	04	01	H1509_007_0	4	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H1509	009	0	1	04	01	H1509_009_0	4	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
H1509	009	0	1	04	01	H1509_009_0	4	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1509	009	0	1	04	01	H1509_009_0	4	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H1509	009	0	1	04	01	H1509_009_0	4	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1509	009	0	1	04	01	H1509_009_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	60.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	60.00	60.00	2		2	2								
H1509	009	0	1	04	01	H1509_009_0	4	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H1509	009	0	1	04	01	H1509_009_0	4	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	35.00	60.00
H1509	010	0	1	04	01	H1509_010_0	4	1	Group 1	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1509	010	0	1	04	01	H1509_010_0	4	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
H1509	010	0	1	04	01	H1509_010_0	4	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	30.00	60.00
H1509	010	0	1	04	01	H1509_010_0	4	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H1509	010	0	1	04	01	H1509_010_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H1509	010	0	1	04	01	H1509_010_0	4	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1509	010	0	1	04	01	H1509_010_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	30.00	60.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H1509	010	0	1	04	01	H1509_010_0	4	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	60.00	60.00	2		2	2								
H1509	801	0	1	04	01	H1509_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	801	0	1	04	01	H1509_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	803	0	1	04	01	H1509_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	803	0	1	04	01	H1509_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	804	0	1	04	01	H1509_804_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	804	0	1	04	01	H1509_804_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	806	0	2	04	01	H1509_806_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	806	0	2	04	01	H1509_806_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	807	0	2	04	01	H1509_807_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	807	0	2	04	01	H1509_807_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	808	0	2	04	01	H1509_808_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	808	0	2	04	01	H1509_808_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	809	0	1	04	01	H1509_809_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	809	0	1	04	01	H1509_809_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	810	0	1	04	01	H1509_810_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	810	0	1	04	01	H1509_810_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	811	0	1	04	01	H1509_811_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	811	0	1	04	01	H1509_811_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	812	0	1	04	01	H1509_812_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	812	0	1	04	01	H1509_812_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	813	0	1	04	01	H1509_813_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	813	0	1	04	01	H1509_813_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	814	0	1	04	01	H1509_814_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	814	0	1	04	01	H1509_814_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	815	0	1	04	01	H1509_815_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	815	0	1	04	01	H1509_815_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	816	0	1	04	01	H1509_816_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	816	0	1	04	01	H1509_816_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1509	817	0	1	04	01	H1509_817_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
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H1509	819	0	1	04	01	H1509_819_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1509	819	0	1	04	01	H1509_819_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1510	001	0	1	04	01	H1510_001_0	4	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H1510	001	0	1	04	01	H1510_001_0	4	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H1510	001	0	1	04	01	H1510_001_0	4	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H1510	001	0	1	04	01	H1510_001_0	4	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
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H1510	001	0	1	04	01	H1510_001_0	4	7		10		000000000000000010100000	2		2			2		2	1			50	50				
H1510	001	0	1	04	01	H1510_001_0	4	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H1510	004	0	1	04	01	H1510_004_0	4	7		10		000000000000000010110000	2		2			2		2	1			50	50				
H1510	004	0	1	04	01	H1510_004_0	4	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H1510	004	0	1	04	01	H1510_004_0	4	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H1510	004	0	1	04	01	H1510_004_0	4	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H1510	004	0	1	04	01	H1510_004_0	4	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H1510	004	0	1	04	01	H1510_004_0	4	6		11	0111111111111111111101100111001101101	000000000000000100000000	2		2			2		2	1			30	30				
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H1510	005	0	1	04	01	H1510_005_0	4	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
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H1517	004	0	1	04	01	H1517_004_0	6	1	$50 OON Group	01	0111100111110110000000100000000000011		2		1	50.00	50.00	2		2	2								
H1517	004	0	1	04	01	H1517_004_0	6	2	$30 OON Group	01	0000001000001000100000000000000000000		2		1	30.00	30.00	2		2	2								
H1517	004	0	1	04	01	H1517_004_0	6	3	35% OON Group	01	0000000000000001010100000000000000000		2		2			2		2	1			35	35				
H1517	004	0	1	04	01	H1517_004_0	6	4	20% OON Group	01	0000000000000000001000000000100000000		2		2			2		2	1			20	20				
H1517	004	0	1	04	01	H1517_004_0	6	5	30% OON Group	01	0000000000000000000001000111000010000		2		2			2		2	1			30	30				
H1517	004	0	1	04	01	H1517_004_0	6	6	$0 OON Group	11	0000010000000000000000010000001101000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1517	004	0	1	04	01	H1517_004_0	6	7	$150 OON Group	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1517	004	0	1	04	01	H1517_004_0	6	8	9A OON Group	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			30	30				
H1517	004	0	1	04	01	H1517_004_0	6	9	$0 TO $50 OON Group	01	0000000000000000000000000000010000100		2		1	0.00	50.00	2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	1	$55 OON Group	01	0111000111010010000000000000000000011		2		1	55.00	55.00	2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	10	9A OON Group	01	0000000000000000000010000000000000000		2		1	20.00	55.00	2		2	1			25	25				
H1517	005	0	1	04	01	H1517_005_0	6	11	$0 to $55 OON Group	01	0000000000000000000000000000010000100		2		1	0.00	55.00	2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	2	$50 OON Group	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	3	$0 OON Group	11	0000010000000000000000010000001101000	000000100000000010000000	2		2			2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	4	$20 OON Group	01	0000001000001000000000000000000000000		2		1	20.00	20.00	2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	5	30% OON Group	01	0000000000000001010100000111000010000		2		2			2		2	1			30	30				
H1517	005	0	1	04	01	H1517_005_0	6	6	$30 OON Group	01	0000000000000000100000000000000000000		2		1	30.00	30.00	2		2	2								
H1517	005	0	1	04	01	H1517_005_0	6	7	20% OON Group	01	0000000000000000001000000000100000000		2		2			2		2	1			20	20				
H1517	005	0	1	04	01	H1517_005_0	6	8	25% OON Group	01	0000000000000000000001000000000000000		2		2			2		2	1			25	25				
H1517	005	0	1	04	01	H1517_005_0	6	9	$150 OON Group	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1517	801	0	1	04	01	H1517_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1517	801	0	1	04	01	H1517_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1517	802	0	1	04	01	H1517_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1517	802	0	1	04	01	H1517_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1517	803	0	1	04	01	H1517_803_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1517	803	0	1	04	01	H1517_803_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	001	0	1	04	01	H1537_001_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H1537	001	0	1	04	01	H1537_001_0	6	9	Group 9	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H1537	001	0	1	04	01	H1537_001_0	6	7	Group 7	01	0000000000000001111100000000000000000		2		1	13.00	13.00	2		1	1	1	40	40	40	40	2		
H1537	001	0	1	04	01	H1537_001_0	6	6	Group 6	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H1537	001	0	1	04	01	H1537_001_0	6	5	Group 5	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1537	001	0	1	04	01	H1537_001_0	6	4	Group 4	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1537	001	0	1	04	01	H1537_001_0	6	3	Group 3	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H1537	001	0	1	04	01	H1537_001_0	6	2	Group 2	11	0000000000000000000000010000000000000	000000100000000010000001	2		1	0.00	0.00	2		2	2								
H1537	001	0	1	04	01	H1537_001_0	6	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	13.00	2		2	1			40	40				
H1537	001	0	1	04	01	H1537_001_0	6	1	Group 1	11	0111001111011010000001000011001111111	000001000000000100001010	2		2			2		2	1			40	40				
H1537	801	0	1	04	01	H1537_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	801	0	1	04	01	H1537_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	802	0	1	04	01	H1537_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	802	0	1	04	01	H1537_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	803	0	1	04	01	H1537_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	803	0	1	04	01	H1537_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	804	0	2	04	01	H1537_804_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	804	0	2	04	01	H1537_804_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	805	0	2	04	01	H1537_805_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	805	0	2	04	01	H1537_805_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	806	0	2	04	01	H1537_806_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	806	0	2	04	01	H1537_806_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	807	0	1	04	01	H1537_807_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	807	0	1	04	01	H1537_807_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	808	0	1	04	01	H1537_808_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	808	0	1	04	01	H1537_808_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	809	0	1	04	01	H1537_809_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	809	0	1	04	01	H1537_809_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	816	0	1	04	01	H1537_816_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	816	0	1	04	01	H1537_816_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	817	0	1	04	01	H1537_817_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	817	0	1	04	01	H1537_817_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	818	0	1	04	01	H1537_818_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	818	0	1	04	01	H1537_818_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	819	0	1	04	01	H1537_819_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	819	0	1	04	01	H1537_819_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	820	0	1	04	01	H1537_820_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	820	0	1	04	01	H1537_820_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1537	821	0	1	04	01	H1537_821_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1537	821	0	1	04	01	H1537_821_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1595	002	0	1	04	01	H1595_002_0	7	2	50% OON	11	0000000000000000000000000110000010000	000000000000000001101110	2		2			2		2	1			50	50				
H1595	002	0	1	04	01	H1595_002_0	7	1	20% OON	01	0111111111111111111111111001111101111		2		2			2		2	1			20	20				
H1595	002	0	1	04	01	H1595_002_0	7	3	$0 Group	10		000000100000000010000000	2		2			2		2	2								
H1595	003	0	1	04	01	H1595_003_0	7	2	50% OON	11	0000000000000000000000000110000010000	000000000000000001001000	2		2			2		2	1			50	50				
H1595	003	0	1	04	01	H1595_003_0	7	3	$0 Group	10		000000100000000010000000	2		2			2		2	2								
H1595	003	0	1	04	01	H1595_003_0	7	1	30% OON	01	0111111111111111111111111001111101111		2		2			2		2	1			30	30				
H1595	801	0	1	04	01	H1595_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1595	801	0	1	04	01	H1595_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1595	802	0	1	04	01	H1595_802_0	4	4	Group 4	01	0000010000000000100000000000010000000		2		2			2		2	2								
H1595	802	0	1	04	01	H1595_802_0	4	3	Group 3	01	0000000000100100000000000000000000000		2		2			2		2	1			35	35				
H1595	802	0	1	04	01	H1595_802_0	4	2	Group 2	01	0111101111011011011111111111101111111		2		2			2		2	1			20	20				
H1595	802	0	1	04	01	H1595_802_0	4	1	Group 1	10		000000000000000001000000	2		2			2		2	1			50	50				
H1595	804	0	1	04	01	H1595_804_0	4	2	Group 2	01	0111101111011011011111111111101111111		2		2			2		2	1			20	20				
H1595	804	0	1	04	01	H1595_804_0	4	4	Group 4	01	0000010000000000100000000000010000000		2		2			2		2	2								
H1595	804	0	1	04	01	H1595_804_0	4	3	Group 3	01	0000000000100100000000000000000000000		2		2			2		2	1			35	35				
H1595	804	0	1	04	01	H1595_804_0	4	1	Group 1	10		000000000000000001000000	2		2			2		2	1			50	50				
H1607	001	0	1	04	01	H1607_001_0	7	2	20%	01	0000000000000000001000000000100000000		2		2			2		2	1			20	20				
H1607	001	0	1	04	01	H1607_001_0	7	3	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	30.00	45.00	2		2	1			30	30				
H1607	001	0	1	04	01	H1607_001_0	7	12	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	45.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	11	Part B Rx	01	0000000000000000000000000000000010000		2		2			2		2	1			20	20				
H1607	001	0	1	04	01	H1607_001_0	7	10	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	1	$0	11	0000010000000000000000010000001101010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	13	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	45.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	5	Specialist	11	0111000111010010000000000000000000001	000000000000000000000010	2		1	45.00	45.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	6	DME/ASC	01	0000000000000000000001000111000000000		2		2			2		2	1			30	30				
H1607	001	0	1	04	01	H1607_001_0	7	7	Mental Health	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H1607	001	0	1	04	01	H1607_001_0	7	8	Radiology	01	0000000000000001010100000000000000000		2		2			2		2	1			30	30				
H1607	001	0	1	04	01	H1607_001_0	7	9	Labs	01	0000000000000000100000000000000000000		2		1	20.00	20.00	2		2	2								
H1607	804	0	1	04	01	H1607_804_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1607	804	0	1	04	01	H1607_804_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1607	805	0	1	04	01	H1607_805_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1607	805	0	1	04	01	H1607_805_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1607	806	0	1	04	01	H1607_806_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1607	806	0	1	04	01	H1607_806_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1608	001	0	1	04	01	H1608_001_0	10	6	Outpatient Diag Proc/Tests/Labs	01	0000000000000001111100000000000000000		2		2			2		1	1	1	0	30	30	30	2		
H1608	001	0	1	04	01	H1608_001_0	10	8	Diabetes Self-Management	01	0000000000000000000000000000000100000		2		2			2		1	1	1	0	0	0	30	2		
H1608	001	0	1	04	01	H1608_001_0	10	7	Eye Exam Glaucoma Screening	01	0000000000000000000000000000000000100		2		2			2		1	1	1	0	0	30	30	2		
H1608	001	0	1	04	01	H1608_001_0	10	5	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			0	30				
H1608	001	0	1	04	01	H1608_001_0	10	4	Preventive	11	0000000000000000000000000000011000000	000000000000000100000000	2		2			2		2	1			0	0				
H1608	001	0	1	04	01	H1608_001_0	10	3	Fitness	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H1608	001	0	1	04	01	H1608_001_0	10	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1608	001	0	1	04	01	H1608_001_0	10	1	30% Out-of-Network	11	0111111111111110000011110110100011011	000000100000000000000000	2		2			2		2	1			30	30				
H1608	004	0	1	04	01	H1608_004_0	8	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H1608	004	0	1	04	01	H1608_004_0	8	3	Fitness	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H1608	004	0	1	04	01	H1608_004_0	8	1	40% Out-of-Network	11	0111111111111110000011110110100011011	000000100000000000000000	2		2			2		2	1			40	40				
H1608	004	0	1	04	01	H1608_004_0	8	9	Diabetes Self-Management	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	40	40	40	2		
H1608	004	0	1	04	01	H1608_004_0	8	4	Preventive	11	0000000000000000000000000000011000000	000000000000000100000000	2		2			2		2	1			40	40				
H1608	004	0	1	04	01	H1608_004_0	8	7	Dental	10		000000000000000000100000	2		2			2		2	1			0	0				
H1608	004	0	1	04	01	H1608_004_0	8	6	Outpatient Diag Proc/Tests/Labs	01	0000000000000001111100000000000000000		2		2			2		1	1	1	40	40	40	40	2		
H1608	004	0	1	04	01	H1608_004_0	8	5	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			0	40				
H1608	004	0	1	04	01	H1608_004_0	8	8	Eye Exams	01	0000000000000000000000000000000000100		2		2			2		1	1	1	40	40	40	40	2		
H1608	007	0	1	04	01	H1608_007_0	8	6	Outpatient Diag Proc/Tests/Labs	01	0000000000000001111100000000000000000		2		2			2		1	1	1	40	40	40	40	2		
H1608	007	0	1	04	01	H1608_007_0	8	3	Fitness	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H1608	007	0	1	04	01	H1608_007_0	8	4	Preventive	11	0000000000000000000000000000011000000	000000000000000100000000	2		2			2		2	1			40	40				
H1608	007	0	1	04	01	H1608_007_0	8	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H1608	007	0	1	04	01	H1608_007_0	8	1	40% Out-of-Network	11	0111111111111110000011110110100011011	000000100000000000000000	2		2			2		2	1			40	40				
H1608	007	0	1	04	01	H1608_007_0	8	9	Diabetes Self-Management	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	40	40	40	2		
H1608	007	0	1	04	01	H1608_007_0	8	7	Dental	10		000000000000000000100000	1	500.00	2			1	75.00	2	1			30	30				
H1608	007	0	1	04	01	H1608_007_0	8	5	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			0	40				
H1608	007	0	1	04	01	H1608_007_0	8	8	Eye Exams	01	0000000000000000000000000000000000100		2		2			2		1	1	1	40	40	40	40	2		
H1608	008	0	1	04	01	H1608_008_0	8	1	40% Out-of-Network	11	0111111111111110000011110110100011011	000000100000000000000000	2		2			2		2	1			40	40				
H1608	008	0	1	04	01	H1608_008_0	8	2	Ambulance Services	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H1608	008	0	1	04	01	H1608_008_0	8	3	Fitness	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H1608	008	0	1	04	01	H1608_008_0	8	4	Preventive	11	0000000000000000000000000000011000000	000000000000000100000000	2		2			2		2	1			40	40				
H1608	008	0	1	04	01	H1608_008_0	8	5	Diabetic Supplies	01	0000000000000000000000000001000000000		2		2			2		2	1			0	40				
H1608	008	0	1	04	01	H1608_008_0	8	6	Outpatient Diag Proc/Tests/Labs	01	0000000000000001111100000000000000000		2		2			2		1	1	1	40	40	40	40	2		
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H1716	001	0	1	04	01	H1716_001_0	4	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1716	001	0	1	04	01	H1716_001_0	4	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H1716	001	0	1	04	01	H1716_001_0	4	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H1716	001	0	1	04	01	H1716_001_0	4	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H1716	001	0	1	04	01	H1716_001_0	4	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H1716	001	0	1	04	01	H1716_001_0	4	6		11	0111111111111111111101100111001101101	000000000000000100000000	2		2			2		2	1			30	30				
H1716	001	0	1	04	01	H1716_001_0	4	7		10		000000000100000010100000	2		2			2		2	1			50	50				
H1716	006	0	1	04	01	H1716_006_0	4	7		10		000000000100000010110000	2		2			2		2	1			50	50				
H1716	006	0	1	04	01	H1716_006_0	4	6		11	0111111111111111111101100111001101101	000000000000000100000000	2		2			2		2	1			30	30				
H1716	006	0	1	04	01	H1716_006_0	4	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H1716	006	0	1	04	01	H1716_006_0	4	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H1716	006	0	1	04	01	H1716_006_0	4	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H1716	006	0	1	04	01	H1716_006_0	4	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1716	006	0	1	04	01	H1716_006_0	4	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H1716	020	0	1	04	01	H1716_020_0	4	8		10		000000000100000010000000	2		2			2		2	1			50	50				
H1716	020	0	1	04	01	H1716_020_0	4	7		11	0111111111111111111101100011001101101	000000000000000100000000	2		2			2		2	1			30	30				
H1716	020	0	1	04	01	H1716_020_0	4	6		01	0000000000000000000000000100000000000		2		2			2		2	1			25	25				
H1716	020	0	1	04	01	H1716_020_0	4	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H1716	020	0	1	04	01	H1716_020_0	4	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H1716	020	0	1	04	01	H1716_020_0	4	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H1716	020	0	1	04	01	H1716_020_0	4	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H1716	020	0	1	04	01	H1716_020_0	4	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H1717	009	0	1	04	01	H1717_009_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H1717	009	0	1	04	01	H1717_009_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000000000000000100	2		1	0.00	0.00	2		2	2								
H1717	009	0	1	04	01	H1717_009_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H1717	009	0	1	04	01	H1717_009_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H1717	009	0	1	04	01	H1717_009_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H1717	009	0	1	04	01	H1717_009_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H1846	001	0	1	04	01	H1846_001_0	4	5	#5 Eye Exam	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	40.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	12	#12 DME / Medicare Part B Rx Drugs	01	0000000000000000000000000110000010000		2		2			2		2	1			20	20				
H1846	001	0	1	04	01	H1846_001_0	4	3	#3 Primary Care Physician / Chiropractic	01	0000001100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	2	#1 Preventative Services	11	0000000000000000000000000000011100000	000000000000000110000000	2		1	0.00	0.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	15	#15 Outpatient Hospital Services	01	0000000000000000000010000000000000000		2		1	0.00	300.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	14	#14 Ambulatory Surgical Center (ASC)	01	0000000000000000000001000000000000000		2		1	300.00	300.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	13	#13 Diabetes Supplies and Services	01	0000000000000000000000000001000000000		2		2			2		2	1			0	20				
H1846	001	0	1	04	01	H1846_001_0	4	9	#9 Outpatient Services	01	0000100010100110011100100000000000000		2		1	60.00	60.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	8	#8 Cardiac Rehab	01	0111000000000000000000000000000000000		2		1	40.00	60.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	7	#7 Other Health Care Professional	01	0000000000001000000000000000000000000		2		1	20.00	40.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	6	#6 Physician Specialty Services	11	0000000001010000000000000000000001001	000000000000000000000010	2		1	40.00	40.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	1	Group #1 Zero Cost Share	11	0000010000000000000000010000000000010	000000100000000000000000	2		2			2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	10	#10 OP Diagnostic Procedures/Test/Lab	01	0000000000000001100000000000000000000		2		1	0.00	60.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	11	#11 Ambulance Services	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H1846	001	0	1	04	01	H1846_001_0	4	4	#4 End Stage Renal	01	0000000000000000000000000000100000000		2		1	30.00	30.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	9	#9 Ambulance Services	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	8	#8 Cardiac Rehab	01	0111000000000000000000000000000000000		2		1	45.00	65.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	7	#7 Other Health Care Professionals	01	0000000000001000000000000000000000000		2		1	20.00	45.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	6	#6 Physician Specialty Services	11	0000000001110100000000100000000001001	000000000000000000000010	2		1	45.00	45.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	5	#5  Eye Exam	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	45.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	2	#2 Preventative / Education/Training	11	0000000000000000000000000000011100000	000000000000000110000000	2		1	0.00	0.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	3	#3 Primary Care Physician / Chiropractic	01	0000001100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	4	#4 End Stage Renal	01	0000000000000000000000000000100000000		2		1	30.00	30.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	15	#15 Outpatient Hospital Services	01	0000000000000000000010000000000000000		2		1	0.00	300.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	14	#14 Ambulatory Surgical Center (ASC)	01	0000000000000000000001000000000000000		2		1	300.00	300.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	13	#13 Diabetes Supplies and Services	01	0000000000000000000000000001000000000		2		2			2		2	1			0	20				
H1846	003	0	1	04	01	H1846_003_0	4	1	#1 Zero Cost Share	11	0000010000000000000000010000000000010	000000100000000000000000	2		2			2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	10	#10 OP Diagnostic Procedures/Test/Lab	01	0000000000000001100000000000000000000		2		1	0.00	65.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	11	# 11 Outpatient Services	01	0000100010000010011100000000000000000		2		1	65.00	65.00	2		2	2								
H1846	003	0	1	04	01	H1846_003_0	4	12	#12 DME / Medicare Part B RX Drugs	01	0000000000000000000000000110000010000		2		2			2		2	1			20	20				
H1846	801	0	1	04	01	H1846_801_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1846	801	0	1	04	01	H1846_801_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H1846	802	0	1	04	01	H1846_802_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H1846	802	0	1	04	01	H1846_802_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2001	001	0	1	04	01	H2001_001_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H2001	001	0	1	04	01	H2001_001_0	6	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H2001	001	0	1	04	01	H2001_001_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	50.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H2001	001	0	1	04	01	H2001_001_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H2001	001	0	1	04	01	H2001_001_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	35.00	50.00
H2001	001	0	1	04	01	H2001_001_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
H2001	001	0	1	04	01	H2001_001_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H2001	001	0	1	04	01	H2001_001_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	50.00	50.00	2		2	2								
H2029	001	0	1	04	01	H2029_001_0	3	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H2029	001	0	1	04	01	H2029_001_0	3	7		10		000000000110000010110000	2		2			2		2	1			50	50				
H2029	001	0	1	04	01	H2029_001_0	3	6		01	0000000000000000010000000000000000000		2		2			2		1	1	1	30	30	30	30	2		
H2029	001	0	1	04	01	H2029_001_0	3	5		11	0111111111111111101101100111011111111	000000000000000100000000	2		2			2		2	1			30	30				
H2029	001	0	1	04	01	H2029_001_0	3	4		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H2029	001	0	1	04	01	H2029_001_0	3	2		01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H2029	001	0	1	04	01	H2029_001_0	3	1		11	0000000000000000000000010000000000000	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H2029	002	0	1	04	01	H2029_002_0	4	2		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H2029	002	0	1	04	01	H2029_002_0	4	6		10		000000000110000010110000	2		2			2		2	1			50	50				
H2029	002	0	1	04	01	H2029_002_0	4	5		11	0111111111111111111101100111001111101	000000000000000100000000	2		2			2		2	1			30	30				
H2029	002	0	1	04	01	H2029_002_0	4	4		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H2029	002	0	1	04	01	H2029_002_0	4	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H2029	002	0	1	04	01	H2029_002_0	4	1		11	0000000000000000000000011000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H2029	801	0	1	04	01	H2029_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	801	0	1	04	01	H2029_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2029	802	0	1	04	01	H2029_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	802	0	1	04	01	H2029_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2029	803	0	1	04	01	H2029_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2029	803	0	1	04	01	H2029_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	805	0	2	04	01	H2029_805_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	805	0	2	04	01	H2029_805_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2029	806	0	2	04	01	H2029_806_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2029	806	0	2	04	01	H2029_806_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	807	0	2	04	01	H2029_807_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2029	807	0	2	04	01	H2029_807_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	808	0	1	04	01	H2029_808_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H2029	808	0	1	04	01	H2029_808_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H2111	001	0	1	04	01	H2111_001_0	5	1	Group 1	11	0111111111111110000001111111001101101	000001100000000000001010	2		2			2		2	1			30	30				
H2111	001	0	1	04	01	H2111_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000100000000110101	2		1	0.00	0.00	2		2	2								
H2111	001	0	1	04	01	H2111_001_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H2111	001	0	1	04	01	H2111_001_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H2111	001	0	1	04	01	H2111_001_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H2111	001	0	1	04	01	H2111_001_0	5	6	Group 6	01	0000000000000000000000000000000010000		2		2			2		2	1			29	29				
H2111	001	0	1	04	01	H2111_001_0	5	7	Group 7	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H2111	008	0	1	04	01	H2111_008_0	8	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H2111	008	0	1	04	01	H2111_008_0	8	2	Group 2	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H2111	008	0	1	04	01	H2111_008_0	8	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H2111	008	0	1	04	01	H2111_008_0	8	4	Group 4	11	0000000000000000000000000000000000010	000000000100000010110100	2		1	0.00	0.00	2		2	2								
H2111	008	0	1	04	01	H2111_008_0	8	5	Group 5	10		000000010000000000000000	2		2			2		2	1			75	75				
H2111	008	0	1	04	01	H2111_008_0	8	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H2228	001	0	1	04	01	H2228_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000000000000000100	2		1	0.00	0.00	2		2	2								
H2228	001	0	1	04	01	H2228_001_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H2228	001	0	1	04	01	H2228_001_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H2228	001	0	1	04	01	H2228_001_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H2228	001	0	1	04	01	H2228_001_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H2228	001	0	1	04	01	H2228_001_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H2228	002	0	1	04	01	H2228_002_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H2228	002	0	1	04	01	H2228_002_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000000000000000100	2		1	0.00	0.00	2		2	2								
H2228	002	0	1	04	01	H2228_002_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H2228	002	0	1	04	01	H2228_002_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H2228	002	0	1	04	01	H2228_002_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H2228	002	0	1	04	01	H2228_002_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H2230	002	0	1	04	01	H2230_002_0	9	6		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H2230	002	0	1	04	01	H2230_002_0	9	5		01	0000000000000000000000000000010001000		2		1	0.00	40.00	2		2	1			0	20				
H2230	002	0	1	04	01	H2230_002_0	9	4		11	0000000000000000000000000000000010010	000000000001000011000101	2		1	0.00	0.00	2		2	2								
H2230	002	0	1	04	01	H2230_002_0	9	1		11	0111110110100111111111110111001100000	000000100000000000000000	2		2			2		2	1			20	20				
H2230	002	0	1	04	01	H2230_002_0	9	2		11	0000001001011000000000000000000000101	000000000000000000101010	2		1	40.00	40.00	2		2	2								
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H2611	824	0	1	04	01	H2611_824_0	5	3	Medicare Covered	01	0111101111011011111111111111101111111		2		2			2		2	1			20	20				
H2676	001	0	1	04	01	H2676_001_0	5	1	30% Coinsurance	11	0111100000101000000011110111100011000	000000100000000000000000	2		2			2		2	1			30	30				
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H2676	001	0	1	04	01	H2676_001_0	5	9	$0 Copay	10		000000000000000010000000	2		2			2		2	2								
H2676	001	0	1	04	01	H2676_001_0	5	6	$0-$60 Copay	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	60.00	2		2	2								
H2676	001	0	1	04	01	H2676_001_0	5	7	0%-30% Coinsurance	11	0000000000000000000000000000000000010	000000000000000000000100	2		2			2		2	1			0	30				
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H3335	008	0	1	04	01	H3335_008_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	008	0	1	04	01	H3335_008_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	20.00	2		2	1			30	30				
H3335	008	0	1	04	01	H3335_008_0	7	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	008	0	1	04	01	H3335_008_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	009	0	1	04	01	H3335_009_0	7	1	30% Coinsurance	11	0000010000000001111011010111001110000	000000100000000000000000	2		2			2		2	1			30	30				
H3335	009	0	1	04	01	H3335_009_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	009	0	1	04	01	H3335_009_0	7	7	$20 Copayment	11	0000001100000000000100000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3335	009	0	1	04	01	H3335_009_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	20.00	2		2	1			30	30				
H3335	009	0	1	04	01	H3335_009_0	7	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	009	0	1	04	01	H3335_009_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	009	0	1	04	01	H3335_009_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	009	0	1	04	01	H3335_009_0	7	8	$40 Copayment - Specialist Services	11	0111000011011010000000000000000001111	000000000000000000101010	2		1	40.00	40.00	2		2	2								
H3335	014	0	1	04	01	H3335_014_0	7	8	$45 Copayment - Specialist Services	11	0111000011011010000000000000000001111	000000000000000000001010	2		1	45.00	45.00	2		2	2								
H3335	014	0	1	04	01	H3335_014_0	7	7	$20 Copayment	11	0000001100000000000100000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3335	014	0	1	04	01	H3335_014_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	014	0	1	04	01	H3335_014_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	20.00	2		2	1			30	30				
H3335	014	0	1	04	01	H3335_014_0	7	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	014	0	1	04	01	H3335_014_0	7	1	30% Coinsurance	11	0000010000000001111011010111001110000	000000100000000000000000	2		2			2		2	1			30	30				
H3335	014	0	1	04	01	H3335_014_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	014	0	1	04	01	H3335_014_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	015	0	1	04	01	H3335_015_0	7	8	$40 Copayment - Specialist Services	11	0111000011011010000000000000000001111	000000000000000000101010	2		1	40.00	40.00	2		2	2								
H3335	015	0	1	04	01	H3335_015_0	7	7	$20 Copayment	11	0000001100000000000100000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3335	015	0	1	04	01	H3335_015_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	015	0	1	04	01	H3335_015_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	20.00	2		2	1			30	30				
H3335	015	0	1	04	01	H3335_015_0	7	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	015	0	1	04	01	H3335_015_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	015	0	1	04	01	H3335_015_0	7	1	30% Coinsurance	11	0000010000000001111011010111001110000	000000100000000000000000	2		2			2		2	1			30	30				
H3335	015	0	1	04	01	H3335_015_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	018	0	1	04	01	H3335_018_0	8	1	30% Coinsurance	11	0111011111011011111111010111001111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	018	0	1	04	01	H3335_018_0	8	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	018	0	1	04	01	H3335_018_0	8	3	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3335	018	0	1	04	01	H3335_018_0	8	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	018	0	1	04	01	H3335_018_0	8	5	Preventive Services	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H3335	018	0	1	04	01	H3335_018_0	8	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	021	0	1	04	01	H3335_021_0	8	1	30% Coinsurance	11	0111011111011011111111010111001111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	021	0	1	04	01	H3335_021_0	8	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	021	0	1	04	01	H3335_021_0	8	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	021	0	1	04	01	H3335_021_0	8	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	021	0	1	04	01	H3335_021_0	8	5	Preventive Services	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H3335	021	0	1	04	01	H3335_021_0	8	3	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3335	032	0	1	04	01	H3335_032_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	032	0	1	04	01	H3335_032_0	7	1	30% Coinsurance	11	0111011111011011111111010111011111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	032	0	1	04	01	H3335_032_0	7	5	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	032	0	1	04	01	H3335_032_0	7	4	$0 Copayment	01	0000000000000000000000000000100000000		2		1	0.00	0.00	2		2	2								
H3335	032	0	1	04	01	H3335_032_0	7	3	$150 Copayment	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H3335	037	0	1	04	01	H3335_037_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	037	0	1	04	01	H3335_037_0	7	7	$25 Copayment	11	0000001100000000000100000000000000000	000000000000000100000000	2		1	25.00	25.00	2		2	2								
H3335	037	0	1	04	01	H3335_037_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	25.00	2		2	1			30	30				
H3335	037	0	1	04	01	H3335_037_0	7	4	End-Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	037	0	1	04	01	H3335_037_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	037	0	1	04	01	H3335_037_0	7	8	$50 Copayment - Specialist Services	11	0111000011011010000000000000000001111	000000000000000000001010	2		1	50.00	50.00	2		2	2								
H3335	037	0	1	04	01	H3335_037_0	7	1	30% Coinsurance	11	0000010000000001111011010111001110000	000000100000000000000000	2		2			2		2	1			30	30				
H3335	037	0	1	04	01	H3335_037_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	038	0	1	04	01	H3335_038_0	7	1	30% Coinsurance	11	0000010000000001111011010111001110000	000000100000000000000000	2		2			2		2	1			30	30				
H3335	038	0	1	04	01	H3335_038_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	038	0	1	04	01	H3335_038_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	038	0	1	04	01	H3335_038_0	7	4	End-Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	038	0	1	04	01	H3335_038_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	25.00	2		2	1			30	30				
H3335	038	0	1	04	01	H3335_038_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	038	0	1	04	01	H3335_038_0	7	7	$25 Copayment	11	0000001100000000000100000000000000000	000000000000000100000000	2		1	25.00	25.00	2		2	2								
H3335	038	0	1	04	01	H3335_038_0	7	8	$50 Copayment - Specialist Services	11	0111000011011010000000000000000001111	000000000000000000001010	2		1	50.00	50.00	2		2	2								
H3335	041	0	1	04	01	H3335_041_0	6	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	041	0	1	04	01	H3335_041_0	6	1	30% Coinsurance	11	0111011111011011111111010111011111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	041	0	1	04	01	H3335_041_0	6	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	041	0	1	04	01	H3335_041_0	6	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	041	0	1	04	01	H3335_041_0	6	5	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	042	0	1	04	01	H3335_042_0	6	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	042	0	1	04	01	H3335_042_0	6	5	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	042	0	1	04	01	H3335_042_0	6	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	042	0	1	04	01	H3335_042_0	6	1	30% Coinsurance	11	0111011111011011111111010111011111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	042	0	1	04	01	H3335_042_0	6	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	043	0	1	04	01	H3335_043_0	6	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	043	0	1	04	01	H3335_043_0	6	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	043	0	1	04	01	H3335_043_0	6	5	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	043	0	1	04	01	H3335_043_0	6	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	043	0	1	04	01	H3335_043_0	6	1	30% Coinsurance	11	0111011111011011111111010111011111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	044	0	1	04	01	H3335_044_0	6	5	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	044	0	1	04	01	H3335_044_0	6	1	30% Coinsurance	11	0111011111011011111111010111011111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	044	0	1	04	01	H3335_044_0	6	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	044	0	1	04	01	H3335_044_0	6	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	044	0	1	04	01	H3335_044_0	6	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	045	0	1	04	01	H3335_045_0	6	4	End Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	045	0	1	04	01	H3335_045_0	6	5	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	045	0	1	04	01	H3335_045_0	6	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	045	0	1	04	01	H3335_045_0	6	1	30% Coinsurance	11	0111011111011011111111010111011111111	000000100000000100001010	2		2			2		2	1			30	30				
H3335	045	0	1	04	01	H3335_045_0	6	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	051	0	1	04	01	H3335_051_0	7	3	$175 Copayment	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H3335	051	0	1	04	01	H3335_051_0	7	4	End-Stage Renal Disease	01	0000000000000000000000000000100000000		2		2			2		2	2								
H3335	051	0	1	04	01	H3335_051_0	7	5	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	25.00	2		2	1			30	30				
H3335	051	0	1	04	01	H3335_051_0	7	6	Supplemental Education/Wellness Programs	10		000000000000000010000000	2		2			2		2	2								
H3335	051	0	1	04	01	H3335_051_0	7	8	$50 Copayment - Specialist Services	11	0111000011011010000000000000000001111	000000000000000000001010	2		1	50.00	50.00	2		2	2								
H3335	051	0	1	04	01	H3335_051_0	7	7	$25 Copayment	11	0000001100000000000100000000000000000	000000000000000100000000	2		1	25.00	25.00	2		2	2								
H3335	051	0	1	04	01	H3335_051_0	7	2	50% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H3335	051	0	1	04	01	H3335_051_0	7	1	30% Coinsurance	11	0000010000000001111011010111001110000	000000100000000000000000	2		2			2		2	1			30	30				
H3335	801	0	1	04	01	H3335_801_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3335	801	0	1	04	01	H3335_801_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3335	811	0	1	04	01	H3335_811_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3335	811	0	1	04	01	H3335_811_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3335	813	0	1	04	01	H3335_813_0	3	3	20% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			20	20				
H3335	813	0	1	04	01	H3335_813_0	3	2	$0 Copayment	01	0000010000000000000000000000000000000		2		1	0.00	0.00	2		2	2								
H3335	813	0	1	04	01	H3335_813_0	3	1	20% Coinsurance	01	0111001111011011111111011111111111111		2		2			2		2	1			20	20				
H3335	819	0	1	04	01	H3335_819_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3335	819	0	1	04	01	H3335_819_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3335	820	0	1	04	01	H3335_820_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3335	820	0	1	04	01	H3335_820_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3335	822	0	1	04	01	H3335_822_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3335	822	0	1	04	01	H3335_822_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3342	001	0	1	04	01	H3342_001_0	7	13	50% Coinsurance Group	10		000000000000000000000011	2		2			2		2	1			50	50				
H3342	001	0	1	04	01	H3342_001_0	7	9	$35 Copay - 25% Coinsurance Group	01	0000000000000000000010000000000000000		2		1	35.00	50.00	2		2	1			25	25				
H3342	001	0	1	04	01	H3342_001_0	7	11	25% Coinsurance Group	01	0000000000000000000001000000000000000		2		2			2		2	1			25	25				
H3342	001	0	1	04	01	H3342_001_0	7	10	20% Coinsurance Group	11	0000000000000000000000000000100001000	000000000000000000100000	2		2			2		2	1			20	20				
H3342	001	0	1	04	01	H3342_001_0	7	1	$0 Copay Group	11	0000000000000000000000010000001100110	000000100000000010001100	2		1	0.00	0.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	14	30% Coinsurance Group - Therapeutic	01	0000000000000000001000000000000000000		2		2			2		1	1	2		30	30		1	35.00	50.00
H3342	001	0	1	04	01	H3342_001_0	7	15	$50 Copay Group - Diagnostic & Lab	01	0000000000000001100000000000000000000		2		1	50.00	50.00	2		1	2	2					1	35.00	50.00
H3342	001	0	1	04	01	H3342_001_0	7	2	$35 Copay Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	3	$50 Copay Group	11	0111000111010010000000000000000000101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	4	$65 Copay Group	01	0000010000000000000000000000000000000		2		1	65.00	65.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	5	$100 Copay Group	01	0000100000100100000000100000000000000		2		1	100.00	100.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	6	$250 Copay Group	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	7	$0 - $100 Copay Group	01	0000000000000000000000000000010000000		2		1	0.00	100.00	2		2	2								
H3342	001	0	1	04	01	H3342_001_0	7	8	$35 - $150 Copay Group	01	0000000000000000010100000000000000000		2		1	75.00	150.00	2		1	2	2					1	35.00	50.00
H3342	001	0	1	04	01	H3342_001_0	7	12	30% Coinsurance Group	01	0000000000000000000000000111000010000		2		2			2		2	1			30	30				
H3342	012	0	1	04	01	H3342_012_0	6	2	$40 Copay Group	01	0000001000001000000000000000000000000		2		1	40.00	40.00	2		2	2								
H3342	012	0	1	04	01	H3342_012_0	6	12	30%  Coinsurance Group - Therapeutic	01	0000000000000000001000000000000000000		2		2			2		1	1	2		30	30		1	40.00	65.00
H3342	012	0	1	04	01	H3342_012_0	6	11	30% Coinsurance Group	01	0000000000000000000001000111000010000		2		2			2		2	1			30	30				
H3342	012	0	1	04	01	H3342_012_0	6	10	20% Coinsurance Group	01	0000000000000000000000000000100001000		2		2			2		2	1			20	20				
H3342	012	0	1	04	01	H3342_012_0	6	1	$0 Copay Group	11	0000000000000000000000010000001100010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H3342	012	0	1	04	01	H3342_012_0	6	3	$65 Copay Group	11	0111010111010010000000000000000000101	000001000000000000000000	2		1	65.00	65.00	2		2	2								
H3342	012	0	1	04	01	H3342_012_0	6	9	$40 Copay - 30% Coinsurance Group	01	0000000000000000000010000000000000000		2		1	40.00	65.00	2		2	1			30	30				
H3342	012	0	1	04	01	H3342_012_0	6	8	$40 - $200 Copay Group	01	0000000000000000010100000000000000000		2		1	150.00	200.00	2		1	2	2					1	40.00	65.00
H3342	012	0	1	04	01	H3342_012_0	6	7	$0 - $100 Copay Group	01	0000000000000000000000000000010000000		2		1	0.00	100.00	2		2	2								
H3342	012	0	1	04	01	H3342_012_0	6	6	$40 - $75 Copay Group	01	0000000000000001100000000000000000000		2		1	50.00	75.00	2		1	2	2					1	40.00	65.00
H3342	012	0	1	04	01	H3342_012_0	6	5	$250 Copay Group	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3342	012	0	1	04	01	H3342_012_0	6	4	$100 Copay Group	01	0000100000100100000000100000000000000		2		1	100.00	100.00	2		2	2								
H3342	013	0	1	04	01	H3342_013_0	7	1	$0 Copay Group	11	0000000000000000000000010000001100110	000000100000000010001100	2		1	0.00	0.00	2		2	2								
H3342	013	0	1	04	01	H3342_013_0	7	10	20% Coinsurance Group	11	0000000000000000000000000000100011000	000000000000000000100000	2		2			2		2	1			20	20				
H3342	013	0	1	04	01	H3342_013_0	7	11	25% Coinsurance Group	01	0000000000000000000001000000000000000		2		2			2		2	1			25	25				
H3342	013	0	1	04	01	H3342_013_0	7	12	30% Coinsurance Group	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H3342	013	0	1	04	01	H3342_013_0	7	13	50% Coinsurance Group	10		000000000000000000000011	2		2			2		2	1			50	50				
H3342	013	0	1	04	01	H3342_013_0	7	14	50% Coinsurance Group	10		000000000000000000000001	2		2			2		2	1			50	50				
H3342	013	0	1	04	01	H3342_013_0	7	9	$30 Copay - 25% Coinsurance Group	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			25	25				
H3342	013	0	1	04	01	H3342_013_0	7	8	$30 Copay - 20% Coins Group	01	0000000000000000011100000000000000000		2		1	125.00	150.00	2		1	1	2		20	20		1	30.00	50.00
H3342	013	0	1	04	01	H3342_013_0	7	7	$30 - $75 Copay Group	01	0000000000000001100000000000000000000		2		1	50.00	75.00	2		1	2	2					1	30.00	50.00
H3342	013	0	1	04	01	H3342_013_0	7	6	$0 - $100 Copay Group	01	0000000000000000000000000000010000000		2		1	0.00	100.00	2		2	2								
H3342	013	0	1	04	01	H3342_013_0	7	5	$250 Copay Group	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3342	013	0	1	04	01	H3342_013_0	7	4	$100 Copay Group	01	0000100000100100000000100000000000000		2		1	100.00	100.00	2		2	2								
H3342	013	0	1	04	01	H3342_013_0	7	3	$50 Copay Group	11	0111010111010010000000000000000000101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H3342	013	0	1	04	01	H3342_013_0	7	2	$30 Copay Group	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	12	30% Coinsurance Group	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H3342	014	0	1	04	01	H3342_014_0	7	13	50% Coinsurance Group	10		000000000000000000000011	2		2			2		2	1			50	50				
H3342	014	0	1	04	01	H3342_014_0	7	14	50% Coinsurance Group	10		000000000000000000000001	2		2			2		2	1			50	50				
H3342	014	0	1	04	01	H3342_014_0	7	2	$30 Copay Group	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	3	$50 Copay Group	11	0111010111010010000000000000000000101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	4	$100 Copay Group	01	0000100000100100000000100000000000000		2		1	100.00	100.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	5	$250 Copay Group	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	6	$0 - $100 Copay Group	01	0000000000000000000000000000010000000		2		1	0.00	100.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	7	$30 - $75 Copay Group	01	0000000000000001100000000000000000000		2		1	50.00	75.00	2		1	2	2					1	30.00	50.00
H3342	014	0	1	04	01	H3342_014_0	7	8	$30 Copay - 20% Coins Group	01	0000000000000000011100000000000000000		2		1	125.00	150.00	2		1	1	2		20	20		1	30.00	50.00
H3342	014	0	1	04	01	H3342_014_0	7	9	$30 Copay - 25% Coinsurance Group	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			25	25				
H3342	014	0	1	04	01	H3342_014_0	7	1	$0 Copay Group	11	0000000000000000000000010000001100110	000000100000000010001100	2		1	0.00	0.00	2		2	2								
H3342	014	0	1	04	01	H3342_014_0	7	10	20% Coinsurance Group	11	0000000000000000000000000000100011000	000000000000000000100000	2		2			2		2	1			20	20				
H3342	014	0	1	04	01	H3342_014_0	7	11	25% Coinsurance Group	01	0000000000000000000001000000000000000		2		2			2		2	1			25	25				
H3342	808	0	1	04	01	H3342_808_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3342	808	0	1	04	01	H3342_808_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3342	809	0	1	04	01	H3342_809_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3342	809	0	1	04	01	H3342_809_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3342	810	0	1	04	01	H3342_810_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3342	810	0	1	04	01	H3342_810_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3344	005	0	1	04	01	H3344_005_0	7	6	50% coinsurance	11	0000000100000000000000000110000000000	000000000000000000100000	2		2			2		2	1			50	50				
H3344	005	0	1	04	01	H3344_005_0	7	5	45%	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H3344	005	0	1	04	01	H3344_005_0	7	4	30% coinsurance	11	0111010010000011111111010001011111001	000000100000000001000010	2		2			2		2	1			30	30				
H3344	005	0	1	04	01	H3344_005_0	7	3	$200 copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H3344	005	0	1	04	01	H3344_005_0	7	1	$0 copayment	11	0000000000000000000000000000100000010	000000000000000010001100	2		2			2		2	2								
H3344	005	0	1	04	01	H3344_005_0	7	2	$40 copayment	01	0000001001011000000000000000000000100		2		1	40.00	40.00	2		2	2								
H3344	801	0	1	04	01	H3344_801_0	2	1	20%	01	0111111111111111111111111111111111111		2		2			2		2	1			20	20				
H3344	803	0	1	04	01	H3344_803_0	2	1	20%	01	0111111111111111111111111111111111111		2		2			2		2	1			20	20				
H3344	804	0	1	04	01	H3344_804_0	2	1	20% copay	01	0111111111111111111111111111111111111		2		2			2		2	1			20	20				
H3404	001	0	1	04	01	H3404_001_0	7	1	$100	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3404	001	0	1	04	01	H3404_001_0	7	2	$0 Copay	11	0000000000000000001000000000011100000	000000000000000110000000	2		1	0.00	0.00	2		2	2								
H3404	001	0	1	04	01	H3404_001_0	7	3	20% Coinsurance	11	0111111111111111110111110111100011111	000000100000000000001000	2		2			2		2	1			20	20				
H3404	002	0	1	04	01	H3404_002_0	8	4	No Cost Sharing	11	0000010000000000001000010000111100000	000000100000000110000000	2		1	0.00	0.00	2		2	2								
H3404	002	0	1	04	01	H3404_002_0	8	5	$125 Copay	01	0000000000000000000011000000000000000		2		1	125.00	125.00	2		2	2								
H3404	002	0	1	04	01	H3404_002_0	8	3	$100 Copay	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3404	002	0	1	04	01	H3404_002_0	8	6	15% Coinsurance	01	0000000000000001110100000000000000000		2		2			2		2	1			15	15				
H3404	002	0	1	04	01	H3404_002_0	8	1	$35 Copay	11	0111101111111110000000100000000001101	000000000000000000001000	2		1	35.00	35.00	2		2	2								
H3404	002	0	1	04	01	H3404_002_0	8	2	20% Coinsurance	01	0000000000000000000000000111000010010		2		2			2		2	1			20	20				
H3404	801	0	1	04	01	H3404_801_0	1	2	20% Coinsurance	01	0111101111011011111111111111101111111		2		2			2		2	1			20	20				
H3404	801	0	1	04	01	H3404_801_0	1	1	40% Coinsurance	01	0000000000100100000000000000000000000		2		2			2		2	1			40	40				
H3404	801	0	1	04	01	H3404_801_0	1	3	No Cost Sharing	01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3404	803	0	1	04	01	H3404_803_0	1	1	No Cost Sharing	01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3404	803	0	1	04	01	H3404_803_0	1	3	20% Cost Sharing	01	0111101111011011111111111111101111111		2		2			2		2	1			20	20				
H3404	803	0	1	04	01	H3404_803_0	1	2	40% Coinsurance	01	0000000000100100000000000000000000000		2		2			2		2	1			40	40				
H3405	001	0	1	04	01	H3405_001_0	9	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3405	001	0	1	04	01	H3405_001_0	9	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	35				
H3405	001	0	1	04	01	H3405_001_0	9	6		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			35	35				
H3405	001	0	1	04	01	H3405_001_0	9	7		01	0000000000000000000000000111000000000		2		2			2		2	1			40	40				
H3405	001	0	1	04	01	H3405_001_0	9	8		10		000000000100000010000000	2		2			2		2	1			50	50				
H3405	001	0	1	04	01	H3405_001_0	9	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H3405	001	0	1	04	01	H3405_001_0	9	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H3405	001	0	1	04	01	H3405_001_0	9	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	35				
H3405	002	0	1	04	01	H3405_002_0	9	7		01	0000000000000000000000000111000000000		2		2			2		2	1			40	40				
H3405	002	0	1	04	01	H3405_002_0	9	8		10		000000000000000010000000	2		2			2		2	1			50	50				
H3405	002	0	1	04	01	H3405_002_0	9	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H3405	002	0	1	04	01	H3405_002_0	9	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H3405	002	0	1	04	01	H3405_002_0	9	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H3405	002	0	1	04	01	H3405_002_0	9	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3405	002	0	1	04	01	H3405_002_0	9	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H3405	002	0	1	04	01	H3405_002_0	9	6		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			30	30				
H3405	005	0	1	04	01	H3405_005_0	10	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3405	005	0	1	04	01	H3405_005_0	10	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H3405	005	0	1	04	01	H3405_005_0	10	8		10		000000000000000010000000	2		2			2		2	1			50	50				
H3405	005	0	1	04	01	H3405_005_0	10	7		01	0000000000000000000000000111000000000		2		2			2		2	1			40	40				
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H3405	007	0	1	04	01	H3405_007_0	10	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
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H3421	001	0	1	09	04	H3421_001_0	4	14	50	10		000000000000000010101111	1	500.00	2			2		2	1			50	50				
H3421	001	0	1	09	04	H3421_001_0	4	1	55	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
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H3421	001	0	1	09	04	H3421_001_0	4	7	40-250	01	0111000000000000000000100000000000000		2		1	40.00	250.00	2		2	2								
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H3421	001	0	1	09	04	H3421_001_0	4	11	20 no	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
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H3812	001	0	1	04	01	H3812_001_0	6	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
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H3813	001	0	1	04	01	H3813_001_0	3	3	$20.00 copayment	01	0000001100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
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H3813	001	0	1	04	01	H3813_001_0	3	8	$100 copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3813	001	0	1	04	01	H3813_001_0	3	7	20% coinsurance	01	0000000000000000011100000110100010000		2		2			2		2	1			20	20				
H3813	001	0	1	04	01	H3813_001_0	3	6	$35.00 copayment	11	0111100011010010000000000000000001001	000000000000000000001000	2		1	35.00	35.00	2		2	2								
H3813	001	0	1	04	01	H3813_001_0	3	5	$20 - $35 copayment	01	0000000000001000000000000000000000000		2		1	20.00	35.00	2		2	2								
H3813	001	0	1	04	01	H3813_001_0	3	4	$20-$30 copayment	01	0000000000100100000000100000000000000		2		1	20.00	30.00	2		2	2								
H3813	001	0	1	04	01	H3813_001_0	3	2	$10.00 copayment	01	0000000000000000000000000001000000000		2		1	10.00	10.00	2		2	1			20	20				
H3813	001	0	1	04	01	H3813_001_0	3	1	zero copay	11	0000010000000001100000010000011100110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H3813	004	0	1	04	01	H3813_004_0	4	3	$20.00 copayment	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H3813	004	0	1	04	01	H3813_004_0	4	1	zero copay	11	0000010000000001100000010000011100110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H3813	004	0	1	04	01	H3813_004_0	4	2	$10.00 copayment	01	0000000000000000000000000001000000000		2		1	10.00	10.00	2		2	1			20	20				
H3813	004	0	1	04	01	H3813_004_0	4	8	$100 copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3813	004	0	1	04	01	H3813_004_0	4	7	20% coinsurance	01	0000000000000000011111000110100010000		2		2			2		2	1			20	20				
H3813	004	0	1	04	01	H3813_004_0	4	6	$35.00 copayment	11	0111101011010010000000000000000001001	000000000000000000001000	2		1	35.00	35.00	2		2	2								
H3813	004	0	1	04	01	H3813_004_0	4	5	$20 - $35 copayment	01	0000000000001000000000000000000000000		2		1	20.00	35.00	2		2	2								
H3813	004	0	1	04	01	H3813_004_0	4	4	$20-$30 copayment	01	0000000000100100000000100000000000000		2		1	20.00	30.00	2		2	2								
H3813	005	0	1	04	01	H3813_005_0	4	3	$20.00 copayment	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H3813	005	0	1	04	01	H3813_005_0	4	2	$10.00 copayment	01	0000000000000000000000000001000000000		2		1	10.00	10.00	2		2	1			20	20				
H3813	005	0	1	04	01	H3813_005_0	4	6	$35.00 copayment	11	0111101011010010000000000000000001001	000000000000000000001000	2		1	35.00	35.00	2		2	2								
H3813	005	0	1	04	01	H3813_005_0	4	7	20% coinsurance	01	0000000000000000011111000110100010000		2		2			2		2	1			20	20				
H3813	005	0	1	04	01	H3813_005_0	4	8	$100 copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3813	005	0	1	04	01	H3813_005_0	4	4	$20-$30 copayment	01	0000000000100100000000100000000000000		2		1	20.00	30.00	2		2	2								
H3813	005	0	1	04	01	H3813_005_0	4	5	$20 - $35 copayment	01	0000000000001000000000000000000000000		2		1	20.00	35.00	2		2	2								
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H3813	006	0	1	04	01	H3813_006_0	3	10	$50.00 copayment	01	0000000001010000000000000000000001001		2		1	50.00	50.00	2		2	2								
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H3813	006	0	1	04	01	H3813_006_0	3	9	25 % coinsurance	01	0000000000000000000011000000000000000		2		2			2		2	1			25	25				
H3813	006	0	1	04	01	H3813_006_0	3	3	$20.00 copayment	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H3813	006	0	1	04	01	H3813_006_0	3	4	$20-$30 copayment	01	0000000000100100000000100000000000000		2		1	20.00	30.00	2		2	2								
H3813	006	0	1	04	01	H3813_006_0	3	5	$20 - $50 copayment	01	0000000000001000000000000000000000000		2		1	20.00	50.00	2		2	2								
H3813	006	0	1	04	01	H3813_006_0	3	6	$35.00 copayment	01	0111100010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H3813	006	0	1	04	01	H3813_006_0	3	2	$10.00 copayment	01	0000000000000000000000000001000000000		2		1	10.00	10.00	2		2	1			20	20				
H3813	006	0	1	04	01	H3813_006_0	3	8	$250 copayment	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3813	006	0	1	04	01	H3813_006_0	3	7	20% coinsurance	01	0000000000000000011100000110100010000		2		2			2		2	1			20	20				
H3813	802	0	1	04	01	H3813_802_0	1	8	diabetic supplies Therapeutic shoes	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			10	10				
H3813	802	0	1	04	01	H3813_802_0	1	7	$125.00 copayment	01	0000000000000000000011000000000000000		2		1	125.00	125.00	2		2	2								
H3813	802	0	1	04	01	H3813_802_0	1	6	$50 copayment	01	0000000000000000000000001000000000000		2		1	50.00	50.00	2		2	2								
H3813	802	0	1	04	01	H3813_802_0	1	5	10% coinsurance	01	0000000000000000011100000110100010000		2		2			2		2	1			10	10				
H3813	802	0	1	04	01	H3813_802_0	1	4	$20.00 copayment	11	0111100111110110000000100000000001001	000000000000000000001000	2		1	20.00	20.00	2		2	2								
H3813	802	0	1	04	01	H3813_802_0	1	2	$15.00 copayment	01	0000001000000000000000000000000000000		2		1	15.00	15.00	2		2	2								
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H3817	001	0	1	04	01	H3817_001_0	7	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H3817	001	0	1	04	01	H3817_001_0	7	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H3817	001	0	1	04	01	H3817_001_0	7	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H3817	001	0	1	04	01	H3817_001_0	7	4	$0 to $150 copay	01	0000000000000000000001000000000000000		2		1	0.00	150.00	2		2	2								
H3817	001	0	1	04	01	H3817_001_0	7	5	$0 to $350 copay	01	0000000000000000000010000000000000000		2		1	0.00	350.00	2		2	2								
H3817	001	0	1	04	01	H3817_001_0	7	6	$100 maximum	10		000000000000000000000100	1	100.00	2			2		2	2								
H3817	001	0	1	04	01	H3817_001_0	7	7	Dental Preventive - $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H3817	001	0	1	04	01	H3817_001_0	7	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H3817	001	0	1	04	01	H3817_001_0	7	3	$100 copay	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3817	002	0	1	04	01	H3817_002_0	15	6	$50 maximum	10		000000000000000000000100	1	50.00	2			2		2	2								
H3817	002	0	1	04	01	H3817_002_0	15	7	Dental Preventive - $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H3817	002	0	1	04	01	H3817_002_0	15	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H3817	002	0	1	04	01	H3817_002_0	15	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H3817	002	0	1	04	01	H3817_002_0	15	1	$40 copay	01	0111001111111110000000100000000001101		2		1	40.00	40.00	2		2	2								
H3817	002	0	1	04	01	H3817_002_0	15	10	30%	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H3817	002	0	1	04	01	H3817_002_0	15	11	$0  Cost Share	11	0000100000000001000000010001011100010	000000100000000111000000	2		2			2		2	2								
H3817	002	0	1	04	01	H3817_002_0	15	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H3817	002	0	1	04	01	H3817_002_0	15	13	$ 5 copay	01	0000000000000000100000000000000000000		2		1	5.00	5.00	2		2	2								
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H3817	002	0	1	04	01	H3817_002_0	15	3	$100 copay	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3817	002	0	1	04	01	H3817_002_0	15	4	$0 to $150 copay	01	0000000000000000000001000000000000000		2		1	0.00	150.00	2		2	2								
H3817	002	0	1	04	01	H3817_002_0	15	5	$0 to $350 copay	01	0000000000000000000010000000000000000		2		1	0.00	350.00	2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	1	$30 copay	01	0111001111111110000000100000000001101		2		1	30.00	30.00	2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	10	$0 to $125	01	0000000000000000000001000000000000000		2		1	0.00	125.00	2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	9	20%	01	0000000000000000011000000110000000000		2		2			2		2	1			20	20				
H3817	003	0	1	04	01	H3817_003_0	11	8	10%	01	0000010000000000010100000000100000000		2		2			2		2	1			10	10				
H3817	003	0	1	04	01	H3817_003_0	11	7	Dental Preventive - $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H3817	003	0	1	04	01	H3817_003_0	11	11	0% to 10%	01	0000000000000000000000000000000010000		2		2			2		2	1			0	10				
H3817	003	0	1	04	01	H3817_003_0	11	2	$25 copay	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	3	$100 copay	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	4	$50 maximum	10		000000000000000000000100	1	50.00	2			2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	5	$0 to $300 copay	01	0000000000000000000010000000000000000		2		1	0.00	300.00	2		2	2								
H3817	003	0	1	04	01	H3817_003_0	11	6	$0  Cost Share	11	0000100000000001100000010001011100010	000000100000000111000000	2		2			2		2	2								
H3817	801	0	1	04	01	H3817_801_0	2	2	20%	01	0111101111111111011111111111101111111		2		2			2		2	1			20	20				
H3817	801	0	1	04	01	H3817_801_0	2	1	$0	01	0000010000000000100000000000010000010		2		2			2		2	2								
H3817	802	0	1	04	01	H3817_802_0	1	1	$0	01	0000010000000000100000000000010000010		2		2			2		2	2								
H3817	802	0	1	04	01	H3817_802_0	1	2	20%	01	0111101111111111011111111111101111111		2		2			2		2	1			20	20				
H3832	001	0	1	04	01	H3832_001_0	9	1	Group 1 - 30%	11	0111111111111111111111100111100011101	000000000000000000001000	2		2			2		2	1			30	30				
H3832	001	0	1	04	01	H3832_001_0	9	2	Group 2 - $0	11	0000000000000000000000010000011100010	000000100000000010000100	2		1	0.00	0.00	2		2	2								
H3832	001	0	1	04	01	H3832_001_0	9	3	Group 3 - $200	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H3832	006	0	1	04	01	H3832_006_0	11	1	Group 1 - 30%	11	0111111111111111111111100111100011101	000000000000000000001000	2		2			2		2	1			30	30				
H3832	006	0	1	04	01	H3832_006_0	11	2	Group 2 - $0	11	0000000000000000000000010000011100010	000000100000000010000100	2		1	0.00	0.00	2		2	2								
H3832	006	0	1	04	01	H3832_006_0	11	3	Group 3 - $200	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H3832	801	0	1	04	01	H3832_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3832	801	0	1	04	01	H3832_801_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3832	802	0	1	04	01	H3832_802_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3832	802	0	1	04	01	H3832_802_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3832	805	0	1	04	01	H3832_805_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3832	805	0	1	04	01	H3832_805_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3832	806	0	1	04	01	H3832_806_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3832	806	0	1	04	01	H3832_806_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3909	001	0	1	04	01	H3909_001_0	8	3	Group3	01	0000000000000000000000001000000000000		2		1	75.00	75.00	2		2	2								
H3909	001	0	1	04	01	H3909_001_0	8	2	Group 2	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3909	001	0	1	04	01	H3909_001_0	8	4	Group4	10		000000000000000010000000	2		2			2		2	2								
H3909	001	0	1	04	01	H3909_001_0	8	1	Group 1	11	0111111111111111111111110111011111111	000000100000000100000000	2		2			2		2	1			30	30				
H3909	007	0	1	04	01	H3909_007_0	7	2	Group 2	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3909	007	0	1	04	01	H3909_007_0	7	1	Group 1	11	0111111111111111111111110111011111111	000000100000000100000000	2		2			2		2	1			30	30				
H3909	007	0	1	04	01	H3909_007_0	7	3	Group3	01	0000000000000000000000001000000000000		2		1	75.00	75.00	2		2	2								
H3909	007	0	1	04	01	H3909_007_0	7	4	Group4	10		000000000000000010000000	2		2			2		2	2								
H3909	009	0	1	04	01	H3909_009_0	9	3	Group3	01	0000000000000000000000001000000000000		2		1	75.00	75.00	2		2	2								
H3909	009	0	1	04	01	H3909_009_0	9	2	Group 2	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3909	009	0	1	04	01	H3909_009_0	9	1	Group 1	11	0111111111111111111111110111011111111	000000100000000100000000	2		2			2		2	1			30	30				
H3909	009	0	1	04	01	H3909_009_0	9	4	Group4	10		000000000000000010000000	2		2			2		2	2								
H3909	801	0	1	04	01	H3909_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3909	801	0	1	04	01	H3909_801_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3909	802	0	1	04	01	H3909_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3909	802	0	1	04	01	H3909_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3912	001	0	1	04	01	H3912_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000100000000110101	2		1	0.00	0.00	2		2	2								
H3912	001	0	1	04	01	H3912_001_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001010	2		2			2		2	1			30	30				
H3912	001	0	1	04	01	H3912_001_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H3912	001	0	1	04	01	H3912_001_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H3912	001	0	1	04	01	H3912_001_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H3912	001	0	1	04	01	H3912_001_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3916	001	0	1	04	01	H3916_001_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	001	0	1	04	01	H3916_001_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	001	0	1	04	01	H3916_001_0	5	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H3916	001	0	1	04	01	H3916_001_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	40.00
H3916	001	0	1	04	01	H3916_001_0	5	4	Group 4	11	0111110110111110000011110111000000011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	001	0	1	04	01	H3916_001_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	001	0	1	04	01	H3916_001_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	40.00
H3916	001	0	1	04	01	H3916_001_0	5	12	Group 12	11	0000000000000000000000000000000001000	000000000000000000010000	2		2			2		2	1			30	50				
H3916	001	0	1	04	01	H3916_001_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	001	0	1	04	01	H3916_001_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	001	0	1	04	01	H3916_001_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	40.00
H3916	001	0	1	04	01	H3916_001_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H3916	002	0	1	04	01	H3916_002_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	002	0	1	04	01	H3916_002_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	002	0	1	04	01	H3916_002_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	002	0	1	04	01	H3916_002_0	5	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H3916	002	0	1	04	01	H3916_002_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	002	0	1	04	01	H3916_002_0	5	4	Group 4	11	0111110110111110000011110111000000011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	002	0	1	04	01	H3916_002_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	40.00
H3916	002	0	1	04	01	H3916_002_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	40.00
H3916	002	0	1	04	01	H3916_002_0	5	12	Group 12	11	0000000000000000000000000000000001000	000000000000000000010000	2		2			2		2	1			30	50				
H3916	002	0	1	04	01	H3916_002_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	002	0	1	04	01	H3916_002_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H3916	002	0	1	04	01	H3916_002_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	40.00
H3916	005	0	1	04	01	H3916_005_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	005	0	1	04	01	H3916_005_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	005	0	1	04	01	H3916_005_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	005	0	1	04	01	H3916_005_0	5	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H3916	005	0	1	04	01	H3916_005_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	40.00
H3916	005	0	1	04	01	H3916_005_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	75.00	75.00	2		2	1			30	30				
H3916	005	0	1	04	01	H3916_005_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	005	0	1	04	01	H3916_005_0	5	12	Group 12	11	0000000000000000000000000000000001000	000000000000000000010000	2		2			2		2	1			30	50				
H3916	005	0	1	04	01	H3916_005_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	40.00
H3916	005	0	1	04	01	H3916_005_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	40.00
H3916	005	0	1	04	01	H3916_005_0	5	4	Group 4	11	0111110110111110000011110111000000011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	005	0	1	04	01	H3916_005_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H3916	012	0	1	04	01	H3916_012_0	4	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	45.00
H3916	012	0	1	04	01	H3916_012_0	4	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	012	0	1	04	01	H3916_012_0	4	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	012	0	1	04	01	H3916_012_0	4	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	012	0	1	04	01	H3916_012_0	4	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	012	0	1	04	01	H3916_012_0	4	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H3916	012	0	1	04	01	H3916_012_0	4	4	Group 4	11	0111110110111110000011110111000001011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	012	0	1	04	01	H3916_012_0	4	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	45.00
H3916	012	0	1	04	01	H3916_012_0	4	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	45.00
H3916	012	0	1	04	01	H3916_012_0	4	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	012	0	1	04	01	H3916_012_0	4	10	Group 10	01	0000000001000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H3916	015	0	1	04	01	H3916_015_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	015	0	1	04	01	H3916_015_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H3916	015	0	1	04	01	H3916_015_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	015	0	1	04	01	H3916_015_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	45.00
H3916	015	0	1	04	01	H3916_015_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	45.00
H3916	015	0	1	04	01	H3916_015_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	015	0	1	04	01	H3916_015_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	45.00
H3916	015	0	1	04	01	H3916_015_0	5	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H3916	015	0	1	04	01	H3916_015_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	015	0	1	04	01	H3916_015_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	015	0	1	04	01	H3916_015_0	5	4	Group 4	11	0111110110111110000011110111000001011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	018	0	1	04	01	H3916_018_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	018	0	1	04	01	H3916_018_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H3916	018	0	1	04	01	H3916_018_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H3916	018	0	1	04	01	H3916_018_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	018	0	1	04	01	H3916_018_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H3916	018	0	1	04	01	H3916_018_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H3916	018	0	1	04	01	H3916_018_0	5	4	Group 4	11	0111110110111110000011110111000001011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	018	0	1	04	01	H3916_018_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	1			30	30				
H3916	018	0	1	04	01	H3916_018_0	5	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H3916	018	0	1	04	01	H3916_018_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	018	0	1	04	01	H3916_018_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	019	0	1	04	01	H3916_019_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	1	30	0	30	30	2		
H3916	019	0	1	04	01	H3916_019_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	1	30	30	30	30	2		
H3916	019	0	1	04	01	H3916_019_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	1	30	0	0	30	2		
H3916	019	0	1	04	01	H3916_019_0	5	4	Group 4	11	0111111111111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H3916	019	0	1	04	01	H3916_019_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	019	0	1	04	01	H3916_019_0	5	6	Group 6	10		000000010000000010000000	2		2			2		2	1			50	50				
H3916	019	0	1	04	01	H3916_019_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	019	0	1	04	01	H3916_019_0	5	8	Group 8	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	020	0	1	04	01	H3916_020_0	5	6	Group 6	10		000000010000000010000000	2		2			2		2	1			50	50				
H3916	020	0	1	04	01	H3916_020_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	020	0	1	04	01	H3916_020_0	5	4	Group 4	11	0111111111111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H3916	020	0	1	04	01	H3916_020_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	1	30	0	0	30	2		
H3916	020	0	1	04	01	H3916_020_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	1	30	30	30	30	2		
H3916	020	0	1	04	01	H3916_020_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	1	30	0	30	30	2		
H3916	020	0	1	04	01	H3916_020_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	020	0	1	04	01	H3916_020_0	5	8	Group 8	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	022	0	1	04	01	H3916_022_0	5	4	Group 4	11	0111110110111110000011110111000001011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	022	0	1	04	01	H3916_022_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	45.00
H3916	022	0	1	04	01	H3916_022_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	45.00
H3916	022	0	1	04	01	H3916_022_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	022	0	1	04	01	H3916_022_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H3916	022	0	1	04	01	H3916_022_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	45.00
H3916	022	0	1	04	01	H3916_022_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	1			30	30				
H3916	022	0	1	04	01	H3916_022_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	022	0	1	04	01	H3916_022_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	022	0	1	04	01	H3916_022_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	022	0	1	04	01	H3916_022_0	5	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H3916	024	0	1	04	01	H3916_024_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	45.00
H3916	024	0	1	04	01	H3916_024_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H3916	024	0	1	04	01	H3916_024_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	024	0	1	04	01	H3916_024_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	45.00
H3916	024	0	1	04	01	H3916_024_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	45.00
H3916	024	0	1	04	01	H3916_024_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	024	0	1	04	01	H3916_024_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	024	0	1	04	01	H3916_024_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	024	0	1	04	01	H3916_024_0	5	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H3916	024	0	1	04	01	H3916_024_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	1			30	30				
H3916	024	0	1	04	01	H3916_024_0	5	4	Group 4	11	0111110110111110000011110111000001011	000011100000000000000110	2		2			2		2	1			30	30				
H3916	025	0	1	04	01	H3916_025_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	1	30	0	30	30	2		
H3916	025	0	1	04	01	H3916_025_0	5	8	Group 8	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	025	0	1	04	01	H3916_025_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	025	0	1	04	01	H3916_025_0	5	6	Group 6	10		000000010000000010000000	2		2			2		2	1			50	50				
H3916	025	0	1	04	01	H3916_025_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H3916	025	0	1	04	01	H3916_025_0	5	4	Group 4	11	0111111111111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H3916	025	0	1	04	01	H3916_025_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	1	30	0	0	30	2		
H3916	025	0	1	04	01	H3916_025_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	1	30	30	30	30	2		
H3916	032	0	1	04	01	H3916_032_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H3916	032	0	1	04	01	H3916_032_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H3916	032	0	1	04	01	H3916_032_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	032	0	1	04	01	H3916_032_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H3916	032	0	1	04	01	H3916_032_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H3916	032	0	1	04	01	H3916_032_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	032	0	1	04	01	H3916_032_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H3916	032	0	1	04	01	H3916_032_0	5	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H3916	032	0	1	04	01	H3916_032_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	032	0	1	04	01	H3916_032_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	032	0	1	04	01	H3916_032_0	5	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H3916	033	0	1	04	01	H3916_033_0	5	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H3916	033	0	1	04	01	H3916_033_0	5	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H3916	033	0	1	04	01	H3916_033_0	5	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H3916	033	0	1	04	01	H3916_033_0	5	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H3916	033	0	1	04	01	H3916_033_0	5	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H3916	033	0	1	04	01	H3916_033_0	5	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H3916	033	0	1	04	01	H3916_033_0	5	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H3916	033	0	1	04	01	H3916_033_0	5	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H3916	033	0	1	04	01	H3916_033_0	5	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H3916	033	0	1	04	01	H3916_033_0	5	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H3916	033	0	1	04	01	H3916_033_0	5	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H3916	801	0	1	04	01	H3916_801_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3916	801	0	1	04	01	H3916_801_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3916	802	0	1	04	01	H3916_802_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3916	802	0	1	04	01	H3916_802_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3916	804	0	1	04	01	H3916_804_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H3916	804	0	1	04	01	H3916_804_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H3921	001	0	1	04	01	H3921_001_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	7	Group7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			30	30				
H3921	001	0	1	04	01	H3921_001_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		30	30		1	20.00	40.00
H3921	001	0	1	04	01	H3921_001_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			30	30				
H3921	001	0	1	04	01	H3921_001_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	40.00	40.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	15	Group 15	01	0000010000000000000000000000000000000		2		2			2		2	1			45	45				
H3921	001	0	1	04	01	H3921_001_0	6	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	20.00	40.00	2		2	2								
H3921	001	0	1	04	01	H3921_001_0	6	12	Group 12	01	0000000000000000000000000100000000000		2		2			2		2	1			50	50				
H3921	001	0	1	04	01	H3921_001_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H3921	001	0	1	04	01	H3921_001_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3921	008	0	1	04	01	H3921_008_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3921	008	0	1	04	01	H3921_008_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	7	Group7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			40	40				
H3921	008	0	1	04	01	H3921_008_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		40	40		1	45.00	70.00
H3921	008	0	1	04	01	H3921_008_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H3921	008	0	1	04	01	H3921_008_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	70.00	70.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	15	Group 15	01	0000010000000000000000000000000000000		2		2			2		2	1			45	45				
H3921	008	0	1	04	01	H3921_008_0	6	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	45.00	70.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H3921	008	0	1	04	01	H3921_008_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H3921	008	0	1	04	01	H3921_008_0	6	12	Group 12	01	0000000000000000000000000100000000000		2		2			2		2	1			50	50				
H3921	009	0	1	04	01	H3921_009_0	6	7	Group7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H3921	009	0	1	04	01	H3921_009_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	15.00	15.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H3921	009	0	1	04	01	H3921_009_0	6	12	Group 12	01	0000000000000000000000000100000000000		2		2			2		2	1			50	50				
H3921	009	0	1	04	01	H3921_009_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	15.00	50.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	15	Group 15	01	0000010000000000000000000000000000000		2		2			2		2	1			45	45				
H3921	009	0	1	04	01	H3921_009_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	50.00	50.00	2		2	2								
H3921	009	0	1	04	01	H3921_009_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			30	30				
H3921	009	0	1	04	01	H3921_009_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		30	30		1	15.00	50.00
H3921	009	0	1	04	01	H3921_009_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			30	30				
H3921	009	0	1	04	01	H3921_009_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H3923	013	0	1	04	01	H3923_013_0	8	1	Fitness/Health Class Benefit	10		000000000000000010000000	2		2			2		2	1			50	50				
H3923	013	0	1	04	01	H3923_013_0	8	2	Out of Network	11	0111111111111111111111111111111111111	000000100000000000001100	2		2			2		2	1			30	30				
H3923	017	0	1	04	01	H3923_017_0	8	1	Fitness/Health Class Benefit	10		000000000000000010000000	2		2			2		2	1			50	50				
H3923	017	0	1	04	01	H3923_017_0	8	2	Out of Network	11	0111111111111111111111111111111111111	000000100000000000101111	2		2			2		2	1			30	30				
H3923	801	0	1	04	01	H3923_801_0	5	1	Out of Network	01	0111111111111111111111111111111111111		2		2			2		2	1			50	50				
H3923	802	0	1	04	01	H3923_802_0	5	1	Out of Network	01	0111111111111111111111111111111111111		2		2			2		2	1			50	50				
H3923	803	0	1	04	01	H3923_803_0	5	1	Out of Network	01	0111111111111111111111111111111111111		2		2			2		2	1			50	50				
H3924	001	0	1	04	01	H3924_001_0	3	3	Medicare Benefits with $35 Copayment	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	35.00	35.00	2		2	2								
H3924	001	0	1	04	01	H3924_001_0	3	2	Primary Care Provider	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3924	001	0	1	04	01	H3924_001_0	3	1	Out-of-Network 20% Coinsurance Benefits	11	0111110010101111111111111111101110000	000000000000000010100000	2		2			2		2	1			20	20				
H3924	001	0	1	04	01	H3924_001_0	3	4	Post-cataract Surgery Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H3924	001	0	1	04	01	H3924_001_0	3	5	Routine Eyewear $200 every 2 years	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	001	0	1	04	01	H3924_001_0	3	6	$800 Hearing Aid Allowance Every 3 Yrs.	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	003	0	1	04	01	H3924_003_0	5	1	Out-of-Network 20% Coinsurance Benefits	11	0111110010101111111111111111101110000	000000000000000010100000	2		2			2		2	1			20	20				
H3924	003	0	1	04	01	H3924_003_0	5	2	Primary Care Provider	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3924	003	0	1	04	01	H3924_003_0	5	3	Medicare Benefits with $35 Copayment	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	35.00	35.00	2		2	2								
H3924	003	0	1	04	01	H3924_003_0	5	4	Post-cataract Surgery Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H3924	003	0	1	04	01	H3924_003_0	5	5	Routine Eyewear $200 every 2 years	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	003	0	1	04	01	H3924_003_0	5	6	$800 Hearing Aid Allowance Every 3 Yrs.	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	021	0	1	04	01	H3924_021_0	3	3	Medicare Benefits with $35 Copayment	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	35.00	35.00	2		2	2								
H3924	021	0	1	04	01	H3924_021_0	3	2	Primary Care Provider	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3924	021	0	1	04	01	H3924_021_0	3	1	Out-of-Network 20% Coinsurance Benefits	11	0111110010101111111111111111101110000	000000000000000010100000	2		2			2		2	1			20	20				
H3924	021	0	1	04	01	H3924_021_0	3	4	Post-cataract Surgery Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H3924	021	0	1	04	01	H3924_021_0	3	6	$800 Hearing Aid Allowance Every 3 Yrs.	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	021	0	1	04	01	H3924_021_0	3	5	Routine Eyewear $200 every 2 years	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	023	0	1	04	01	H3924_023_0	4	6	$800 Hearing Aid Allowance Every 3 Yrs.	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	023	0	1	04	01	H3924_023_0	4	5	Routine Eyewear $200 every 2 years	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	023	0	1	04	01	H3924_023_0	4	4	Post-cataract Surgery Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H3924	023	0	1	04	01	H3924_023_0	4	3	Medicare Benefits with $35 Copayment	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	35.00	35.00	2		2	2								
H3924	023	0	1	04	01	H3924_023_0	4	2	Primary Care Provider	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3924	023	0	1	04	01	H3924_023_0	4	1	Out-of-Network 20% Coinsurance Benefits	11	0111110010101111111111111111101110000	000000000000000010100000	2		2			2		2	1			20	20				
H3924	045	0	1	04	01	H3924_045_0	3	5	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			25	25				
H3924	045	0	1	04	01	H3924_045_0	3	6	Eyewear	11	0000000000000000000000000000000000010	000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	045	0	1	04	01	H3924_045_0	3	4	Mental Health Services	01	0000100000100100000000100000000000000		2		2			2		2	1			25	25				
H3924	045	0	1	04	01	H3924_045_0	3	3	Other OON Services	11	0111010010001011111111011111101110000	000000000000000010000000	2		2			2		2	1			25	25				
H3924	045	0	1	04	01	H3924_045_0	3	2	Speciality OON Services	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	45.00	45.00	2		2	2								
H3924	045	0	1	04	01	H3924_045_0	3	7	Hearing Aid	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	045	0	1	04	01	H3924_045_0	3	1	Primary Care Physician Care Services	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	30.00	30.00	2		2	2								
H3924	046	0	1	04	01	H3924_046_0	5	7	Hearing Aid	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	046	0	1	04	01	H3924_046_0	5	1	Primary Care Physician Care Services	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	30.00	30.00	2		2	2								
H3924	046	0	1	04	01	H3924_046_0	5	2	Speciality OON Services	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	45.00	45.00	2		2	2								
H3924	046	0	1	04	01	H3924_046_0	5	3	Other OON Services	11	0111010010001011111111011111101110000	000000000000000010000000	2		2			2		2	1			25	25				
H3924	046	0	1	04	01	H3924_046_0	5	4	Mental Health Services	01	0000100000100100000000100000000000000		2		2			2		2	1			25	25				
H3924	046	0	1	04	01	H3924_046_0	5	5	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			25	25				
H3924	046	0	1	04	01	H3924_046_0	5	6	Eyewear	11	0000000000000000000000000000000000010	000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	047	0	1	04	01	H3924_047_0	3	3	Other OON Services	11	0111010010001011111111011111101110000	000000000000000010000000	2		2			2		2	1			25	25				
H3924	047	0	1	04	01	H3924_047_0	3	1	Primary Care Physician Care Services	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	30.00	30.00	2		2	2								
H3924	047	0	1	04	01	H3924_047_0	3	2	Speciality OON Services	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	45.00	45.00	2		2	2								
H3924	047	0	1	04	01	H3924_047_0	3	4	Mental Health Services	01	0000100000100100000000100000000000000		2		2			2		2	1			25	25				
H3924	047	0	1	04	01	H3924_047_0	3	5	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			25	25				
H3924	047	0	1	04	01	H3924_047_0	3	6	Eyewear	11	0000000000000000000000000000000000010	000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	047	0	1	04	01	H3924_047_0	3	7	Hearing Aid	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	048	0	1	04	01	H3924_048_0	4	3	Other OON Services	11	0111010010001011111111011111101110000	000000000000000010000000	2		2			2		2	1			25	25				
H3924	048	0	1	04	01	H3924_048_0	4	2	Speciality OON Services	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	45.00	45.00	2		2	2								
H3924	048	0	1	04	01	H3924_048_0	4	1	Primary Care Physician Care Services	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	30.00	30.00	2		2	2								
H3924	048	0	1	04	01	H3924_048_0	4	4	Mental Health Services	01	0000100000100100000000100000000000000		2		2			2		2	1			25	25				
H3924	048	0	1	04	01	H3924_048_0	4	7	Hearing Aid	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	048	0	1	04	01	H3924_048_0	4	6	Eyewear	11	0000000000000000000000000000000000010	000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	048	0	1	04	01	H3924_048_0	4	5	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			25	25				
H3924	051	0	1	04	01	H3924_051_0	3	1	Primary Care Physician Care Services	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	30.00	30.00	2		2	2								
H3924	051	0	1	04	01	H3924_051_0	3	2	Speciality OON Services	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	45.00	45.00	2		2	2								
H3924	051	0	1	04	01	H3924_051_0	3	3	Other OON Services	11	0111010010001011111111011111101110000	000000000000000010000000	2		2			2		2	1			25	25				
H3924	051	0	1	04	01	H3924_051_0	3	6	Eyewear	11	0000000000000000000000000000000000010	000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	051	0	1	04	01	H3924_051_0	3	5	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			25	25				
H3924	051	0	1	04	01	H3924_051_0	3	4	Mental Health Services	01	0000100000100100000000100000000000000		2		2			2		2	1			25	25				
H3924	051	0	1	04	01	H3924_051_0	3	7	Hearing Aid	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	052	0	1	04	01	H3924_052_0	4	2	Speciality OON Services	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	45.00	45.00	2		2	2								
H3924	052	0	1	04	01	H3924_052_0	4	1	Primary Care Physician Care Services	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	30.00	30.00	2		2	2								
H3924	052	0	1	04	01	H3924_052_0	4	3	Other OON Services	11	0111010010001011111111011111101110000	000000000000000010000000	2		2			2		2	1			25	25				
H3924	052	0	1	04	01	H3924_052_0	4	7	Hearing Aid	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	052	0	1	04	01	H3924_052_0	4	6	Eyewear	11	0000000000000000000000000000000000010	000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	052	0	1	04	01	H3924_052_0	4	5	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			25	25				
H3924	052	0	1	04	01	H3924_052_0	4	4	Mental Health Services	01	0000100000100100000000100000000000000		2		2			2		2	1			25	25				
H3924	053	0	1	04	01	H3924_053_0	3	2	Primary Care Provider	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3924	053	0	1	04	01	H3924_053_0	3	1	Out-of-Network 20% Coinsurance Benefits	11	0000110010101111111111111111101110000	000000000000000010100000	2		2			2		2	1			20	20				
H3924	053	0	1	04	01	H3924_053_0	3	3	Medicare Benefits with $35 Copayment	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	35.00	35.00	2		2	2								
H3924	053	0	1	04	01	H3924_053_0	3	4	Post-cataract Surgery Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H3924	053	0	1	04	01	H3924_053_0	3	5	Routine Eyewear $200 every 2 years	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	053	0	1	04	01	H3924_053_0	3	6	$800 Hearing Aid Allowance Every 3 Yrs.	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	053	0	1	04	01	H3924_053_0	3	7	25% Medicare-covered benefits	01	0111000000000000000000000000000000000		2		2			2		2	1			25	25				
H3924	054	0	1	04	01	H3924_054_0	4	2	Primary Care Provider	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	20.00	20.00	2		2	2								
H3924	054	0	1	04	01	H3924_054_0	4	1	Out-of-Network 20% Coinsurance Benefits	11	0000110010101111111111111111101110000	000000000000000010100000	2		2			2		2	1			20	20				
H3924	054	0	1	04	01	H3924_054_0	4	3	Medicare Benefits with $35 Copayment	11	0000000101010000000000000000010001101	000001000000000000001010	2		1	35.00	35.00	2		2	2								
H3924	054	0	1	04	01	H3924_054_0	4	7	25% Medicare-covered benefits	01	0111000000000000000000000000000000000		2		2			2		2	1			25	25				
H3924	054	0	1	04	01	H3924_054_0	4	6	$800 Hearing Aid Allowance Every 3 Yrs.	10		000000000000000000000001	1	800.00	1	0.00	0.00	2		2	2								
H3924	054	0	1	04	01	H3924_054_0	4	5	Routine Eyewear $200 every 2 years	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H3924	054	0	1	04	01	H3924_054_0	4	4	Post-cataract Surgery Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H3924	801	0	1	04	01	H3924_801_0	3	1	OON Medicare Covered Services	01	0111011111011011111111111111111111111		2		2			2		2	1			20	20				
H3924	801	0	1	04	01	H3924_801_0	3	2	Medicare Covered Mental Health/Substance	01	0000000000100100000000100000000000000		2		1	40.00	40.00	2		2	2								
H3924	801	0	1	04	01	H3924_801_0	3	3	Partial Hospitalization	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H3924	802	0	1	04	01	H3924_802_0	3	1	OON Medicare Covered Services	01	0111011111011011111111111111111111111		2		2			2		2	1			20	20				
H3924	802	0	1	04	01	H3924_802_0	3	2	Medicare Covered Mental Health/Substance	01	0000000000100100000000100000000000000		2		1	40.00	40.00	2		2	2								
H3924	802	0	1	04	01	H3924_802_0	3	3	Partial Hospitalization	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H4005	001	0	1	04	01	H4005_001_0	5	2	Group 2	11	0111000110110010000000100000000101000	000011000000000000010000	2		2			2		2	1			25	25				
H4005	001	0	1	04	01	H4005_001_0	5	1	Group 1	11	0000111001001101111111011011010010101	000000100000000000101010	2		2			2		2	1			0	20				
H4005	001	0	1	04	01	H4005_001_0	5	3	Group 3	11	0000000000000000000000000000101000010	000000010100000010000101	2		1	0.00	0.00	2		2	2								
H4005	001	0	1	04	01	H4005_001_0	5	4	Group 4	01	0000000000000000000000000100000000000		2		2			2		2	1			30	30				
H4005	004	0	1	04	01	H4005_004_0	12	2	Group 2	11	0111000110110010000000100000000101000	000010001000000000010000	2		2			2		2	1			25	25				
H4005	004	0	1	04	01	H4005_004_0	12	1	Group 1	11	0000111001001101111111011001010010101	000000100000000000101010	2		2			2		2	1			0	20				
H4005	004	0	1	04	01	H4005_004_0	12	3	Group 3	11	0000000000000000000000000000101000010	000000010100000010000101	2		1	0.00	0.00	2		2	2								
H4005	004	0	1	04	01	H4005_004_0	12	4	Group 4	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4005	801	0	1	04	01	H4005_801_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4005	801	0	1	04	01	H4005_801_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4005	802	0	1	04	01	H4005_802_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4005	802	0	1	04	01	H4005_802_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4005	804	0	1	04	01	H4005_804_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4005	804	0	1	04	01	H4005_804_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4005	807	0	1	04	01	H4005_807_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4005	807	0	1	04	01	H4005_807_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	001	0	1	04	01	H4011_001_0	10	3	50% coinsurance with limits	10		000000000000000000000100	2		2			2		2	1			50	50				
H4011	001	0	1	04	01	H4011_001_0	10	2	50% coinsurance group	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H4011	001	0	1	04	01	H4011_001_0	10	1	20% coinsurance group	11	0111011111011011111111011111110011111	000011100000000001101010	2		2			2		2	1			20	20				
H4011	001	0	1	04	01	H4011_001_0	10	4	0% Coinsurance Group	11	0000000000000000000000000000001100000	000000000100000010000000	2		2			2		2	2								
H4011	001	0	1	04	01	H4011_001_0	10	5	0%Coinsurance Group with limits	10		000000000000000000000001	2		2			2		2	2								
H4011	003	0	1	04	01	H4011_003_0	12	3	50% coinsurance with limits	10		000000000000000000000100	2		2			2		2	1			50	50				
H4011	003	0	1	04	01	H4011_003_0	12	2	50% coinsurance group	01	0000100000100100000000100000000000000		2		2			2		2	1			50	50				
H4011	003	0	1	04	01	H4011_003_0	12	1	20% coinsurance group	11	0111011111011011111111011111110011111	000011100000000001101010	2		2			2		2	1			20	20				
H4011	003	0	1	04	01	H4011_003_0	12	4	0% Coinsurance Group	11	0000000000000000000000000000001100000	000000000000000010000000	2		2			2		2	2								
H4011	003	0	1	04	01	H4011_003_0	12	5	0%Coinsurance Group with limits	10		000000000000000000000001	2		2			2		2	2								
H4011	801	0	1	04	01	H4011_801_0	9	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	801	0	1	04	01	H4011_801_0	9	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	803	0	1	04	01	H4011_803_0	8	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	803	0	1	04	01	H4011_803_0	8	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	805	0	1	04	01	H4011_805_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	805	0	1	04	01	H4011_805_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	807	0	1	04	01	H4011_807_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	807	0	1	04	01	H4011_807_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	809	0	1	04	01	H4011_809_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	809	0	1	04	01	H4011_809_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	811	0	1	04	01	H4011_811_0	8	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	811	0	1	04	01	H4011_811_0	8	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	813	0	1	04	01	H4011_813_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	813	0	1	04	01	H4011_813_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	815	0	1	04	01	H4011_815_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	815	0	1	04	01	H4011_815_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	817	0	1	04	01	H4011_817_0	8	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	817	0	1	04	01	H4011_817_0	8	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	820	0	1	04	01	H4011_820_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	820	0	1	04	01	H4011_820_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	821	0	1	04	01	H4011_821_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	821	0	1	04	01	H4011_821_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	822	0	1	04	01	H4011_822_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	822	0	1	04	01	H4011_822_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	823	0	1	04	01	H4011_823_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	823	0	1	04	01	H4011_823_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	824	0	1	04	01	H4011_824_0	7	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	824	0	1	04	01	H4011_824_0	7	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4011	825	0	1	04	01	H4011_825_0	6	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4011	825	0	1	04	01	H4011_825_0	6	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4036	004	0	1	04	01	H4036_004_0	5	7	30% OON Group	01	0000000000000000000001000111000010000		2		2			2		2	1			30	30				
H4036	004	0	1	04	01	H4036_004_0	5	6	20% OON Group	01	0000000000000000001000000000100000000		2		2			2		2	1			20	20				
H4036	004	0	1	04	01	H4036_004_0	5	5	$20 OON Group	01	0000000000000000100000000000000000000		2		1	20.00	20.00	2		2	2								
H4036	004	0	1	04	01	H4036_004_0	5	4	35% OON Group	01	0000000000000001010100000000000000000		2		2			2		2	1			35	35				
H4036	004	0	1	04	01	H4036_004_0	5	9	9A OON Group	01	0000000000000000000010000000000000000		2		1	20.00	50.00	2		2	1			30	30				
H4036	004	0	1	04	01	H4036_004_0	5	2	$0 OON Group	11	0000010000000000000000010000001101000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H4036	004	0	1	04	01	H4036_004_0	5	10	$0 to $50 OON Group	01	0000000000000000000000000000010000100		2		1	0.00	50.00	2		2	2								
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H4520	022	0	1	04	01	H4520_022_0	4	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
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H4522	001	0	1	04	01	H4522_001_0	5	14	Group 14	01	0000000000001000000000000000000000000		2		1	30.00	55.00	2		2	2								
H4522	001	0	1	04	01	H4522_001_0	5	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H4522	001	0	1	04	01	H4522_001_0	5	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H4522	001	0	1	04	01	H4522_001_0	5	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H4522	001	0	1	04	01	H4522_001_0	5	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H4522	001	0	1	04	01	H4522_001_0	5	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			40	40				
H4522	001	0	1	04	01	H4522_001_0	5	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		40	40		1	30.00	55.00
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H4522	001	0	1	04	01	H4522_001_0	5	15	Group 15	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H4522	001	0	1	04	01	H4522_001_0	5	13	Group 13	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H4522	001	0	1	04	01	H4522_001_0	5	12	Group 12	11	0000000000000000000001000000001100000	000000000000000100000000	2		2			2		2	1			40	40				
H4522	001	0	1	04	01	H4522_001_0	5	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H4522	001	0	1	04	01	H4522_001_0	5	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H4522	001	0	1	04	01	H4522_001_0	5	1	Group 1	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H4522	007	0	1	04	01	H4522_007_0	8	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001010	2		2			2		2	1			30	30				
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H4522	007	0	1	04	01	H4522_007_0	8	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
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H4524	001	0	1	04	01	H4524_001_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H4524	001	0	1	04	01	H4524_001_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
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H4524	007	0	1	04	01	H4524_007_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H4524	013	0	1	04	01	H4524_013_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H4524	013	0	1	04	01	H4524_013_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
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H4524	013	0	1	04	01	H4524_013_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			25	25				
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H4524	802	0	1	04	01	H4524_802_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4524	802	0	1	04	01	H4524_802_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4524	805	0	2	04	01	H4524_805_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4524	805	0	2	04	01	H4524_805_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4524	806	0	2	04	01	H4524_806_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4524	806	0	2	04	01	H4524_806_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4605	001	0	1	04	01	H4605_001_0	6	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H4605	001	0	1	04	01	H4605_001_0	6	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H4605	001	0	1	04	01	H4605_001_0	6	7	Dental  $500 Maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H4605	001	0	1	04	01	H4605_001_0	6	6	$100 maximum	10		000000000000000000000100	1	100.00	2			2		2	2								
H4605	001	0	1	04	01	H4605_001_0	6	5	$0 to $300 copay	01	0000000000000000000010000000000000000		2		1	0.00	300.00	2		2	2								
H4605	001	0	1	04	01	H4605_001_0	6	10	30%	01	0000000000000000010000000110000000000		2		2			2		2	1			30	30				
H4605	001	0	1	04	01	H4605_001_0	6	3	$200 copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H4605	001	0	1	04	01	H4605_001_0	6	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H4605	001	0	1	04	01	H4605_001_0	6	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H4605	001	0	1	04	01	H4605_001_0	6	11	0 - Zero Cost Share	11	0000100000000001100000010001011100010	000000100000000110000000	2		2			2		2	2								
H4605	001	0	1	04	01	H4605_001_0	6	1	$45 copay	01	0111001111111110000000100000000001101		2		1	45.00	45.00	2		2	2								
H4605	001	0	1	04	01	H4605_001_0	6	4	$0 to $250 copay	01	0000000000000000000001000000000000000		2		1	0.00	250.00	2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	8	10%	01	0000000000000000000000000000100000000		2		2			2		2	1			10	10				
H4605	002	0	1	04	01	H4605_002_0	15	7	Dental  $500 Maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H4605	002	0	1	04	01	H4605_002_0	15	6	$50 maximum	10		000000000000000000000100	1	50.00	2			2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	5	$0 to $300 copay	01	0000000000000000000010000000000000000		2		1	0.00	300.00	2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	4	$0 to $250 copay	01	0000000000000000000001000000000000000		2		1	0.00	250.00	2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	3	$200 copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	2	$35 copay	10		000000000000000000001000	2		1	35.00	35.00	2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	13	$7 copay	01	0000000000000000100000000000000000000		2		1	7.00	7.00	2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	12	10% to 20%	01	0000000000000000000000000000000010000		2		2			2		2	1			10	20				
H4605	002	0	1	04	01	H4605_002_0	15	11	$0  Cost Share	11	0000100000000001000000010001011100010	000000100000000111000000	2		2			2		2	2								
H4605	002	0	1	04	01	H4605_002_0	15	10	30%	01	0000000000000000010000000110000000000		2		2			2		2	1			30	30				
H4605	002	0	1	04	01	H4605_002_0	15	9	20%	01	0000010000000000011100000000000000000		2		2			2		2	1			20	20				
H4605	002	0	1	04	01	H4605_002_0	15	1	$45 copay	01	0111001111111110000000100000000001101		2		1	45.00	45.00	2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	10	30%	01	0000000000000000010000000000000000000		2		2			2		2	1			30	30				
H4605	004	0	1	04	01	H4605_004_0	10	1	$30 copay	01	0111001111111110000000100000000001101		2		1	30.00	30.00	2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	11	$0  Cost Share	11	0000100000000001100000010001011100010	000000100000000111000000	2		2			2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	9	20%	01	0000000000000000001000000110000000000		2		2			2		2	1			20	20				
H4605	004	0	1	04	01	H4605_004_0	10	8	10%	01	0000010000000000010100000000100000000		2		2			2		2	1			10	10				
H4605	004	0	1	04	01	H4605_004_0	10	7	Dental Preventive $500 maximum	10		000000000000000000100000	1	500.00	2			2		2	1			50	50				
H4605	004	0	1	04	01	H4605_004_0	10	6	$200 maximum	10		000000000000000000000100	1	200.00	2			2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	5	Hearing Aid $500 maximum	10		000000000000000000000001	1	500.00	2			2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	4	$0 to $250 copay	01	0000000000000000000010000000000000000		2		1	0.00	250.00	2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	3	$200 copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	2	$25 copay	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H4605	004	0	1	04	01	H4605_004_0	10	13	0% to 10%	01	0000000000000000000000000000000010000		2		2			2		2	1			0	10				
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H4754	010	0	1	04	01	H4754_010_0	5	5	Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H4754	010	0	1	04	01	H4754_010_0	5	9	Other heatlh care professional	01	0000000000001000000000000000000000000		2		1	25.00	40.00	2		2	2								
H4754	010	0	1	04	01	H4754_010_0	5	3	Specialist Copay	01	0000100001000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H4754	010	0	1	04	01	H4754_010_0	5	2	PCP Copay	01	0000001000000000000000000000100000000		2		1	25.00	25.00	2		2	2								
H4754	010	0	1	04	01	H4754_010_0	5	11	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	25.00	300.00	2		2	1			20	20				
H4754	010	0	1	04	01	H4754_010_0	5	10	Routine eyewear	10		000000000000000000000100	1	100.00	2			2		2	2								
H4754	010	0	1	04	01	H4754_010_0	5	4	10% coinsurance	01	0000010000000000000000000000000000000		2		2			2		2	1			10	10				
H4754	011	0	1	04	01	H4754_011_0	8	9	Other health care professional	01	0000000000001000000000000000000000000		2		1	25.00	40.00	2		2	2								
H4754	011	0	1	04	01	H4754_011_0	8	1	20% coinsurance	11	0111010110110110000000110001011111001	000000000000000100000010	2		2			2		2	1			20	20				
H4754	011	0	1	04	01	H4754_011_0	8	10	Routine eyewear	10		000000000000000000000100	1	100.00	2			2		2	2								
H4754	011	0	1	04	01	H4754_011_0	8	11	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	25.00	300.00	2		2	1			20	20				
H4754	011	0	1	04	01	H4754_011_0	8	2	PCP Copay	01	0000001000000000000000000000100000000		2		1	25.00	25.00	2		2	2								
H4754	011	0	1	04	01	H4754_011_0	8	3	Specialist Copay	01	0000100001000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H4754	011	0	1	04	01	H4754_011_0	8	4	30% coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4754	011	0	1	04	01	H4754_011_0	8	5	Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H4754	011	0	1	04	01	H4754_011_0	8	6	ASC	01	0000000000000000000001000000000000000		2		1	300.00	300.00	2		2	2								
H4754	011	0	1	04	01	H4754_011_0	8	7	Office visit copay	11	0000000000000001111100000000000000100	000000000000000000001000	2		2			2		1	1	2		20	20		1	25.00	40.00
H4754	011	0	1	04	01	H4754_011_0	8	8	Ambulance	01	0000000000000000000000001000000000000		2		1	155.00	155.00	2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	1	20% coinsurance	11	0111000110110110000000110111011111001	000000000000000100000010	2		2			2		2	1			20	20				
H4754	012	0	1	04	01	H4754_012_0	5	10	Routine eyewear	10		000000000000000000000100	1	100.00	2			2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	9	Other heatlh care professional	01	0000000000001000000000000000000000000		2		1	25.00	40.00	2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	8	Ambulance	01	0000000000000000000000001000000000000		2		1	155.00	155.00	2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	7	Office visit copay	11	0000000000000001111100000000000000100	000000000000000000001000	2		2			2		1	1	2		20	20		1	25.00	40.00
H4754	012	0	1	04	01	H4754_012_0	5	11	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	25.00	300.00	2		2	1			20	20				
H4754	012	0	1	04	01	H4754_012_0	5	2	PCP Copay	01	0000001000000000000000000000100000000		2		1	25.00	25.00	2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	3	Specialist Copay	01	0000100001000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	4	10% coinsurance	01	0000010000000000000000000000000000000		2		2			2		2	1			10	10				
H4754	012	0	1	04	01	H4754_012_0	5	5	Eyewear	01	0000000000000000000000000000000000010		2		2			2		2	2								
H4754	012	0	1	04	01	H4754_012_0	5	6	ASC	01	0000000000000000000001000000000000000		2		1	300.00	300.00	2		2	2								
H4754	801	0	1	04	01	H4754_801_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4754	801	0	1	04	01	H4754_801_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4754	802	0	1	04	01	H4754_802_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4754	802	0	1	04	01	H4754_802_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4871	001	0	1	04	01	H4871_001_0	5	1	30% Coinsurance	11	0111100000101000000011110111100011000	000000100000000000000000	2		2			2		2	1			30	30				
H4871	001	0	1	04	01	H4871_001_0	5	2	$40 Copay	01	0000011000000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H4871	001	0	1	04	01	H4871_001_0	5	9	$0 Copay	10		000000000000000010000000	2		2			2		2	2								
H4871	001	0	1	04	01	H4871_001_0	5	8	$50 Copay	01	0000000000000000000000001000000000000		2		1	50.00	50.00	2		2	2								
H4871	001	0	1	04	01	H4871_001_0	5	7	0%-30% Coinsurance	11	0000000000000000000000000000000000010	000000000000000000000100	2		2			2		2	1			0	30				
H4871	001	0	1	04	01	H4871_001_0	5	6	$0-$60 Copay	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	60.00	2		2	2								
H4871	001	0	1	04	01	H4871_001_0	5	5	30% Coinsurance	01	0000000000000001111100000000000000000		2		2			2		1	1	2		30	30		1	40.00	60.00
H4871	001	0	1	04	01	H4871_001_0	5	3	$60 Copay	01	0000000111010110000000000000000000000		2		1	60.00	60.00	2		2	2								
H4871	001	0	1	04	01	H4871_001_0	5	4	$40-$60 Copay	01	0000000000000000000000000000011100001		2		1	40.00	60.00	2		2	2								
H4875	016	1	1	04	01	H4875_016_1	9	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	016	1	1	04	01	H4875_016_1	9	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	016	1	1	04	01	H4875_016_1	9	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	016	1	1	04	01	H4875_016_1	9	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	016	1	1	04	01	H4875_016_1	9	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	016	1	1	04	01	H4875_016_1	9	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	016	2	1	04	01	H4875_016_2	8	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	016	2	1	04	01	H4875_016_2	8	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	016	2	1	04	01	H4875_016_2	8	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	016	2	1	04	01	H4875_016_2	8	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	016	2	1	04	01	H4875_016_2	8	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	016	2	1	04	01	H4875_016_2	8	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	016	3	1	04	01	H4875_016_3	9	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	016	3	1	04	01	H4875_016_3	9	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	016	3	1	04	01	H4875_016_3	9	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	016	3	1	04	01	H4875_016_3	9	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	016	3	1	04	01	H4875_016_3	9	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	016	3	1	04	01	H4875_016_3	9	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	016	4	1	04	01	H4875_016_4	8	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	016	4	1	04	01	H4875_016_4	8	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	016	4	1	04	01	H4875_016_4	8	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	016	4	1	04	01	H4875_016_4	8	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	016	4	1	04	01	H4875_016_4	8	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	016	4	1	04	01	H4875_016_4	8	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	016	5	1	04	01	H4875_016_5	8	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	016	5	1	04	01	H4875_016_5	8	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	016	5	1	04	01	H4875_016_5	8	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	016	5	1	04	01	H4875_016_5	8	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	016	5	1	04	01	H4875_016_5	8	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	016	5	1	04	01	H4875_016_5	8	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	017	1	1	04	01	H4875_017_1	8	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	017	1	1	04	01	H4875_017_1	8	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	017	1	1	04	01	H4875_017_1	8	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	017	1	1	04	01	H4875_017_1	8	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	017	1	1	04	01	H4875_017_1	8	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	017	1	1	04	01	H4875_017_1	8	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	017	2	1	04	01	H4875_017_2	8	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	017	2	1	04	01	H4875_017_2	8	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	017	2	1	04	01	H4875_017_2	8	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	017	2	1	04	01	H4875_017_2	8	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	017	2	1	04	01	H4875_017_2	8	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	017	2	1	04	01	H4875_017_2	8	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	017	3	1	04	01	H4875_017_3	8	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	017	3	1	04	01	H4875_017_3	8	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	017	3	1	04	01	H4875_017_3	8	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	017	3	1	04	01	H4875_017_3	8	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	017	3	1	04	01	H4875_017_3	8	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	017	3	1	04	01	H4875_017_3	8	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	017	4	1	04	01	H4875_017_4	9	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	017	4	1	04	01	H4875_017_4	9	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	017	4	1	04	01	H4875_017_4	9	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	017	4	1	04	01	H4875_017_4	9	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	017	4	1	04	01	H4875_017_4	9	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	017	4	1	04	01	H4875_017_4	9	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	017	5	1	04	01	H4875_017_5	9	1	40% Coinsurance	01	0000100000000000000000000000000000000		2		2			2		2	1			40	40				
H4875	017	5	1	04	01	H4875_017_5	9	2	30% Coinsurance	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H4875	017	5	1	04	01	H4875_017_5	9	5	$0 Copayment	11	0000010000000000000000000000000000000	000000100000000011100000	2		1	0.00	0.00	2		2	2								
H4875	017	5	1	04	01	H4875_017_5	9	6	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H4875	017	5	1	04	01	H4875_017_5	9	4	$100 Copayment	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H4875	017	5	1	04	01	H4875_017_5	9	3	20% Coinsurance	11	0111001111111110000011110001111011111	000000000000000100000000	2		2			2		2	1			20	20				
H4875	803	0	1	04	01	H4875_803_0	6	2	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100100		2		2			2		1	1	1	20	20	20	20	2		
H4875	803	0	1	04	01	H4875_803_0	6	1	20% Coinsurance	01	0111111111111110000011111111111011011		2		2			2		2	1			20	20				
H4875	804	0	1	04	01	H4875_804_0	8	1	20% Coinsurance	01	0111111111111110000011111111111011011		2		2			2		2	1			20	20				
H4875	804	0	1	04	01	H4875_804_0	8	2	20% Coinsurance (+ physician coinsur.)	01	0000000000000001111100000000000100100		2		2			2		1	1	1	20	20	20	20	2		
H4876	001	0	1	04	01	H4876_001_0	7	1		11	0111111111111111111111111111111111111	000000000000000000111100	2		2			2		2	1			20	20				
H4876	801	0	1	04	01	H4876_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4876	801	0	1	04	01	H4876_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4876	802	0	1	04	01	H4876_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H4876	802	0	1	04	01	H4876_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H4909	009	0	1	04	01	H4909_009_0	9	7	Mental Health	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	6	DME / ASC	01	0000000000000000000001000111000000000		2		2			2		2	1			30	30				
H4909	009	0	1	04	01	H4909_009_0	9	5	Specialist	01	0111000111010010000000000000000000011		2		1	50.00	50.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	3	Outpatient	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			30	30				
H4909	009	0	1	04	01	H4909_009_0	9	2	20%	01	0000000000000000001000000000100000000		2		2			2		2	1			20	20				
H4909	009	0	1	04	01	H4909_009_0	9	8	Radiology	01	0000000000000001010100000000000000000		2		1	150.00	200.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	12	Preventive	01	0000000000000000000000000000010000000		2		1	0.00	50.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	11	Part B Rx	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H4909	009	0	1	04	01	H4909_009_0	9	10	Amubulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	1	$0	11	0000010000000000000000010000001101000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	9	Labs	01	0000000000000000100000000000000000000		2		1	25.00	25.00	2		2	2								
H4909	009	0	1	04	01	H4909_009_0	9	13	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	50.00	2		2	2								
H4909	010	0	1	04	01	H4909_010_0	8	6	DME	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H4909	010	0	1	04	01	H4909_010_0	8	5	Specialist	01	0111000111010010000000000000000000011		2		1	50.00	50.00	2		2	2								
H4909	010	0	1	04	01	H4909_010_0	8	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H4909	010	0	1	04	01	H4909_010_0	8	3	Outpatient	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			25	25				
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H5042	001	0	1	04	01	H5042_001_0	8	3	$25 copayment	01	0000000000000001111100000000100000000		2		1	25.00	25.00	2		2	2								
H5042	001	0	1	04	01	H5042_001_0	8	2	$45 copayment	11	0000000001111100000000100000000000001	000000000000000000000010	2		1	45.00	45.00	2		2	2								
H5042	001	0	1	04	01	H5042_001_0	8	12	$20 copayment	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H5042	001	0	1	04	01	H5042_001_0	8	1	$0 copayment	11	0001010000000000000000010000011111000	000100010000000011100000	2		1	0.00	0.00	2		2	2								
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H5042	004	0	1	04	01	H5042_004_0	8	7	20% coinsurance	11	0000000000000000000000000111000000010	000000000000000000000100	2		2			2		2	1			20	20				
H5042	004	0	1	04	01	H5042_004_0	8	8	$10 Copayment	11	0110000000000000000000000000000000000	001000000000000000000000	2		1	10.00	10.00	2		2	2								
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H5042	005	0	1	04	01	H5042_005_0	8	10	$20 Copayment	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H5042	005	0	1	04	01	H5042_005_0	8	1	$0 copayment	11	0001010000000000000000010000011111000	000100010000000011100000	2		1	0.00	0.00	2		2	2								
H5042	005	0	1	04	01	H5042_005_0	8	4	$125 copayment	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
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H5042	005	0	1	04	01	H5042_005_0	8	7	20% coinsurance	01	0000000000000000000000000111000000010		2		2			2		2	1			20	20				
H5042	005	0	1	04	01	H5042_005_0	8	8	$30 Copayment	01	0000000000000000000000000000100000000		2		1	30.00	30.00	2		2	2								
H5042	005	0	1	04	01	H5042_005_0	8	9	$55 Copayment	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H5042	005	0	1	04	01	H5042_005_0	8	12	$45 copayment	01	0000001000000000000000000000000000000		2		1	45.00	45.00	2		2	2								
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H5042	007	0	1	04	01	H5042_007_0	6	2	$35 copayment	11	0000001011111110000000100000000000001	000000000000000000000010	2		1	35.00	35.00	2		2	2								
H5042	007	0	1	04	01	H5042_007_0	6	1	$0 copayment	11	0001010000000000000000010000011111000	000100010000000011100000	2		1	0.00	0.00	2		2	2								
H5042	007	0	1	04	01	H5042_007_0	6	10	$10 copayment	11	0110000100000000000000000000000000000	001000000000000000000000	2		1	10.00	10.00	2		2	2								
H5042	801	0	1	04	01	H5042_801_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5042	801	0	1	04	01	H5042_801_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5042	802	0	1	04	01	H5042_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5042	802	0	1	04	01	H5042_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5042	803	0	1	04	01	H5042_803_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5042	803	0	1	04	01	H5042_803_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5106	013	0	1	04	01	H5106_013_0	8	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	013	0	1	04	01	H5106_013_0	8	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	013	0	1	04	01	H5106_013_0	8	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H5106	013	0	1	04	01	H5106_013_0	8	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H5106	013	0	1	04	01	H5106_013_0	8	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	013	0	1	04	01	H5106_013_0	8	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H5106	013	0	1	04	01	H5106_013_0	8	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H5106	013	0	1	04	01	H5106_013_0	8	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	013	0	1	04	01	H5106_013_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	013	0	1	04	01	H5106_013_0	8	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H5106	013	0	1	04	01	H5106_013_0	8	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	014	0	1	04	01	H5106_014_0	8	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	45.00
H5106	014	0	1	04	01	H5106_014_0	8	12	Group 12	11	0000000000000000000000000000000001000	000000000000000000010000	2		2			2		2	1			30	50				
H5106	014	0	1	04	01	H5106_014_0	8	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	014	0	1	04	01	H5106_014_0	8	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	014	0	1	04	01	H5106_014_0	8	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	014	0	1	04	01	H5106_014_0	8	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H5106	014	0	1	04	01	H5106_014_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	014	0	1	04	01	H5106_014_0	8	4	Group 4	11	0111110110111110000011110111000000011	000011100000000000000110	2		2			2		2	1			30	30				
H5106	014	0	1	04	01	H5106_014_0	8	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	45.00
H5106	014	0	1	04	01	H5106_014_0	8	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	45.00
H5106	014	0	1	04	01	H5106_014_0	8	10	Group 10	01	0000000001000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H5106	014	0	1	04	01	H5106_014_0	8	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	015	0	1	04	01	H5106_015_0	8	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	015	0	1	04	01	H5106_015_0	8	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	015	0	1	04	01	H5106_015_0	8	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H5106	015	0	1	04	01	H5106_015_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	015	0	1	04	01	H5106_015_0	8	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	015	0	1	04	01	H5106_015_0	8	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	015	0	1	04	01	H5106_015_0	8	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H5106	015	0	1	04	01	H5106_015_0	8	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	015	0	1	04	01	H5106_015_0	8	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H5106	015	0	1	04	01	H5106_015_0	8	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H5106	015	0	1	04	01	H5106_015_0	8	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H5106	016	0	1	04	01	H5106_016_0	8	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	45.00
H5106	016	0	1	04	01	H5106_016_0	8	12	Group 12	11	0000000000000000000000000000000001000	000000000000000000010000	2		2			2		2	1			30	50				
H5106	016	0	1	04	01	H5106_016_0	8	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	016	0	1	04	01	H5106_016_0	8	10	Group 10	01	0000000001000000000000000000000000000		2		1	45.00	45.00	2		2	2								
H5106	016	0	1	04	01	H5106_016_0	8	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	45.00
H5106	016	0	1	04	01	H5106_016_0	8	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	45.00
H5106	016	0	1	04	01	H5106_016_0	8	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	016	0	1	04	01	H5106_016_0	8	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	016	0	1	04	01	H5106_016_0	8	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	016	0	1	04	01	H5106_016_0	8	6	Group 6	10		000000010000000000100000	2		2			2		2	1			50	50				
H5106	016	0	1	04	01	H5106_016_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	016	0	1	04	01	H5106_016_0	8	4	Group 4	11	0111110110111110000011110111000000011	000011100000000000000110	2		2			2		2	1			30	30				
H5106	017	0	1	04	01	H5106_017_0	7	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H5106	017	0	1	04	01	H5106_017_0	7	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H5106	017	0	1	04	01	H5106_017_0	7	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	017	0	1	04	01	H5106_017_0	7	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	017	0	1	04	01	H5106_017_0	7	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	017	0	1	04	01	H5106_017_0	7	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H5106	017	0	1	04	01	H5106_017_0	7	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	017	0	1	04	01	H5106_017_0	7	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	017	0	1	04	01	H5106_017_0	7	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H5106	017	0	1	04	01	H5106_017_0	7	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H5106	017	0	1	04	01	H5106_017_0	7	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	018	0	1	04	01	H5106_018_0	7	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H5106	018	0	1	04	01	H5106_018_0	7	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H5106	018	0	1	04	01	H5106_018_0	7	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	018	0	1	04	01	H5106_018_0	7	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	018	0	1	04	01	H5106_018_0	7	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H5106	018	0	1	04	01	H5106_018_0	7	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	018	0	1	04	01	H5106_018_0	7	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	018	0	1	04	01	H5106_018_0	7	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H5106	018	0	1	04	01	H5106_018_0	7	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	018	0	1	04	01	H5106_018_0	7	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H5106	018	0	1	04	01	H5106_018_0	7	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	025	0	1	04	01	H5106_025_0	10	8	Group 8	01	0000000000000000000000000111000000000		2		2			2		2	1			0	10				
H5106	025	0	1	04	01	H5106_025_0	10	9	Group 9	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	025	0	1	04	01	H5106_025_0	10	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	1	30	0	30	30	2		
H5106	025	0	1	04	01	H5106_025_0	10	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	1	30	30	30	30	2		
H5106	025	0	1	04	01	H5106_025_0	10	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	1	0	0	30	30	2		
H5106	025	0	1	04	01	H5106_025_0	10	4	Group 4	11	0111111111111110000011110000000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	025	0	1	04	01	H5106_025_0	10	5	Group 5	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	1			30	30				
H5106	025	0	1	04	01	H5106_025_0	10	6	Group 6	10		000000010000000010000000	2		2			2		2	1			50	50				
H5106	025	0	1	04	01	H5106_025_0	10	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	027	0	1	04	01	H5106_027_0	7	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H5106	027	0	1	04	01	H5106_027_0	7	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H5106	027	0	1	04	01	H5106_027_0	7	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	027	0	1	04	01	H5106_027_0	7	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H5106	027	0	1	04	01	H5106_027_0	7	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H5106	027	0	1	04	01	H5106_027_0	7	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	027	0	1	04	01	H5106_027_0	7	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	027	0	1	04	01	H5106_027_0	7	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H5106	027	0	1	04	01	H5106_027_0	7	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	027	0	1	04	01	H5106_027_0	7	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	027	0	1	04	01	H5106_027_0	7	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	028	0	1	04	01	H5106_028_0	7	10	Group 10	01	0000000001000000000000000000000000000		2		1	50.00	50.00	2		2	2								
H5106	028	0	1	04	01	H5106_028_0	7	1	Group 1	01	0000000000000001100000000000000000100		2		2			2		1	1	2		0	30		1	30.00	50.00
H5106	028	0	1	04	01	H5106_028_0	7	11	Group 11	01	0000000000000000000000000000100010000		2		2			2		2	1			0	30				
H5106	028	0	1	04	01	H5106_028_0	7	9	Group 9	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5106	028	0	1	04	01	H5106_028_0	7	8	Group 8	10		000000000000000010000000	2		2			1	500.00	2	1			50	50				
H5106	028	0	1	04	01	H5106_028_0	7	7	Group 7	11	0000000000000000000000000000011000000	000000000000000000000001	2		2			2		2	1			0	0				
H5106	028	0	1	04	01	H5106_028_0	7	6	Group 6	10		000000010000000000000000	2		2			2		2	1			50	50				
H5106	028	0	1	04	01	H5106_028_0	7	5	Group 5	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	1			30	30				
H5106	028	0	1	04	01	H5106_028_0	7	2	Group 2	11	0000000000000000011100000000000000000	000000000000000000001000	2		2			2		1	1	2		30	30		1	30.00	50.00
H5106	028	0	1	04	01	H5106_028_0	7	3	Group 3	01	0000000000000000000000000000000100000		2		2			2		1	1	2		0	0		1	30.00	50.00
H5106	028	0	1	04	01	H5106_028_0	7	4	Group 4	11	0111110110111110000011110111000001011	000000100000000000000110	2		2			2		2	1			30	30				
H5106	806	0	1	04	01	H5106_806_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5106	806	0	1	04	01	H5106_806_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5106	807	0	1	04	01	H5106_807_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5106	807	0	1	04	01	H5106_807_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5106	808	0	1	04	01	H5106_808_0	6	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5106	808	0	1	04	01	H5106_808_0	6	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5141	001	0	1	04	01	H5141_001_0	8	1	Medicare Covered	01	0111111111111111111111111111111111111		2		2			2		2	1			30	30				
H5141	001	0	1	04	01	H5141_001_0	8	2	Non-Medicare Covered	10		000000000100000010001000	2		2			2		2	2								
H5141	001	0	1	04	01	H5141_001_0	8	3	Non-Medicare Covered Eyewear	10		000000000000000000000100	1	100.00	2			2		2	2								
H5141	003	0	1	04	01	H5141_003_0	8	1	Medicare Covered	01	0111111111111111111111111111111111111		2		2			2		2	1			20	20				
H5141	003	0	1	04	01	H5141_003_0	8	2	Non-Medicare Covered	10		000001010101000000101110	2		2			2		2	2								
H5214	003	0	1	04	01	H5214_003_0	8	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H5214	003	0	1	04	01	H5214_003_0	8	8		10		000000000000000010000000	2		2			2		2	1			50	50				
H5214	003	0	1	04	01	H5214_003_0	8	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H5214	003	0	1	04	01	H5214_003_0	8	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H5214	003	0	1	04	01	H5214_003_0	8	7		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			30	30				
H5214	003	0	1	04	01	H5214_003_0	8	6		01	0000000000000000000000000111000000000		2		2			2		2	1			25	25				
H5214	003	0	1	04	01	H5214_003_0	8	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5214	003	0	1	04	01	H5214_003_0	8	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5214	004	0	1	04	01	H5214_004_0	6	8		10		000000000100000010000000	2		2			2		2	1			50	50				
H5214	004	0	1	04	01	H5214_004_0	6	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5214	004	0	1	04	01	H5214_004_0	6	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5214	004	0	1	04	01	H5214_004_0	6	7		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			30	30				
H5214	004	0	1	04	01	H5214_004_0	6	6		01	0000000000000000000000000111000000000		2		2			2		2	1			25	25				
H5214	004	0	1	04	01	H5214_004_0	6	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5214	004	0	1	04	01	H5214_004_0	6	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H5214	004	0	1	04	01	H5214_004_0	6	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H5214	008	0	1	04	01	H5214_008_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5214	008	0	1	04	01	H5214_008_0	5	6		11	0111111111111111111101100111001111101	000000000000000100000000	2		2			2		2	1			30	30				
H5214	008	0	1	04	01	H5214_008_0	5	7		10		000000000100000010000000	2		2			2		2	1			50	50				
H5214	008	0	1	04	01	H5214_008_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5214	008	0	1	04	01	H5214_008_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5214	008	0	1	04	01	H5214_008_0	5	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H5214	008	0	1	04	01	H5214_008_0	5	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H5214	009	0	1	04	01	H5214_009_0	5	6		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			30	30				
H5214	009	0	1	04	01	H5214_009_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5214	009	0	1	04	01	H5214_009_0	5	8		10		000000000110000010100000	2		2			2		2	1			50	50				
H5214	009	0	1	04	01	H5214_009_0	5	7		01	0000000000000000000000000111000000000		2		2			2		2	1			35	35				
H5214	009	0	1	04	01	H5214_009_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5214	009	0	1	04	01	H5214_009_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5214	009	0	1	04	01	H5214_009_0	5	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H5214	009	0	1	04	01	H5214_009_0	5	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H5214	011	0	1	04	01	H5214_011_0	5	6		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			30	30				
H5214	011	0	1	04	01	H5214_011_0	5	7		01	0000000000000000000000000111000000000		2		2			2		2	1			35	35				
H5214	011	0	1	04	01	H5214_011_0	5	8		10		000000000110000010000000	2		2			2		2	1			50	50				
H5214	011	0	1	04	01	H5214_011_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5214	011	0	1	04	01	H5214_011_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5214	011	0	1	04	01	H5214_011_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5214	011	0	1	04	01	H5214_011_0	5	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H5214	011	0	1	04	01	H5214_011_0	5	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H5214	012	0	1	04	01	H5214_012_0	6	8		10		000000000110000010000000	2		2			2		2	1			50	50				
H5214	012	0	1	04	01	H5214_012_0	6	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5214	012	0	1	04	01	H5214_012_0	6	6		01	0000000000000000000000000111000000000		2		2			2		2	1			25	25				
H5214	012	0	1	04	01	H5214_012_0	6	7		11	0111111111111111111101100000001111101	000000000000000100000000	2		2			2		2	1			30	30				
H5214	012	0	1	04	01	H5214_012_0	6	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5214	012	0	1	04	01	H5214_012_0	6	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5214	012	0	1	04	01	H5214_012_0	6	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
H5214	012	0	1	04	01	H5214_012_0	6	1		11	0000000000000000000000010000000000010	000000100000000000000000	2		1	0.00	0.00	2		2	2								
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H5378	190	0	1	04	01	H5378_190_0	6	5		01	0000000100000000000000000000000000000		2		2			2		2	1			50	50				
H5378	190	0	1	04	01	H5378_190_0	6	11		01	0000000000000000000010000000000000000		2		1	300.00	300.00	2		2	2								
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H5378	190	0	1	04	01	H5378_190_0	6	13		11	0000000000000000000000000000000000011	000000000000000000000010	2		1	20.00	20.00	2		2	2								
H5378	190	0	1	04	01	H5378_190_0	6	14		11	0000000000000000000000000000000100100	000000000000000000001000	2		1	0.00	0.00	2		1	2	2					1	30.00	60.00
H5378	190	0	1	04	01	H5378_190_0	6	2		01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H5378	190	0	1	04	01	H5378_190_0	6	3		11	0000010000000000000000010000011001000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H5378	190	0	1	04	01	H5378_190_0	6	4		01	0000001000000000000000000000100000000		2		1	30.00	30.00	2		2	2								
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H5378	801	0	1	04	01	H5378_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
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H5378	802	0	1	04	01	H5378_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5378	803	0	1	04	01	H5378_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5378	803	0	1	04	01	H5378_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	056	0	1	04	01	H5415_056_0	3	2		01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H5415	056	0	1	04	01	H5415_056_0	3	1		11	0000000000000000000000010000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H5415	056	0	1	04	01	H5415_056_0	3	9		10		000000000110000010000000	2		2			2		2	1			50	50				
H5415	056	0	1	04	01	H5415_056_0	3	8		01	0000000000000000000000000000010000000		2		1	0.00	40.00	2		2	1			30	50				
H5415	056	0	1	04	01	H5415_056_0	3	7		01	0111000010000011101100000000000100000		2		1	40.00	40.00	2		2	1			30	30				
H5415	056	0	1	04	01	H5415_056_0	3	6		01	0000110000000000010001100111000000000		2		2			2		2	1			30	30				
H5415	056	0	1	04	01	H5415_056_0	3	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H5415	056	0	1	04	01	H5415_056_0	3	4		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H5415	056	0	1	04	01	H5415_056_0	3	3		11	0000001101111100000000000000001001101	000000000000000100000000	2		1	40.00	40.00	2		2	2								
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H5415	066	0	1	04	01	H5415_066_0	3	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5415	066	0	1	04	01	H5415_066_0	3	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H5415	066	0	1	04	01	H5415_066_0	3	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5415	066	0	1	04	01	H5415_066_0	3	1		11	0000000000000000000000010000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H5415	066	0	1	04	01	H5415_066_0	3	6		11	0111111111111111111101100111001101101	000000000000000100000000	2		2			2		2	1			30	30				
H5415	066	0	1	04	01	H5415_066_0	3	7		10		000000000110000010000000	2		2			2		2	1			50	50				
H5415	069	0	1	04	01	H5415_069_0	3	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5415	069	0	1	04	01	H5415_069_0	3	1		11	0000000000000000000000010000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H5415	069	0	1	04	01	H5415_069_0	3	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H5415	069	0	1	04	01	H5415_069_0	3	7		10		000000000110000010000000	2		2			2		2	1			50	50				
H5415	069	0	1	04	01	H5415_069_0	3	6		11	0111111111111111111101100111001101101	000000000000000100000000	2		2			2		2	1			30	30				
H5415	069	0	1	04	01	H5415_069_0	3	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H5415	069	0	1	04	01	H5415_069_0	3	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5415	070	0	1	04	01	H5415_070_0	4	1		11	0000000000000000000000010000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H5415	070	0	1	04	01	H5415_070_0	4	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5415	070	0	1	04	01	H5415_070_0	4	9		10		000000000110000010000000	2		2			2		2	1			50	50				
H5415	070	0	1	04	01	H5415_070_0	4	8		01	0000000000000000000000000000010000000		2		1	0.00	40.00	2		2	1			30	50				
H5415	070	0	1	04	01	H5415_070_0	4	7		01	0111000010000011101100000000000100000		2		1	40.00	40.00	2		2	1			30	30				
H5415	070	0	1	04	01	H5415_070_0	4	6		01	0000110000000000010001100111000000000		2		2			2		2	1			30	30				
H5415	070	0	1	04	01	H5415_070_0	4	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H5415	070	0	1	04	01	H5415_070_0	4	3		11	0000001101111100000000000000001001101	000000000000000100000000	2		1	40.00	40.00	2		2	2								
H5415	070	0	1	04	01	H5415_070_0	4	4		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H5415	801	0	1	04	01	H5415_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	801	0	1	04	01	H5415_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	803	0	1	04	01	H5415_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	803	0	1	04	01	H5415_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	804	0	1	04	01	H5415_804_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	804	0	1	04	01	H5415_804_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	806	0	2	04	01	H5415_806_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	806	0	2	04	01	H5415_806_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	807	0	2	04	01	H5415_807_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	807	0	2	04	01	H5415_807_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	808	0	2	04	01	H5415_808_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	808	0	2	04	01	H5415_808_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5415	815	0	1	04	01	H5415_815_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5415	815	0	1	04	01	H5415_815_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5417	001	0	1	04	01	H5417_001_0	5	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
H5417	001	0	1	04	01	H5417_001_0	5	2	Group 2	11	0000000000000000000000000000000000010	000000000000000000110100	2		1	0.00	0.00	2		2	2								
H5417	001	0	1	04	01	H5417_001_0	5	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5417	001	0	1	04	01	H5417_001_0	5	4	Group 4	10		000000010000000000000000	2		2			2		2	1			75	75				
H5417	001	0	1	04	01	H5417_001_0	5	5	Group 5	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H5417	001	0	1	04	01	H5417_001_0	5	6	Group 6	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H5424	001	0	1	04	01	H5424_001_0	4	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		40	40		1	35.00	65.00
H5424	001	0	1	04	01	H5424_001_0	4	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H5424	001	0	1	04	01	H5424_001_0	4	2	Group 2	11	0111000111010010000000000000000001101	000011001000000000001010	2		1	65.00	65.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	65.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H5424	001	0	1	04	01	H5424_001_0	4	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000100	2		1	0.00	0.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5424	001	0	1	04	01	H5424_001_0	4	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			40	40				
H5424	001	0	1	04	01	H5424_001_0	4	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H5424	001	0	1	04	01	H5424_001_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H5424	003	0	1	04	01	H5424_003_0	2	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5424	003	0	1	04	01	H5424_003_0	2	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
H5424	003	0	1	04	01	H5424_003_0	2	2	Group 2	11	0111000111010010000000000000000001101	000011001000000000001010	2		1	65.00	65.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H5424	003	0	1	04	01	H5424_003_0	2	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	35.00	65.00
H5424	003	0	1	04	01	H5424_003_0	2	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	65.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H5424	003	0	1	04	01	H5424_003_0	2	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H5424	003	0	1	04	01	H5424_003_0	2	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H5424	003	0	1	04	01	H5424_003_0	2	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000100	2		1	0.00	0.00	2		2	2								
H5424	005	0	1	04	01	H5424_005_0	8	1	Group 1	11	0111111111111110000001111111001101101	000001100000000000000000	2		2			2		2	1			30	30				
H5424	005	0	1	04	01	H5424_005_0	8	2	Group 2	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
H5424	005	0	1	04	01	H5424_005_0	8	3	Group 3	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H5424	005	0	1	04	01	H5424_005_0	8	4	Group 4	11	0000000000000000000000000000000000010	000000000100000000110000	2		1	0.00	0.00	2		2	2								
H5424	005	0	1	04	01	H5424_005_0	8	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
H5434	002	0	1	04	01	H5434_002_0	10	2	50% coinsurance	01	0000010000000000000000000100000010000		2		2			2		2	1			50	50				
H5434	002	0	1	04	01	H5434_002_0	10	6	Dental	11	0000000000000000000000000000000001000	000000000000000000110000	2		2			2		2	1			30	50				
H5434	002	0	1	04	01	H5434_002_0	10	5	0 copayment	10		000000000000000010001011	2		2			2		2	2								
H5434	002	0	1	04	01	H5434_002_0	10	4	20%	01	0000000000000000000000000001100000000		2		2			2		2	1			20	20				
H5434	002	0	1	04	01	H5434_002_0	10	1	30% coinsurance	11	0111101111111111111111110010011100111	000001100000000000000000	2		2			2		2	1			30	30				
H5434	002	0	1	04	01	H5434_002_0	10	7	Eye wear	10		000000000000000000000100	2		1	20.00	225.00	2		2	2								
H5434	002	0	1	04	01	H5434_002_0	10	3	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H5434	801	0	1	04	01	H5434_801_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5434	801	0	1	04	01	H5434_801_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5434	802	0	1	04	01	H5434_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5434	802	0	1	04	01	H5434_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5439	001	0	1	04	01	H5439_001_0	5	8	Group 8 - 30%	01	0000000000000000000001000000000000000		2		2			2		2	1			30	30				
H5439	001	0	1	04	01	H5439_001_0	5	9	Group 9 - 5%	01	0000010000000000000000000000000000000		2		2			2		2	1			5	5				
H5439	001	0	1	04	01	H5439_001_0	5	7	Group 7 - $40	01	0000000001001000000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	001	0	1	04	01	H5439_001_0	5	6	Group 6 - $30	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5439	001	0	1	04	01	H5439_001_0	5	5	Group 5 - $50	01	0000100100100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5439	001	0	1	04	01	H5439_001_0	5	4	Group 4 - $0	11	0000000000000000000000000000000000010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	001	0	1	04	01	H5439_001_0	5	3	Group 3 - $35	01	0111000010010010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5439	001	0	1	04	01	H5439_001_0	5	2	Group 2 - $275	01	0000000000000000000000001000000000000		2		1	275.00	275.00	2		2	2								
H5439	001	0	1	04	01	H5439_001_0	5	14	Group 14 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	001	0	1	04	01	H5439_001_0	5	13	Group 13 - 10% to 30%	01	0000000000000000000010000000000000000		2		2			2		2	1			10	30				
H5439	001	0	1	04	01	H5439_001_0	5	12	Group 12 - 10% or 15%	01	0000000000000000000000000010000000000		2		2			2		2	1			10	15				
H5439	001	0	1	04	01	H5439_001_0	5	11	Group 11 - 0% or 10%	11	0000000000000000000000000000010000100	000000000000000000001000	2		2			2		2	1			0	10				
H5439	001	0	1	04	01	H5439_001_0	5	1	Group 1 - 10%	11	0000000000000001111100010100001111001	000000100000000100000010	2		2			2		2	1			10	10				
H5439	001	0	1	04	01	H5439_001_0	5	10	Group 10 - 15% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			15	20				
H5439	002	0	1	04	01	H5439_002_0	6	8	Group 8 - 10%	11	0000000000000000000000000110000010000	000000000000000100000000	2		2			2		2	1			10	10				
H5439	002	0	1	04	01	H5439_002_0	6	7	Group 7 - 10% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			10	20				
H5439	002	0	1	04	01	H5439_002_0	6	6	Group 6 - 30%	11	0000000000000001111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H5439	002	0	1	04	01	H5439_002_0	6	5	Group 5 - 0% or 30%	11	0000000000000000000000000000000000100	000000000000000000001000	2		2			2		2	1			0	30				
H5439	002	0	1	04	01	H5439_002_0	6	9	Group 9 - 0% or 15%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	15				
H5439	002	0	1	04	01	H5439_002_0	6	3	Group 3 - $40	01	0111100111111110000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	002	0	1	04	01	H5439_002_0	6	2	Group 2 - $340	01	0000000000000000000000001000000000000		2		1	340.00	340.00	2		2	2								
H5439	002	0	1	04	01	H5439_002_0	6	10	Group 10 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	002	0	1	04	01	H5439_002_0	6	1	Group 1 - $30	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5439	002	0	1	04	01	H5439_002_0	6	4	Group 4 - $0	11	0000010000000000000000000000000001010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	005	0	1	04	01	H5439_005_0	7	9	Group 9 - 0% or 15%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	15				
H5439	005	0	1	04	01	H5439_005_0	7	1	Group 1 - $35	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H5439	005	0	1	04	01	H5439_005_0	7	10	Group 10 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	005	0	1	04	01	H5439_005_0	7	2	Group 2 - $345	01	0000000000000000000000001000000000000		2		1	345.00	345.00	2		2	2								
H5439	005	0	1	04	01	H5439_005_0	7	3	Group 3 - $40	01	0111100111111110000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	005	0	1	04	01	H5439_005_0	7	4	Group 4 - $0	11	0000010000000000000000000000000001010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	005	0	1	04	01	H5439_005_0	7	5	Group 5 - 0% or 30%	11	0000000000000000000000000000000000100	000000000000000000001000	2		2			2		2	1			0	30				
H5439	005	0	1	04	01	H5439_005_0	7	6	Group 6 - 30%	11	0000000000000001111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H5439	005	0	1	04	01	H5439_005_0	7	7	Group 7 - 10% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			10	20				
H5439	005	0	1	04	01	H5439_005_0	7	8	Group 8 - 10%	11	0000000000000000000000000110000010000	000000000000000100000000	2		2			2		2	1			10	10				
H5439	006	0	1	04	01	H5439_006_0	7	7	Group 7 - 10% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			10	20				
H5439	006	0	1	04	01	H5439_006_0	7	8	Group 8 - 10%	11	0000000000000000000000000110000010000	000000000000000100000000	2		2			2		2	1			10	10				
H5439	006	0	1	04	01	H5439_006_0	7	9	Group 9 - 0% or 15%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	15				
H5439	006	0	1	04	01	H5439_006_0	7	4	Group 4 - $0	11	0000010000000000000000000000000001010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	006	0	1	04	01	H5439_006_0	7	2	Group 2 - $320	01	0000000000000000000000001000000000000		2		1	320.00	320.00	2		2	2								
H5439	006	0	1	04	01	H5439_006_0	7	5	Group 5 - 0% or 30%	11	0000000000000000000000000000000000100	000000000000000000001000	2		2			2		2	1			0	30				
H5439	006	0	1	04	01	H5439_006_0	7	6	Group 6 - 30%	11	0000000000000001111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H5439	006	0	1	04	01	H5439_006_0	7	1	Group 1 - $30	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5439	006	0	1	04	01	H5439_006_0	7	10	Group 10 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	006	0	1	04	01	H5439_006_0	7	3	Group 3 - $40	01	0111100111111110000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	007	0	1	04	01	H5439_007_0	7	9	Group 9 - 0% or 15%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	15				
H5439	007	0	1	04	01	H5439_007_0	7	8	Group 8 - 10%	11	0000000000000000000000000110000010000	000000000000000100000000	2		2			2		2	1			10	10				
H5439	007	0	1	04	01	H5439_007_0	7	7	Group 7 - 10% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			10	20				
H5439	007	0	1	04	01	H5439_007_0	7	6	Group 6 - 30%	11	0000000000000001111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H5439	007	0	1	04	01	H5439_007_0	7	5	Group 5 - 0% or 30%	11	0000000000000000000000000000000000100	000000000000000000001000	2		2			2		2	1			0	30				
H5439	007	0	1	04	01	H5439_007_0	7	3	Group 3 - $40	01	0111100111111110000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	007	0	1	04	01	H5439_007_0	7	4	Group 4 - $0	11	0000010000000000000000000000000001010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	007	0	1	04	01	H5439_007_0	7	2	Group 2 - $315	01	0000000000000000000000001000000000000		2		1	315.00	315.00	2		2	2								
H5439	007	0	1	04	01	H5439_007_0	7	10	Group 10 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	007	0	1	04	01	H5439_007_0	7	1	Group 1 - $30	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5439	008	0	1	04	01	H5439_008_0	7	8	Group 8 - 10%	11	0000000000000000000000000110000010000	000000000000000100000000	2		2			2		2	1			10	10				
H5439	008	0	1	04	01	H5439_008_0	7	3	Group 3 - $40	01	0111100111111110000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	008	0	1	04	01	H5439_008_0	7	9	Group 9 - 0% or 15%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	15				
H5439	008	0	1	04	01	H5439_008_0	7	4	Group 4 - $0	11	0000010000000000000000000000000001010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	008	0	1	04	01	H5439_008_0	7	5	Group 5 - 0% or 30%	11	0000000000000000000000000000000000100	000000000000000000001000	2		2			2		2	1			0	30				
H5439	008	0	1	04	01	H5439_008_0	7	6	Group 6 - 30%	11	0000000000000001111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H5439	008	0	1	04	01	H5439_008_0	7	7	Group 7 - 10% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			10	20				
H5439	008	0	1	04	01	H5439_008_0	7	1	Group 1 - $30	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5439	008	0	1	04	01	H5439_008_0	7	10	Group 10 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	008	0	1	04	01	H5439_008_0	7	2	Group 2 - $330	01	0000000000000000000000001000000000000		2		1	330.00	330.00	2		2	2								
H5439	009	0	1	04	01	H5439_009_0	7	8	Group 8 - 10%	11	0000000000000000000000000110000010000	000000000000000100000000	2		2			2		2	1			10	10				
H5439	009	0	1	04	01	H5439_009_0	7	1	Group 1 - $30	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5439	009	0	1	04	01	H5439_009_0	7	9	Group 9 - 0% or 15%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	15				
H5439	009	0	1	04	01	H5439_009_0	7	10	Group 10 - 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5439	009	0	1	04	01	H5439_009_0	7	2	Group 2 - $340	01	0000000000000000000000001000000000000		2		1	340.00	340.00	2		2	2								
H5439	009	0	1	04	01	H5439_009_0	7	3	Group 3 - $40	01	0111100111111110000000000000000000000		2		1	40.00	40.00	2		2	2								
H5439	009	0	1	04	01	H5439_009_0	7	4	Group 4 - $0	11	0000010000000000000000000000000001010	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5439	009	0	1	04	01	H5439_009_0	7	5	Group 5 - 0% or 30%	11	0000000000000000000000000000000000100	000000000000000000001000	2		2			2		2	1			0	30				
H5439	009	0	1	04	01	H5439_009_0	7	7	Group 7 - 10% or 20%	01	0000000000000000000000000001000000000		2		2			2		2	1			10	20				
H5439	009	0	1	04	01	H5439_009_0	7	6	Group 6 - 30%	11	0000000000000001111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H5439	801	0	1	04	01	H5439_801_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5439	801	0	1	04	01	H5439_801_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5439	802	0	1	04	01	H5439_802_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5439	802	0	1	04	01	H5439_802_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5439	803	0	1	04	01	H5439_803_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5439	803	0	1	04	01	H5439_803_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5507	001	0	1	04	01	H5507_001_0	4	10	Group 10	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H5507	001	0	1	04	01	H5507_001_0	4	1	Group 1	11	0111001111011010000001000011001111111	000001000000000100001010	2		2			2		2	1			30	30				
H5507	001	0	1	04	01	H5507_001_0	4	11	Group 11	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H5507	001	0	1	04	01	H5507_001_0	4	2	Group 2	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	1	30	30	30	30	2		
H5507	001	0	1	04	01	H5507_001_0	4	3	Group 3	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			30	30				
H5507	001	0	1	04	01	H5507_001_0	4	9	Group 9	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5507	001	0	1	04	01	H5507_001_0	4	5	Group 5	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5507	001	0	1	04	01	H5507_001_0	4	6	Group 6	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H5507	001	0	1	04	01	H5507_001_0	4	7	Group 7	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5507	001	0	1	04	01	H5507_001_0	4	8	Group 8	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H5507	001	0	1	04	01	H5507_001_0	4	4	Group 4	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H5508	001	0	1	04	01	H5508_001_0	10	2		01	0000010000000000000000000000011100000		2		1	0.00	0.00	2		2	2								
H5508	001	0	1	04	01	H5508_001_0	10	1		11	0111101111011111111111111111100011111	000000100000000010001100	2		2			2		2	1			20	20				
H5508	001	0	1	04	01	H5508_001_0	10	3		01	0000000000100000000000000000000000000		2		2			2		2	1			35	35				
H5508	001	0	1	04	01	H5508_001_0	10	4		10		000000000000000000100000	2		2			2		2	1			50	50				
H5508	002	0	1	04	01	H5508_002_0	12	2		01	0000010000000000000000000000011100000		2		2			2		2	1			0	0				
H5508	002	0	1	04	01	H5508_002_0	12	1		11	0111101111011111111111111111100011111	000000100000000010001100	2		2			2		2	1			20	20				
H5508	002	0	1	04	01	H5508_002_0	12	3		01	0000000000100000000000000000000000000		2		2			2		2	1			35	35				
H5508	002	0	1	04	01	H5508_002_0	12	4		10		000000000000000000100000	2		2			2		2	1			50	50				
H5508	005	0	1	04	01	H5508_005_0	14	2		11	0000010000000000000000000000011100000	000000000000000010000000	2		2			2		2	1			0	0				
H5508	005	0	1	04	01	H5508_005_0	14	1		11	0111101111011111111111111111100011111	000000100000000000000000	2		2			2		2	1			20	20				
H5508	005	0	1	04	01	H5508_005_0	14	3		01	0000000000100000000000000000000000000		2		2			2		2	1			35	35				
H5508	006	0	1	04	01	H5508_006_0	13	1		11	0111101111011111111111111111100011111	000000100000000000001000	2		2			2		2	1			20	20				
H5508	006	0	1	04	01	H5508_006_0	13	2		11	0000010000000000000000000000011100000	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H5508	006	0	1	04	01	H5508_006_0	13	3		01	0000000000100000000000000000000000000		2		2			2		2	1			35	35				
H5508	006	0	1	04	01	H5508_006_0	13	4		10		000000000000000000101100	2		2			2		2	1			50	50				
H5508	801	0	1	04	01	H5508_801_0	10	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5508	801	0	1	04	01	H5508_801_0	10	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5508	802	0	1	04	01	H5508_802_0	9	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5508	802	0	1	04	01	H5508_802_0	9	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5508	803	0	1	04	01	H5508_803_0	8	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5508	803	0	1	04	01	H5508_803_0	8	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5508	804	0	1	04	01	H5508_804_0	9	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5508	804	0	1	04	01	H5508_804_0	9	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5509	001	0	1	04	01	H5509_001_0	6	2	Group 2	01	0000010000000000000000000000000000000		2		1	0.00	0.00	2		2	2								
H5509	001	0	1	04	01	H5509_001_0	6	1	Group 1	11	0111101111111111111111110111111111111	000000100000000000000000	2		2			2		2	1			40	40				
H5509	001	0	1	04	01	H5509_001_0	6	3	Group 3	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	001	0	1	04	01	H5509_001_0	6	4	Group 4	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5509	003	0	1	04	01	H5509_003_0	7	1	Group 1	11	0111101111111111111111110000111111111	000000100000000000000000	2		2			2		2	1			40	40				
H5509	003	0	1	04	01	H5509_003_0	7	2	Group 2	01	0000010000000000000000000000000000000		2		1	0.00	0.00	2		2	2								
H5509	003	0	1	04	01	H5509_003_0	7	3	Group 3	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	003	0	1	04	01	H5509_003_0	7	4	Group 4	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5509	003	0	1	04	01	H5509_003_0	7	5	Group 5	01	0000000000000000000000000111000000000		2		2			2		2	1			20	20				
H5509	010	0	1	04	01	H5509_010_0	5	1	Group 1	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5509	010	0	1	04	01	H5509_010_0	5	2	Group 2	11	0000010000000000000000000000000000000	000000000000000000100000	2		1	0.00	0.00	2		2	2								
H5509	010	0	1	04	01	H5509_010_0	5	5	Group 5	01	0000000000000000000000000111000000000		2		2			2		2	1			25	25				
H5509	010	0	1	04	01	H5509_010_0	5	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	010	0	1	04	01	H5509_010_0	5	3	Group 3	11	0111101111111111111111110000111111111	000000100000000000001000	2		2			2		2	1			40	40				
H5509	011	0	1	04	01	H5509_011_0	5	1	Group 1	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5509	011	0	1	04	01	H5509_011_0	5	2	Group 2	11	0000010000000000000000000000000000000	000000000000000000100000	2		1	0.00	0.00	2		2	2								
H5509	011	0	1	04	01	H5509_011_0	5	3	Group 3	11	0111101111111111111111110111111111111	000000100000000000001000	2		2			2		2	1			35	35				
H5509	011	0	1	04	01	H5509_011_0	5	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	012	0	1	04	01	H5509_012_0	6	1	Group 1	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5509	012	0	1	04	01	H5509_012_0	6	2	Group 2	01	0000010000000000000000000000000000000		2		1	0.00	0.00	2		2	2								
H5509	012	0	1	04	01	H5509_012_0	6	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	012	0	1	04	01	H5509_012_0	6	3	Group 3	11	0111101111111111111111110111111111111	000000100000000000001000	2		2			2		2	1			25	25				
H5509	016	0	1	04	01	H5509_016_0	4	3	Group 3	11	0111101111111111111111110111111111111	000000100000000000000000	2		2			2		2	1			35	35				
H5509	016	0	1	04	01	H5509_016_0	4	1	Group 1	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5509	016	0	1	04	01	H5509_016_0	4	2	Group 2	11	0000010000000000000000000000000000000	000000000000000000100000	2		1	0.00	0.00	2		2	2								
H5509	016	0	1	04	01	H5509_016_0	4	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	017	0	1	04	01	H5509_017_0	5	1	Group 1	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5509	017	0	1	04	01	H5509_017_0	5	2	Group 2	11	0000010000000000000000000000000000000	000000000000000000100100	2		1	0.00	0.00	2		2	2								
H5509	017	0	1	04	01	H5509_017_0	5	3	Group 3	11	0111101111111111111111110111111111111	000000100000000000001000	2		2			2		2	1			35	35				
H5509	017	0	1	04	01	H5509_017_0	5	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	018	0	1	04	01	H5509_018_0	4	2	Group 2	11	0000010000000000000000000000000000000	000000000000000000100000	2		1	0.00	0.00	2		2	2								
H5509	018	0	1	04	01	H5509_018_0	4	1	Group 1	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5509	018	0	1	04	01	H5509_018_0	4	3	Group 3	11	0111101111111111111100110111111111111	000000100000000000001000	2		2			2		2	1			35	35				
H5509	018	0	1	04	01	H5509_018_0	4	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	018	0	1	04	01	H5509_018_0	4	5	Group 5	01	0000000000000000000011000000000000000		2		1	300.00	300.00	2		2	2								
H5509	019	0	1	04	01	H5509_019_0	7	2	Group 2	11	0000010000000000000000000000000000000	000000000000000000100000	2		1	0.00	0.00	2		2	2								
H5509	019	0	1	04	01	H5509_019_0	7	1	Group 1	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5509	019	0	1	04	01	H5509_019_0	7	3	Group 3	11	0111101111111111111111110111111111111	000000100000000000001000	2		2			2		2	1			35	35				
H5509	019	0	1	04	01	H5509_019_0	7	4	Group 4	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H5509	801	0	1	04	01	H5509_801_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5509	801	0	1	04	01	H5509_801_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5509	802	0	1	04	01	H5509_802_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5509	802	0	1	04	01	H5509_802_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5509	803	0	1	04	01	H5509_803_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5509	803	0	1	04	01	H5509_803_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5516	001	0	1	04	01	H5516_001_0	4	1	Group 1	01	0000001000000000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H5516	001	0	1	04	01	H5516_001_0	4	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
H5516	001	0	1	04	01	H5516_001_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	30.00	50.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5516	001	0	1	04	01	H5516_001_0	4	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			40	40				
H5516	001	0	1	04	01	H5516_001_0	4	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		40	40		1	30.00	50.00
H5516	001	0	1	04	01	H5516_001_0	4	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			40	40				
H5516	001	0	1	04	01	H5516_001_0	4	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H5516	001	0	1	04	01	H5516_001_0	4	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	50.00	50.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	8	Group $15	11	0000000100000000000000000000000000000	000010001000000000000000	2		1	15.00	15.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	7	Group $100	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	6	Group $0  or 20%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			20	20				
H5520	001	0	1	04	01	H5520_001_0	3	5	Group $0 - $20	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	20.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	4	Group 20%	01	0000000000000000011000000110100010000		2		2			2		2	1			20	20				
H5520	001	0	1	04	01	H5520_001_0	3	9	Group 20% or $200	01	0000000000000000000010000000000000000		2		1	200.00	200.00	2		2	1			20	20				
H5520	001	0	1	04	01	H5520_001_0	3	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	12	Group 0% or 20%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	20				
H5520	001	0	1	04	01	H5520_001_0	3	11	Group $0	11	0000110000000000100000010000011100010	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	10	Group $175	01	0000000000000000000001000000000000000		2		1	175.00	175.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	1	Group $20	01	0000001001011000000100000000000001001		2		1	20.00	20.00	2		2	2								
H5520	001	0	1	04	01	H5520_001_0	3	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	1	Group $20	01	0000001001011000100100000000000001001		2		1	20.00	20.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	10	Group $0	11	0000110000000000000000010000011100010	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	11	Group 0% - 18%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	18				
H5520	002	0	1	04	01	H5520_002_0	5	12	Group $0 or 18%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			18	18				
H5520	002	0	1	04	01	H5520_002_0	5	13	Group $295	01	0000000000000000000000001000000000000		2		1	295.00	295.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	4	Group 18%	01	0000000000000000011000000110000010000		2		2			2		2	1			18	18				
H5520	002	0	1	04	01	H5520_002_0	5	5	Group 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5520	002	0	1	04	01	H5520_002_0	5	6	Group $0 - $20	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	20.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	7	Group $175	01	0000000000000000000001000000000000000		2		1	175.00	175.00	2		2	2								
H5520	002	0	1	04	01	H5520_002_0	5	9	Group 18% or $200	01	0000000000000000000010000000000000000		2		1	200.00	200.00	2		2	1			18	18				
H5520	002	0	1	04	01	H5520_002_0	5	8	Group $15	11	0000000100000000000000000000000000000	000010001000000000000000	2		1	15.00	15.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	8	Group $15	11	0000000100000000000000000000000000000	000010001000000000000000	2		1	15.00	15.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	9	Group 20% or $200	01	0000000000000000000010000000000000000		2		1	200.00	200.00	2		2	1			20	20				
H5520	003	0	1	04	01	H5520_003_0	3	7	Group $100	01	0000000000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	6	Group $0 or 20%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			20	20				
H5520	003	0	1	04	01	H5520_003_0	3	5	Group $0 - $20	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	20.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	4	Group 20%	01	0000000000000000011000000110100010000		2		2			2		2	1			20	20				
H5520	003	0	1	04	01	H5520_003_0	3	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	12	Group 0% - 20%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	20				
H5520	003	0	1	04	01	H5520_003_0	3	11	Group $0	11	0000110000000000100000010000011100010	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	10	Group $175	01	0000000000000000000001000000000000000		2		1	175.00	175.00	2		2	2								
H5520	003	0	1	04	01	H5520_003_0	3	1	Group $20	01	0000001001011000000100000000000001001		2		1	20.00	20.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	1	Group $20	01	0000001001011000100100000000000001001		2		1	20.00	20.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	10	Group $0	11	0000110000000000000000010000011100010	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	11	Group 0% - 18%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	18				
H5520	004	0	1	04	01	H5520_004_0	5	12	Group $0 or 18%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			18	18				
H5520	004	0	1	04	01	H5520_004_0	5	13	Group $295	01	0000000000000000000000001000000000000		2		1	295.00	295.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	9	Group 18% or $200	01	0000000000000000000010000000000000000		2		1	200.00	200.00	2		2	1			18	18				
H5520	004	0	1	04	01	H5520_004_0	5	4	Goup 18%	01	0000000000000000011000000110000010000		2		2			2		2	1			18	18				
H5520	004	0	1	04	01	H5520_004_0	5	5	Group 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5520	004	0	1	04	01	H5520_004_0	5	6	Group $0 - $20	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	20.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	7	Group $175	01	0000000000000000000001000000000000000		2		1	175.00	175.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	8	Group $15	11	0000000100000000000000000000000000000	000010001000000000000000	2		1	15.00	15.00	2		2	2								
H5520	004	0	1	04	01	H5520_004_0	5	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	1	Group $20	11	0000001101011000100100000000000001001	000010001000000000000000	2		1	20.00	20.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	4	Group 20%	01	0000000000000000011011000110100010010		2		2			2		2	1			20	20				
H5520	006	0	1	04	01	H5520_006_0	5	5	Group $0 or 20%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			20	20				
H5520	006	0	1	04	01	H5520_006_0	5	6	Group $395	01	0000000000000000000000001000000000000		2		1	395.00	395.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	7	Group $0	11	0000110000000000000000010000011100000	000000100000000110000000	2		1	0.00	0.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	8	Group $0 - $20	01	0000000000000000000000000000000000100		2		1	0.00	20.00	2		2	2								
H5520	006	0	1	04	01	H5520_006_0	5	9	Group 0% - 20%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	20				
H5520	009	0	1	04	01	H5520_009_0	5	1	Group $0	11	0000110000000000100100010000011100010	000000100000000110000101	2		1	0.00	0.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	10	Group $0 - $20	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	0.00	20.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	9	Group 20% + $35 Deductible	10		000000000000000000100000	1	500.00	2			1	35.00	2	1			20	20				
H5520	009	0	1	04	01	H5520_009_0	5	8	Group 12%	01	0000000000000000011000000110000010000		2		2			2		2	1			12	12				
H5520	009	0	1	04	01	H5520_009_0	5	7	Group 12% or $200	01	0000000000000000000010000000000000000		2		1	200.00	200.00	2		2	1			12	12				
H5520	009	0	1	04	01	H5520_009_0	5	6	Group $150	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	5	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	4	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	3	Group $15	11	0000000100000000000000000000000000000	000010001000000000000000	2		1	15.00	15.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	2	Group $20	01	0000001001011000000000000000000001001		2		1	20.00	20.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	14	Group 0% - 12%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	12				
H5520	009	0	1	04	01	H5520_009_0	5	13	Group $0 or 12%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			12	12				
H5520	009	0	1	04	01	H5520_009_0	5	12	Group $100	01	0000000000000000000001000000000000000		2		1	100.00	100.00	2		2	2								
H5520	009	0	1	04	01	H5520_009_0	5	11	Group 20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5520	012	1	1	04	01	H5520_012_1	5	4	Group 20%	01	0000000000000000011011000110100010010		2		2			2		2	1			20	20				
H5520	012	1	1	04	01	H5520_012_1	5	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	012	1	1	04	01	H5520_012_1	5	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	012	1	1	04	01	H5520_012_1	5	1	Group $20	11	0000001101011000100100000000000001001	000010001000000000000000	2		1	20.00	20.00	2		2	2								
H5520	012	1	1	04	01	H5520_012_1	5	5	Group $0 or 20%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			20	20				
H5520	012	1	1	04	01	H5520_012_1	5	8	Group $0 - $20	01	0000000000000000000000000000000000100		2		1	0.00	20.00	2		2	2								
H5520	012	1	1	04	01	H5520_012_1	5	7	Group $0	11	0000110000000000000000010000011100000	000000100000000110000000	2		1	0.00	0.00	2		2	2								
H5520	012	1	1	04	01	H5520_012_1	5	6	Group $380	01	0000000000000000000000001000000000000		2		1	380.00	380.00	2		2	2								
H5520	012	1	1	04	01	H5520_012_1	5	9	Group 0% - 20%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	20				
H5520	012	2	1	04	01	H5520_012_2	5	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	012	2	1	04	01	H5520_012_2	5	6	Group $415	01	0000000000000000000000001000000000000		2		1	415.00	415.00	2		2	2								
H5520	012	2	1	04	01	H5520_012_2	5	7	Group 18%	01	0000000000000000000000000000000010000		2		2			2		2	1			18	18				
H5520	012	2	1	04	01	H5520_012_2	5	8	Group $0 - $20	01	0000000000000000000000000000000000100		2		1	0.00	20.00	2		2	2								
H5520	012	2	1	04	01	H5520_012_2	5	9	Group 0% - 20%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	20				
H5520	012	2	1	04	01	H5520_012_2	5	4	Group 20%	01	0000000000000000011011000110100000010		2		2			2		2	1			20	20				
H5520	012	2	1	04	01	H5520_012_2	5	5	Group $0 or 20%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			20	20				
H5520	012	2	1	04	01	H5520_012_2	5	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	012	2	1	04	01	H5520_012_2	5	11	Group $25	01	0000000000000000100100000000000000000		2		1	25.00	25.00	2		2	2								
H5520	012	2	1	04	01	H5520_012_2	5	10	Group $0	11	0000110000000000000000010000011100000	000000100000000110000000	2		1	0.00	0.00	2		2	2								
H5520	012	2	1	04	01	H5520_012_2	5	1	Group $20	11	0000001101011000000000000000000001001	000010001000000000000000	2		1	20.00	20.00	2		2	2								
H5520	012	3	1	04	01	H5520_012_3	6	9	Group 0% - 20%	01	0000000000000001000000000000000000000		2		2			2		2	1			0	20				
H5520	012	3	1	04	01	H5520_012_3	6	5	Group $0 or 20%	01	0000000000000000000000000001000000000		2		1	0.00	0.00	2		2	1			20	20				
H5520	012	3	1	04	01	H5520_012_3	6	4	Group 20%	01	0000000000000000011011000110100010010		2		2			2		2	1			20	20				
H5520	012	3	1	04	01	H5520_012_3	6	3	Group $50	01	0000000000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5520	012	3	1	04	01	H5520_012_3	6	2	Group $35	01	0111000010000010000000000000000000000		2		1	35.00	35.00	2		2	2								
H5520	012	3	1	04	01	H5520_012_3	6	1	Group $20	11	0000001101011000100100000000000001001	000010001000000000000000	2		1	20.00	20.00	2		2	2								
H5520	012	3	1	04	01	H5520_012_3	6	7	Group $0	11	0000110000000000000000010000011100000	000000100000000110000000	2		1	0.00	0.00	2		2	2								
H5520	012	3	1	04	01	H5520_012_3	6	6	Group $375	01	0000000000000000000000001000000000000		2		1	375.00	375.00	2		2	2								
H5520	012	3	1	04	01	H5520_012_3	6	8	Group $0 - $20	01	0000000000000000000000000000000000100		2		1	0.00	20.00	2		2	2								
H5520	807	0	1	04	01	H5520_807_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5520	807	0	1	04	01	H5520_807_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5520	808	0	1	04	01	H5520_808_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5520	808	0	1	04	01	H5520_808_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5520	809	0	1	04	01	H5520_809_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5520	809	0	1	04	01	H5520_809_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5521	012	0	1	04	01	H5521_012_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	012	0	1	04	01	H5521_012_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	012	0	1	04	01	H5521_012_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	012	0	1	04	01	H5521_012_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			25	25				
H5521	013	0	1	04	01	H5521_013_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	013	0	1	04	01	H5521_013_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	013	0	1	04	01	H5521_013_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	013	0	1	04	01	H5521_013_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			30	30				
H5521	015	0	1	04	01	H5521_015_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	015	0	1	04	01	H5521_015_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	015	0	1	04	01	H5521_015_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	015	0	1	04	01	H5521_015_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			35	35				
H5521	016	0	1	04	01	H5521_016_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	016	0	1	04	01	H5521_016_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	016	0	1	04	01	H5521_016_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	016	0	1	04	01	H5521_016_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			30	30				
H5521	020	0	1	04	01	H5521_020_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	020	0	1	04	01	H5521_020_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	020	0	1	04	01	H5521_020_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	020	0	1	04	01	H5521_020_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			25	25				
H5521	022	0	1	04	01	H5521_022_0	6	2	Tier 2	01	0000000000000000000000001000000000000		2		1	400.00	400.00	2		2	2								
H5521	022	0	1	04	01	H5521_022_0	6	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	022	0	1	04	01	H5521_022_0	6	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	022	0	1	04	01	H5521_022_0	6	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			40	40				
H5521	027	0	1	04	01	H5521_027_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	027	0	1	04	01	H5521_027_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	027	0	1	04	01	H5521_027_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	027	0	1	04	01	H5521_027_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			35	35				
H5521	028	0	1	04	01	H5521_028_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			40	40				
H5521	028	0	1	04	01	H5521_028_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	350.00	350.00	2		2	2								
H5521	028	0	1	04	01	H5521_028_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	028	0	1	04	01	H5521_028_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	033	0	1	04	01	H5521_033_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			30	30				
H5521	033	0	1	04	01	H5521_033_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	033	0	1	04	01	H5521_033_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	033	0	1	04	01	H5521_033_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	037	0	1	04	01	H5521_037_0	6	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	037	0	1	04	01	H5521_037_0	6	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	037	0	1	04	01	H5521_037_0	6	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	037	0	1	04	01	H5521_037_0	6	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			30	30				
H5521	038	0	1	04	01	H5521_038_0	6	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	038	0	1	04	01	H5521_038_0	6	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	038	0	1	04	01	H5521_038_0	6	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			35	35				
H5521	038	0	1	04	01	H5521_038_0	6	4	Tier 4	10		000000000000000010000101	2		2			2		2	2								
H5521	040	0	1	04	01	H5521_040_0	5	3	Tier 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5521	040	0	1	04	01	H5521_040_0	5	2	Tier 2	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
H5521	040	0	1	04	01	H5521_040_0	5	1	Tier 1	11	0111111111111111111111110111011111111	000000000000000100001010	2		2			2		2	1			40	40				
H5521	040	0	1	04	01	H5521_040_0	5	4	Tier 4	10		000000000000000010000000	2		2			2		2	2								
H5521	801	0	1	04	01	H5521_801_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5521	801	0	1	04	01	H5521_801_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5521	802	0	1	04	01	H5521_802_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5521	802	0	1	04	01	H5521_802_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5521	805	0	2	04	01	H5521_805_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5521	805	0	2	04	01	H5521_805_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5521	806	0	2	04	01	H5521_806_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5521	806	0	2	04	01	H5521_806_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5522	001	0	1	04	01	H5522_001_0	7	9	0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H5522	001	0	1	04	01	H5522_001_0	7	1	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	001	0	1	04	01	H5522_001_0	7	10	30% Dental Coinsurance OON	10		000000000000000000100000	2		2			1	100.00	2	1			30	30				
H5522	001	0	1	04	01	H5522_001_0	7	11	$0 Copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	001	0	1	04	01	H5522_001_0	7	2	20% Coinsurance OON	01	0000000000000000000000000111001110000		2		2			2		2	1			20	20				
H5522	001	0	1	04	01	H5522_001_0	7	3	30% Coinsurance OON	11	0111001111011011111111010000100001111	000001100000000000001010	2		2			2		2	1			30	30				
H5522	001	0	1	04	01	H5522_001_0	7	4	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	001	0	1	04	01	H5522_001_0	7	5	50% Non-Medicare Dental OON Coinsurance	10		000000000000000000010000	2		2			1	100.00	2	1			50	50				
H5522	001	0	1	04	01	H5522_001_0	7	6	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	001	0	1	04	01	H5522_001_0	7	7	Ambulance OON	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H5522	001	0	1	04	01	H5522_001_0	7	8	50% Coinsurance	10		000000000000000000000001	2		2			2		2	1			50	50				
H5522	002	0	1	04	01	H5522_002_0	6	1	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	002	0	1	04	01	H5522_002_0	6	10	30% Dental OON Coinsurance	10		000000000000000000100000	2		2			1	100.00	2	1			30	30				
H5522	002	0	1	04	01	H5522_002_0	6	11	$0 Copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	002	0	1	04	01	H5522_002_0	6	2	20% Coinsurance OON	11	0111001111011011111111010110101111111	000001100000000000001010	2		2			2		2	1			20	20				
H5522	002	0	1	04	01	H5522_002_0	6	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	002	0	1	04	01	H5522_002_0	6	6	30% Coinsurance	01	0000000000000000000000000001000000000		2		2			2		2	1			30	30				
H5522	002	0	1	04	01	H5522_002_0	6	5	50% Coinsurance	10		000000000000000000000001	2		2			2		2	1			50	50				
H5522	002	0	1	04	01	H5522_002_0	6	9	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	002	0	1	04	01	H5522_002_0	6	8	0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H5522	002	0	1	04	01	H5522_002_0	6	7	50% Dental Coinsurance	10		000000000000000000010000	2		2			1	100.00	2	1			50	50				
H5522	002	0	1	04	01	H5522_002_0	6	4	Ambulance OON	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H5522	004	0	1	04	01	H5522_004_0	6	7	25% OON	01	0000000000000000000000000111000000000		2		2			2		2	1			25	25				
H5522	004	0	1	04	01	H5522_004_0	6	6	0%-40%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H5522	004	0	1	04	01	H5522_004_0	6	5	Ambulance OON	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5522	004	0	1	04	01	H5522_004_0	6	4	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	004	0	1	04	01	H5522_004_0	6	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	004	0	1	04	01	H5522_004_0	6	2	40% Coinsurance OON	11	0111001111011011111111010000101111111	000001100000000000001010	2		2			2		2	1			40	40				
H5522	004	0	1	04	01	H5522_004_0	6	1	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	005	0	1	04	01	H5522_005_0	6	1	0% Coinsurance	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	005	0	1	04	01	H5522_005_0	6	4	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	005	0	1	04	01	H5522_005_0	6	5	Ambulance OON	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5522	005	0	1	04	01	H5522_005_0	6	6	0%-25%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	25				
H5522	005	0	1	04	01	H5522_005_0	6	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	005	0	1	04	01	H5522_005_0	6	2	25%  Coinsurance OON	11	0111001111011011111111010111101111111	000001100000000000001010	2		2			2		2	1			25	25				
H5522	008	0	1	04	01	H5522_008_0	6	1	0% Coinsurance	01	0000010000000000000000001000000000000		2		2			2		2	1			0	0				
H5522	008	0	1	04	01	H5522_008_0	6	3	45% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	008	0	1	04	01	H5522_008_0	6	4	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	008	0	1	04	01	H5522_008_0	6	6	$0 copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	008	0	1	04	01	H5522_008_0	6	5	0%-35%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	35				
H5522	008	0	1	04	01	H5522_008_0	6	2	35% Coinsurance	11	0111001111011011111111010111101111111	000001100000000000001010	2		2			2		2	1			35	35				
H5522	009	0	1	04	01	H5522_009_0	6	5	0%-35%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	35				
H5522	009	0	1	04	01	H5522_009_0	6	6	$0 Copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	009	0	1	04	01	H5522_009_0	6	4	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	009	0	1	04	01	H5522_009_0	6	3	45% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	009	0	1	04	01	H5522_009_0	6	2	35% Coinsurance	11	0111001111011011111111010111101111111	000001100000000000001010	2		2			2		2	1			35	35				
H5522	009	0	1	04	01	H5522_009_0	6	1	0% Coinsurance	01	0000010000000000000000001000000000000		2		2			2		2	1			0	0				
H5522	013	0	1	04	01	H5522_013_0	7	1	20% Coinsurance OON	01	0000000000000000000000000111000000000		2		2			2		2	1			20	20				
H5522	013	0	1	04	01	H5522_013_0	7	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	013	0	1	04	01	H5522_013_0	7	4	GYM OON Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	013	0	1	04	01	H5522_013_0	7	5	Ambulance OON	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5522	013	0	1	04	01	H5522_013_0	7	8	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	013	0	1	04	01	H5522_013_0	7	2	30% Coinsurance OON	11	0111001111011011111111010000101111111	000001100000000000001010	2		2			2		2	1			30	30				
H5522	013	0	1	04	01	H5522_013_0	7	6	0%-30%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H5522	013	0	1	04	01	H5522_013_0	7	7	$0 Copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	014	0	1	04	01	H5522_014_0	7	7	50 % COMPREHENSIVE DENTAL	10		000000000000000000010000	2		2			1	100.00	2	1			50	50				
H5522	014	0	1	04	01	H5522_014_0	7	8	50% Coinsurance	10		000000000000000000000001	2		2			2		2	1			50	50				
H5522	014	0	1	04	01	H5522_014_0	7	6	30% Coinsurance OON	10		000000000000000000100000	2		2			1	100.00	2	1			30	30				
H5522	014	0	1	04	01	H5522_014_0	7	5	Ambulance OON	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H5522	014	0	1	04	01	H5522_014_0	7	2	20% Coinsurance OON	11	0111001111011011111111010110101111111	000001100000000000001010	2		2			2		2	1			20	20				
H5522	014	0	1	04	01	H5522_014_0	7	11	$0 Copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	014	0	1	04	01	H5522_014_0	7	10	30% Coinsurance	01	0000000000000000000000000001000000000		2		2			2		2	1			30	30				
H5522	014	0	1	04	01	H5522_014_0	7	1	0% Coinsurance	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	014	0	1	04	01	H5522_014_0	7	9	0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H5522	014	0	1	04	01	H5522_014_0	7	4	GYM OON Monthly	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H5522	014	0	1	04	01	H5522_014_0	7	3	45% Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H5522	015	0	1	04	01	H5522_015_0	6	9	0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H5522	015	0	1	04	01	H5522_015_0	6	1	0% Coinsurance	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H5522	015	0	1	04	01	H5522_015_0	6	10	$0 Copay	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H5522	015	0	1	04	01	H5522_015_0	6	2	20%  Coinsurance	11	0111001111011011111111010111101111111	000001100000000000001010	2		2			2		2	1			20	20				
H5522	015	0	1	04	01	H5522_015_0	6	3	45%Coinsurance	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
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H5529	004	0	1	04	01	H5529_004_0	7	5	Specialist	11	0111000111010010000000000000000000001	000000000000000000000010	2		1	40.00	40.00	2		2	2								
H5529	004	0	1	04	01	H5529_004_0	7	11	Part B Rx	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H5529	004	0	1	04	01	H5529_004_0	7	12	Preventive	01	0000000000000000000000000000010000000		2		1	0.00	40.00	2		2	2								
H5529	004	0	1	04	01	H5529_004_0	7	13	ASC	01	0000000000000000000001000000000000000		2		2			2		2	1			30	30				
H5529	004	0	1	04	01	H5529_004_0	7	14	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	40.00	2		2	2								
H5529	004	0	1	04	01	H5529_004_0	7	2	20%	11	0000000000000000001000000000100000000	000000000000000000100000	2		2			2		2	1			20	20				
H5529	004	0	1	04	01	H5529_004_0	7	3	Outpatient	01	0000000000000000000010000000000000000		2		1	25.00	40.00	2		2	1			30	30				
H5529	004	0	1	04	01	H5529_004_0	7	4	PCP	01	0000001000001000000000000000000000000		2		1	25.00	25.00	2		2	2								
H5529	804	0	1	04	01	H5529_804_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5529	804	0	1	04	01	H5529_804_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5529	805	0	1	04	01	H5529_805_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5529	805	0	1	04	01	H5529_805_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5529	806	0	1	04	01	H5529_806_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5529	806	0	1	04	01	H5529_806_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5530	001	0	1	04	01	H5530_001_0	7	5	Specialist	11	0111000111010010000000000000000000001	000000000000000000000010	2		1	50.00	50.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	12	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	50.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	11	Part B Rx	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H5530	001	0	1	04	01	H5530_001_0	7	10	Ambulance	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	1	$0	11	0000010000000000000000010000001101010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	2	20%	01	0000000000000000001000000000100000000		2		2			2		2	1			20	20				
H5530	001	0	1	04	01	H5530_001_0	7	9	Labs	01	0000000000000000100000000000000000000		2		1	20.00	20.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	8	Radiology	01	0000000000000001010100000000000000000		2		2			2		2	1			30	30				
H5530	001	0	1	04	01	H5530_001_0	7	7	Mental Health	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	6	DME/ASC	01	0000000000000000000001000111000000000		2		2			2		2	1			30	30				
H5530	001	0	1	04	01	H5530_001_0	7	13	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	50.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H5530	001	0	1	04	01	H5530_001_0	7	3	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			30	30				
H5530	804	0	1	04	01	H5530_804_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5530	804	0	1	04	01	H5530_804_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5530	805	0	1	04	01	H5530_805_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5530	805	0	1	04	01	H5530_805_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5530	806	0	1	04	01	H5530_806_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H5530	806	0	1	04	01	H5530_806_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H5532	001	0	1	04	01	H5532_001_0	5	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5532	001	0	1	04	01	H5532_001_0	5	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	5	Group 5	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			40	40				
H5532	001	0	1	04	01	H5532_001_0	5	4	Group 4	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		40	40		1	40.00	70.00
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H5532	001	0	1	04	01	H5532_001_0	5	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	70.00	70.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	13	Group 13	01	0000000000001000000000000000000000000		2		1	40.00	70.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	12	Group 12	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H5532	001	0	1	04	01	H5532_001_0	5	11	Group 11	01	0000010000000000000000000100000010000		2		2			2		2	1			50	50				
H5532	001	0	1	04	01	H5532_001_0	5	1	Group 1	01	0000001000000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H5532	001	0	1	04	01	H5532_001_0	5	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H5533	003	0	1	04	01	H5533_003_0	13	3	$40 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	40.00	40.00	2		2	2								
H5533	003	0	1	04	01	H5533_003_0	13	2	30% Coins - PCP/Spec Copay could apply	01	0000000000000001111100000000000000000		2		2			2		1	1	2		30	30		1	40.00	60.00
H5533	003	0	1	04	01	H5533_003_0	13	1	30% Coinsurance	11	0111110010000010000011011000111000010	000000100000000100000000	2		2			2		2	1			30	30				
H5533	003	0	1	04	01	H5533_003_0	13	4	$60 OON Copay	11	0000000001111100000000100000000001101	000001000000000000000000	2		1	60.00	60.00	2		2	2								
H5533	003	0	1	04	01	H5533_003_0	13	5	OON Routine Vision	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H5533	003	0	1	04	01	H5533_003_0	13	6	50% with $250 annual max	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H5533	003	0	1	04	01	H5533_003_0	13	7	50% OON	01	0000000000000000000000000111000010000		2		2			2		2	1			50	50				
H5533	003	0	1	04	01	H5533_003_0	13	8	50% Coins - PCP/Spec Copay could apply	01	0000000000000000000000000000000100000		2		2			2		1	1	2		50	50		1	40.00	60.00
H5533	005	0	1	04	01	H5533_005_0	7	3	$50 OON Copay	11	0000000011111110000000100000000001101	000001000000000000000010	2		1	50.00	50.00	2		2	2								
H5533	005	0	1	04	01	H5533_005_0	7	2	$30 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	30.00	30.00	2		2	2								
H5533	005	0	1	04	01	H5533_005_0	7	1	30% Coinsurance	11	0111110000000000000011011000111010010	000000100000000100000000	2		2			2		2	1			30	30				
H5533	005	0	1	04	01	H5533_005_0	7	4	50% OON	11	0000000000000000000000000111000000000	000000000000000000000001	2		2			2		2	1			50	50				
H5533	005	0	1	04	01	H5533_005_0	7	7	OON Routine Vision	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H5533	005	0	1	04	01	H5533_005_0	7	6	30% Coins PCP/Spec Copay could apply	01	0000000000000001111100000000000100000		2		2			2		1	1	2		30	30		1	30.00	50.00
H5533	005	0	1	04	01	H5533_005_0	7	5	50% with $250 Annual Max	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H5533	006	0	1	04	01	H5533_006_0	9	1	30% Coinsurance	11	0111110010000010000011011000111000010	000000100000000100000000	2		2			2		2	1			30	30				
H5533	006	0	1	04	01	H5533_006_0	9	2	30% Coins - PCP/Spec Copay could apply	01	0000000000000001111100000000000000000		2		2			2		1	1	2		30	30		1	40.00	60.00
H5533	006	0	1	04	01	H5533_006_0	9	3	$40 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	40.00	40.00	2		2	2								
H5533	006	0	1	04	01	H5533_006_0	9	4	$60 OON Copay	11	0000000001111100000000100000000001101	000001000000000000000000	2		1	60.00	60.00	2		2	2								
H5533	006	0	1	04	01	H5533_006_0	9	7	50% OON	01	0000000000000000000000000111000010000		2		2			2		2	1			50	50				
H5533	006	0	1	04	01	H5533_006_0	9	6	50% with $250 annual max	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H5533	006	0	1	04	01	H5533_006_0	9	5	OON Routine Vision	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H5533	006	0	1	04	01	H5533_006_0	9	8	50% Coins - PCP/Spec Copay could apply	01	0000000000000000000000000000000100000		2		2			2		1	1	2		50	50		1	40.00	60.00
H5533	801	0	1	04	01	H5533_801_0	6	3	OON Wellness - Fitness Benefit	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H5533	801	0	1	04	01	H5533_801_0	6	4	OON Eye Exams and Eyewear	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H5533	801	0	1	04	01	H5533_801_0	6	5	20% Coins with PCP/Spec Copay	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H5533	801	0	1	04	01	H5533_801_0	6	1	20% coinsurance	11	0111111111111110000011111000111001111	000011100000000100000010	2		2			2		2	1			20	20				
H5533	801	0	1	04	01	H5533_801_0	6	2	50% Coinsurance	11	0000000000000000000000000111000010000	000000000000000000110001	2		2			2		2	1			50	50				
H5533	802	0	1	04	01	H5533_802_0	6	1	20% coinsurance	11	0111111111111110000011111000111001111	000011100000000100000010	2		2			2		2	1			20	20				
H5533	802	0	1	04	01	H5533_802_0	6	2	50% Coinsurance	11	0000000000000000000000000111000010000	000000000000000000110001	2		2			2		2	1			50	50				
H5533	802	0	1	04	01	H5533_802_0	6	3	OON Wellness - Fitness Benefit	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H5533	802	0	1	04	01	H5533_802_0	6	4	OON Eye Exams and Eyewear	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H5533	802	0	1	04	01	H5533_802_0	6	5	20% Coins with PCP/Spec Copay	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H5533	803	0	1	04	01	H5533_803_0	6	1	20% coinsurance	11	0111111111111110000011111000111001111	000011100000000100000010	2		2			2		2	1			20	20				
H5533	803	0	1	04	01	H5533_803_0	6	2	50% Coinsurance	11	0000000000000000000000000111000010000	000000000000000000110001	2		2			2		2	1			50	50				
H5533	803	0	1	04	01	H5533_803_0	6	3	OON Wellness - Fitness Benefit	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H5533	803	0	1	04	01	H5533_803_0	6	4	OON Eye Exams and Eyewear	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H5533	803	0	1	04	01	H5533_803_0	6	5	20% Coins with PCP/Spec Copay	01	0000000000000001111100000000000100000		2		2			2		1	1	1	20	20	20	20	2		
H5868	001	0	1	04	01	H5868_001_0	7	1		11	0000000000000000000000010000000000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
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H5868	001	0	1	04	01	H5868_001_0	7	7		10		000000000100000010000000	2		2			2		2	1			50	50				
H5868	001	0	1	04	01	H5868_001_0	7	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H5868	001	0	1	04	01	H5868_001_0	7	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5868	001	0	1	04	01	H5868_001_0	7	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
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H5868	004	0	1	04	01	H5868_004_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H5868	004	0	1	04	01	H5868_004_0	5	4		01	0000000000000000000000000111100000000		2		2			2		2	1			20	20				
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H5868	009	0	1	04	01	H5868_009_0	5	3		01	0000000000000001100000000000000000100		2		2			2		2	1			0	20				
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H5868	010	0	1	04	01	H5868_010_0	5	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
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H5868	010	0	1	04	01	H5868_010_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5868	010	0	1	04	01	H5868_010_0	5	7		10		000000000110000010110000	2		2			2		2	1			50	50				
H5868	011	0	1	04	01	H5868_011_0	3	7		10		000000000110000010000000	2		2			2		2	1			50	50				
H5868	011	0	1	04	01	H5868_011_0	3	6		11	0111111111111111111101100000001101101	000000000000000100000000	2		2			2		2	1			30	30				
H5868	011	0	1	04	01	H5868_011_0	3	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H5868	011	0	1	04	01	H5868_011_0	3	4		01	0000000000000000000000000111100000000		2		2			2		2	1			20	20				
H5868	011	0	1	04	01	H5868_011_0	3	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
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H5868	012	0	1	04	01	H5868_012_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H5868	012	0	1	04	01	H5868_012_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	40				
H5868	012	0	1	04	01	H5868_012_0	5	6		01	0000000000000000000000000100000000000		2		2			2		2	1			26	26				
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H6328	003	0	1	04	01	H6328_003_0	7	2	$25 Copay	01	0111000010000010000000000000000000000		2		1	25.00	25.00	2		2	2								
H6328	003	0	1	04	01	H6328_003_0	7	15	50% Coinsurance	01	0000000000000000000000000000000000010		2		2			2		2	1			50	50				
H6328	003	0	1	04	01	H6328_003_0	7	14	30% Coinsurance	01	0000000000000000001000010110000010000		2		2			2		2	1			30	30				
H6328	003	0	1	04	01	H6328_003_0	7	13	20% Coinsurance	01	0000000000000000000000000001001100000		2		2			2		2	1			20	20				
H6328	003	0	1	04	01	H6328_003_0	7	12	$75 to $250 Copay	01	0000000000000000010000000000000000000		2		1	75.00	250.00	2		2	2								
H6328	003	0	1	04	01	H6328_003_0	7	10	$250 Copay	01	0000000000000000000010000000000000000		2		1	250.00	250.00	2		2	2								
H6328	003	0	1	04	01	H6328_003_0	7	1	$20 copay	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	1	$20 Copay	01	0111000110000010000000000000000000000		2		1	20.00	20.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	2	$30 Copay	11	0000001000000000000000000000010000000	000000010000000010000000	2		1	30.00	30.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	3	$40 Copay	11	0000010001011000000000000000000001101	000000000000000000101010	2		1	40.00	40.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	4	$50 Copay	01	0000000000100100000000100000100000000		2		1	50.00	50.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	5	$100 Copay	01	0000100000000000000000001000000000000		2		1	100.00	100.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	6	$150 Copay	01	0000000000000000000001000000000000000		2		1	150.00	150.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	7	$200 Copay	01	0000000000000000000010000000000000000		2		1	200.00	200.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	8	$10 to $25 Copay	01	0000000000000001100100000000000000000		2		1	10.00	25.00	2		2	2								
H6328	005	0	1	04	01	H6328_005_0	7	10	20% Coinsurance	01	0000001000000000000000000001001100000		2		2			2		2	1			20	20				
H6328	005	0	1	04	01	H6328_005_0	7	11	30% Coinsurance	01	0000000000000000001000010110000010000		2		2			2		2	1			30	30				
H6328	005	0	1	04	01	H6328_005_0	7	12	50% Coinsurance	11	0000000000000000000000000000000000010	000000000000000000000101	2		2			2		2	1			50	50				
H6328	005	0	1	04	01	H6328_005_0	7	9	$75 to $200 Copay	01	0000000000000000010000000000000000000		2		1	75.00	200.00	2		2	2								
H6328	801	0	1	04	01	H6328_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H6328	801	0	1	04	01	H6328_801_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H6328	802	0	1	04	01	H6328_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H6328	802	0	1	04	01	H6328_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H6328	803	0	1	04	01	H6328_803_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H6328	803	0	1	04	01	H6328_803_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H6328	804	0	1	04	01	H6328_804_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H6328	804	0	1	04	01	H6328_804_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H6411	002	0	1	04	01	H6411_002_0	7	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H6411	002	0	1	04	01	H6411_002_0	7	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H6411	002	0	1	04	01	H6411_002_0	7	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6411	002	0	1	04	01	H6411_002_0	7	1		11	0000000000000000000000010000000000010	000000100000000000001100	2		1	0.00	0.00	2		2	2								
H6411	002	0	1	04	01	H6411_002_0	7	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
H6411	002	0	1	04	01	H6411_002_0	7	6		11	0111111111111111111101100111001101101	000000000000000100000000	2		2			2		2	1			30	30				
H6411	002	0	1	04	01	H6411_002_0	7	7		10		000000000100000010000000	2		2			2		2	1			50	50				
H6411	007	0	1	04	01	H6411_007_0	6	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H6411	007	0	1	04	01	H6411_007_0	6	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H6411	007	0	1	04	01	H6411_007_0	6	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6411	007	0	1	04	01	H6411_007_0	6	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H6411	007	0	1	04	01	H6411_007_0	6	5		01	0000010000000000000000000000000000000		2		2			2		2	1			20	20				
H6411	007	0	1	04	01	H6411_007_0	6	9		10		000000000110000010000000	2		2			2		2	1			50	50				
H6411	007	0	1	04	01	H6411_007_0	6	8		11	0111101111111110111101100011001111101	000000000000000100000000	2		2			2		2	1			40	40				
H6411	007	0	1	04	01	H6411_007_0	6	7		01	0000000000000000000000000100000000000		2		2			2		2	1			35	35				
H6411	007	0	1	04	01	H6411_007_0	6	6		01	0000000000000001000010000000000000000		2		2			2		2	1			20	40				
H6411	008	0	1	04	01	H6411_008_0	3	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H6411	008	0	1	04	01	H6411_008_0	3	2		01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6411	008	0	1	04	01	H6411_008_0	3	3		01	0000000000000000000000000000100000000		2		2			2		2	1			0	20				
H6411	008	0	1	04	01	H6411_008_0	3	7		11	0111101111111110111101100011001111101	000000000000000100000000	2		2			2		2	1			40	40				
H6411	008	0	1	04	01	H6411_008_0	3	6		01	0000000000000001000010000000000000000		2		2			2		2	1			20	40				
H6411	008	0	1	04	01	H6411_008_0	3	5		01	0000010000000000000000000100000000000		2		2			2		2	1			20	20				
H6411	008	0	1	04	01	H6411_008_0	3	4		01	0000000000000000000000000000010000000		2		2			2		2	1			0	50				
H6411	008	0	1	04	01	H6411_008_0	3	8		10		000000000110000010000000	2		2			2		2	1			50	50				
H6528	006	0	1	04	01	H6528_006_0	6	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H6528	006	0	1	04	01	H6528_006_0	6	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	5	Group 5	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	7	Group 7	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H6528	006	0	1	04	01	H6528_006_0	6	8	Group 8	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
H6528	006	0	1	04	01	H6528_006_0	6	9	Group 9	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
H6528	006	0	1	04	01	H6528_006_0	6	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000100010	2		1	30.00	30.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	15	Group 15	01	0000000000000000000000000000000000100		2		1	0.00	50.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	14	Group 14	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	30.00	50.00
H6528	006	0	1	04	01	H6528_006_0	6	13	Group 13	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	12	Group 12	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	11	Group 11	11	0000000000000000000000010001011100010	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	10	Group 10	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H6528	006	0	1	04	01	H6528_006_0	6	1	Group 1	11	0111000011011010000000000000000001001	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H6528	016	0	1	04	01	H6528_016_0	6	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	5	Group 5	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	7	Group 7	10		000000000000000000100000	2		1	30.00	30.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
H6528	016	0	1	04	01	H6528_016_0	6	9	Group 9	01	0000000000000001111100000000000000000		2		1	14.00	15.00	2		1	1	2		20	20		1	35.00	50.00
H6528	016	0	1	04	01	H6528_016_0	6	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	35.00	35.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	10	Group 10	10		000000000000000000000001	2		1	340.00	390.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	12	Group 12	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H6528	016	0	1	04	01	H6528_016_0	6	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	14	Group 14	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H6528	016	0	1	04	01	H6528_016_0	6	15	Group 15	01	0000000000000000000010000000000000000		2		1	14.00	15.00	2		2	1			20	20				
H6528	016	0	1	04	01	H6528_016_0	6	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H6528	029	0	1	04	01	H6528_029_0	5	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	7	Group 7	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
H6528	029	0	1	04	01	H6528_029_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	20.00	50.00
H6528	029	0	1	04	01	H6528_029_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
H6528	029	0	1	04	01	H6528_029_0	5	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	12	Group 12	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	2	Group 2	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H6528	029	0	1	04	01	H6528_029_0	5	3	Group 3	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H6528	029	0	1	04	01	H6528_029_0	5	4	Group 4	11	0000001100001000000000000000000000000	000000000000000000100010	2		1	20.00	20.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
H6528	030	0	1	04	01	H6528_030_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	7	Group 7	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	8	Group 8	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
H6528	030	0	1	04	01	H6528_030_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	25.00	50.00
H6528	030	0	1	04	01	H6528_030_0	5	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000001010	2		1	25.00	25.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	1	Group 1	11	0111000011011010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	2	Group 2	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
H6528	030	0	1	04	01	H6528_030_0	5	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	12	Group 12	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	11	Group 11	11	0000000000000000000000010001011100110	000000100000000110000100	2		1	0.00	0.00	2		2	2								
H6528	030	0	1	04	01	H6528_030_0	5	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
H6528	030	0	1	04	01	H6528_030_0	5	3	Group 3	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H6609	001	0	1	04	01	H6609_001_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H6609	001	0	1	04	01	H6609_001_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H6609	001	0	1	04	01	H6609_001_0	5	1		11	0000000000000000000000010000000000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H6609	001	0	1	04	01	H6609_001_0	5	7		10		000000000100000010100000	2		2			2		2	1			50	50				
H6609	001	0	1	04	01	H6609_001_0	5	6		11	0111111111111111111101100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H6609	001	0	1	04	01	H6609_001_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H6609	001	0	1	04	01	H6609_001_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H6609	003	0	1	04	01	H6609_003_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H6609	003	0	1	04	01	H6609_003_0	5	7		10		000000000100000010000000	2		2			2		2	1			50	50				
H6609	003	0	1	04	01	H6609_003_0	5	6		11	0111111111111111111101100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
H6609	003	0	1	04	01	H6609_003_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H6609	003	0	1	04	01	H6609_003_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H6609	003	0	1	04	01	H6609_003_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H6609	003	0	1	04	01	H6609_003_0	5	1		11	0000000000000000000000010000000000000	000000100000000000000000	2		1	0.00	0.00	2		2	2								
H6609	004	0	1	04	01	H6609_004_0	5	4		01	0000000000000000000000000111100000000		2		2			2		2	1			20	20				
H6609	004	0	1	04	01	H6609_004_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H6609	004	0	1	04	01	H6609_004_0	5	6		11	0111111111111111111101100000001111111	000000000000000100000000	2		2			2		2	1			30	30				
H6609	004	0	1	04	01	H6609_004_0	5	7		10		000000000110000010110000	2		2			2		2	1			50	50				
H6609	004	0	1	04	01	H6609_004_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H6609	004	0	1	04	01	H6609_004_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H6609	004	0	1	04	01	H6609_004_0	5	1		11	0000000000000000000000010000000000000	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H6609	005	0	1	04	01	H6609_005_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H6609	005	0	1	04	01	H6609_005_0	5	7		10		000000000100000010000000	2		2			2		2	1			50	50				
H6609	005	0	1	04	01	H6609_005_0	5	6		11	0111111111111111111101100111001111111	000000000000000100000000	2		2			2		2	1			30	30				
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H7301	803	0	1	04	01	H7301_803_0	4	1	Home Health and Preventive Services	01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
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H7306	001	0	1	04	01	H7306_001_0	7	5	Group 5	11	0000010000000000000000000000000000010	000000000000000000000100	2		2			2		2	2								
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H7728	001	0	1	04	01	H7728_001_0	5	9	9A OON Group	01	0000000000000000000010000000000000000		2		1	40.00	65.00	2		2	1			30	30				
H7728	001	0	1	04	01	H7728_001_0	5	2	30% OON Copay	11	0000110000000001111101010111001110011	000000100000000000000000	2		2			2		2	1			30	30				
H7728	001	0	1	04	01	H7728_001_0	5	3	$40 OON Group	01	0000001000001000000000000000000000000		2		1	40.00	40.00	2		2	2								
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H7728	001	0	1	04	01	H7728_001_0	5	8	$0 - 30% OON Group	01	0000000000000000000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H7728	001	0	1	04	01	H7728_001_0	5	7	$45 OON Group	01	0000000100000000000000000000000000000		2		1	45.00	45.00	2		2	2								
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H7787	001	0	1	04	01	H7787_001_0	5	9	$0 Copay	10		000000000000000010000000	2		2			2		2	2								
H7787	001	0	1	04	01	H7787_001_0	5	8	50% Coinsurace	01	0000000000000001111100000000000000000		2		2			2		1	1	2		50	50		1	40.00	60.00
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H7787	001	0	1	04	01	H7787_001_0	5	6	$0-$60 Copay	01	0000000000000000000000000000000000100		2		1	0.00	60.00	2		2	2								
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H7787	001	0	1	04	01	H7787_001_0	5	4	$50 Copay	01	0000000000000000000000001000000000000		2		1	50.00	50.00	2		2	2								
H7787	001	0	1	04	01	H7787_001_0	5	3	$60 Copay	01	0000000111011010000000000000000000000		2		1	60.00	60.00	2		2	2								
H7787	001	0	1	04	01	H7787_001_0	5	2	$40 Copay	01	0000011000000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H7787	001	0	1	04	01	H7787_001_0	5	1	50% Coinsurance	11	0111100000100100000011110111100010000	000000100000000000100000	2		2			2		2	1			50	50				
H7787	001	0	1	04	01	H7787_001_0	5	10	30% Coinsurance	01	0000000000000000000000000000000001000		2		2			2		2	1			30	30				
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H7787	002	0	1	04	01	H7787_002_0	2	9	$0 Copay	10		000000000000000010000000	2		2			2		2	2								
H7787	002	0	1	04	01	H7787_002_0	2	3	$60 Copay	01	0000000111011010000000000000000000000		2		1	60.00	60.00	2		2	2								
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H7787	002	0	1	04	01	H7787_002_0	2	4	$50 Copay	01	0000000000000000000000001000000000000		2		1	50.00	50.00	2		2	2								
H7917	008	0	1	04	01	H7917_008_0	6	1	40% Cost Share Group	01	0111111111111111111111100110010011000		2		2			2		2	1			40	40				
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H7917	008	0	1	04	01	H7917_008_0	6	5	20% Cost Share	01	0000000000000000000000000001101000000		2		2			2		2	1			20	20				
H7917	008	0	1	04	01	H7917_008_0	6	6	$15 Copay	11	0000000000000000000000000000000000001	000000000000000000000010	2		1	15.00	15.00	2		2	2								
H7917	008	0	1	04	01	H7917_008_0	6	7	20% Cost Share w/ OV	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	20	20	40	2		
H7917	009	0	1	04	01	H7917_009_0	6	3	$0 Cost Share	11	0000000000000000000000010000000000010	000000100000000010000100	2		2			2		2	2								
H7917	009	0	1	04	01	H7917_009_0	6	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H7917	009	0	1	04	01	H7917_009_0	6	1	40% Cost Share Group	01	0111111111111111111111100110010011000		2		2			2		2	1			40	40				
H7917	009	0	1	04	01	H7917_009_0	6	4	$30 Cost Share	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	30.00	30.00	2		2	2								
H7917	009	0	1	04	01	H7917_009_0	6	7	20% Cost Share w/ OV	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	20	20	40	2		
H7917	009	0	1	04	01	H7917_009_0	6	6	$15 Copay	11	0000000000000000000000000000000000001	000000000000000000000010	2		1	15.00	15.00	2		2	2								
H7917	009	0	1	04	01	H7917_009_0	6	5	20% Cost Share	01	0000000000000000000000000001101000000		2		2			2		2	1			20	20				
H7917	010	0	1	04	01	H7917_010_0	6	1	40% Cost Share Group	01	0111111111111111111111100110010011000		2		2			2		2	1			40	40				
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H7917	010	0	1	04	01	H7917_010_0	6	5	20% Cost Share	01	0000000000000000000000000001101000000		2		2			2		2	1			20	20				
H7917	010	0	1	04	01	H7917_010_0	6	4	$30 Cost Share	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	30.00	30.00	2		2	2								
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H7917	011	0	1	04	01	H7917_011_0	6	2	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H7917	011	0	1	04	01	H7917_011_0	6	1	40% Cost Share Group	01	0111111111111111111111100110010011000		2		2			2		2	1			40	40				
H7917	011	0	1	04	01	H7917_011_0	6	4	$30 Cost Share	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	30.00	30.00	2		2	2								
H7917	011	0	1	04	01	H7917_011_0	6	7	20% Cost Share w/ OV	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	20	20	40	2		
H7917	011	0	1	04	01	H7917_011_0	6	6	$15 Copay	11	0000000000000000000000000000000000001	000000000000000000000010	2		1	15.00	15.00	2		2	2								
H7917	011	0	1	04	01	H7917_011_0	6	5	20% Cost Share	01	0000000000000000000000000001101000000		2		2			2		2	1			20	20				
H7917	012	0	1	04	01	H7917_012_0	6	3	$0 Cost Share	11	0000000000000000000000010000000000010	000000100000000010000100	2		2			2		2	2								
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H7917	012	0	1	04	01	H7917_012_0	6	4	$40 Cost Share	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	40.00	40.00	2		2	2								
H7917	012	0	1	04	01	H7917_012_0	6	5	20% Cost Share	01	0000000000000000000000000001101000000		2		2			2		2	1			20	20				
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H7917	012	0	1	04	01	H7917_012_0	6	7	20% Cost Share w/ OV	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	20	20	40	2		
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H7917	013	0	1	04	01	H7917_013_0	6	7	20% Cost Share w/ OV	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	20	20	40	2		
H7917	013	0	1	04	01	H7917_013_0	6	6	$15 Copay	11	0000000000000000000000000000000000001	000000000000000000000010	2		1	15.00	15.00	2		2	2								
H7917	013	0	1	04	01	H7917_013_0	6	5	20% Cost Share	01	0000000000000000000000000001101000000		2		2			2		2	1			20	20				
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H7917	014	0	1	04	01	H7917_014_0	6	7	20% Cost Share w/ OV	01	0000000000000000000000000000000100000		2		2			2		1	1	1	40	20	20	40	2		
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H7917	015	0	1	04	01	H7917_015_0	6	6	$15 Copay	11	0000000000000000000000000000000000001	000000000000000000000010	2		1	15.00	15.00	2		2	2								
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H7917	030	0	1	04	01	H7917_030_0	8	4	$40 Cost Share	11	0000000000000000000000000000000000100	000000000000000000001000	2		1	40.00	40.00	2		2	2								
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H7917	033	0	1	04	01	H7917_033_0	8	6	$15 Copay	11	0000000000000000000000000000000000001	000000000000000000000010	2		1	15.00	15.00	2		2	2								
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H8552	002	0	1	04	01	H8552_002_0	7	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
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H8552	002	0	1	04	01	H8552_002_0	7	9	19% Coinsurance Group	01	0000000000000000000000000000000010000		2		2			2		2	1			19	19				
H8552	002	0	1	04	01	H8552_002_0	7	1	30% OON Coinsurance Group	11	0111110010100110111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	003	0	1	04	01	H8552_003_0	8	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	003	0	1	04	01	H8552_003_0	8	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	003	0	1	04	01	H8552_003_0	8	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	003	0	1	04	01	H8552_003_0	8	5	25% OON Coinsurance Group	01	0000000000000000000011000111000000000		2		2			2		2	1			25	25				
H8552	003	0	1	04	01	H8552_003_0	8	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	003	0	1	04	01	H8552_003_0	8	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	003	0	1	04	01	H8552_003_0	8	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	003	0	1	04	01	H8552_003_0	8	10	20% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8552	003	0	1	04	01	H8552_003_0	8	1	30% OON Coinsurance Group	11	0111110010100110011100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	003	0	1	04	01	H8552_003_0	8	9	$15 Copayment Group	01	0000000000000000100000000000000000000		2		1	15.00	15.00	2		2	2								
H8552	006	0	1	04	01	H8552_006_0	6	5	25% OON Coinsurance Group	01	0000000000000000000000000111000000000		2		2			2		2	1			25	25				
H8552	006	0	1	04	01	H8552_006_0	6	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	006	0	1	04	01	H8552_006_0	6	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	006	0	1	04	01	H8552_006_0	6	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	006	0	1	04	01	H8552_006_0	6	9	20% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8552	006	0	1	04	01	H8552_006_0	6	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	006	0	1	04	01	H8552_006_0	6	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	006	0	1	04	01	H8552_006_0	6	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	006	0	1	04	01	H8552_006_0	6	1	30% OON Coinsurance Group	11	0111110010100110111111110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	007	0	1	04	01	H8552_007_0	6	5	25% OON Coinsurance Group	01	0000000000000000000011000111000000000		2		2			2		2	1			25	25				
H8552	007	0	1	04	01	H8552_007_0	6	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	007	0	1	04	01	H8552_007_0	6	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	007	0	1	04	01	H8552_007_0	6	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	007	0	1	04	01	H8552_007_0	6	1	30% OON Coinsurance Group	11	0111110010100110111100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	007	0	1	04	01	H8552_007_0	6	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	007	0	1	04	01	H8552_007_0	6	9	20% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8552	007	0	1	04	01	H8552_007_0	6	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	007	0	1	04	01	H8552_007_0	6	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	008	0	1	04	01	H8552_008_0	7	1	30% OON Coinsurance Group	11	0111110010100110011100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	008	0	1	04	01	H8552_008_0	7	10	25% Coinsurance Group	01	0000000000000000000011000000000000000		2		2			2		2	1			25	25				
H8552	008	0	1	04	01	H8552_008_0	7	11	$15 Copayment Group	01	0000000000000000100000000000000000000		2		1	15.00	15.00	2		2	2								
H8552	008	0	1	04	01	H8552_008_0	7	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	008	0	1	04	01	H8552_008_0	7	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	008	0	1	04	01	H8552_008_0	7	9	19% Coinsurance Group	01	0000000000000000000000000000000010000		2		2			2		2	1			19	19				
H8552	008	0	1	04	01	H8552_008_0	7	5	20% OON Coinsurance Group	01	0000000000000000000000000111100000000		2		2			2		2	1			20	20				
H8552	008	0	1	04	01	H8552_008_0	7	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	008	0	1	04	01	H8552_008_0	7	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	008	0	1	04	01	H8552_008_0	7	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	008	0	1	04	01	H8552_008_0	7	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	009	0	1	04	01	H8552_009_0	7	5	20% OON Coinsurance Group	01	0000000000000000000000000111100000000		2		2			2		2	1			20	20				
H8552	009	0	1	04	01	H8552_009_0	7	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	009	0	1	04	01	H8552_009_0	7	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	009	0	1	04	01	H8552_009_0	7	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	009	0	1	04	01	H8552_009_0	7	9	19% Coinsurance Group	01	0000000000000000000000000000000010000		2		2			2		2	1			19	19				
H8552	009	0	1	04	01	H8552_009_0	7	1	30% OON Coinsurance Group	11	0111110010100110011100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	009	0	1	04	01	H8552_009_0	7	10	25% Coinsurance Group	01	0000000000000000000011000000000000000		2		2			2		2	1			25	25				
H8552	009	0	1	04	01	H8552_009_0	7	11	$15 Copayment Group	01	0000000000000000100000000000000000000		2		1	15.00	15.00	2		2	2								
H8552	009	0	1	04	01	H8552_009_0	7	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	009	0	1	04	01	H8552_009_0	7	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	009	0	1	04	01	H8552_009_0	7	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	015	0	1	04	01	H8552_015_0	6	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	015	0	1	04	01	H8552_015_0	6	9	20% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8552	015	0	1	04	01	H8552_015_0	6	1	30% OON Coinsurance Group	11	0111110010100110111100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	015	0	1	04	01	H8552_015_0	6	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	015	0	1	04	01	H8552_015_0	6	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	015	0	1	04	01	H8552_015_0	6	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	015	0	1	04	01	H8552_015_0	6	5	25% OON Coinsurance Group	01	0000000000000000000011000111000000000		2		2			2		2	1			25	25				
H8552	015	0	1	04	01	H8552_015_0	6	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	015	0	1	04	01	H8552_015_0	6	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	017	0	1	04	01	H8552_017_0	6	2	$35 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	35.00	35.00	2		2	2								
H8552	017	0	1	04	01	H8552_017_0	6	1	30% OON Coinsurance Group	11	0111110010100110111100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	017	0	1	04	01	H8552_017_0	6	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	017	0	1	04	01	H8552_017_0	6	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	017	0	1	04	01	H8552_017_0	6	9	20% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8552	017	0	1	04	01	H8552_017_0	6	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	017	0	1	04	01	H8552_017_0	6	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	017	0	1	04	01	H8552_017_0	6	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	017	0	1	04	01	H8552_017_0	6	5	25% OON Coinsurance Group	01	0000000000000000000011000111000000000		2		2			2		2	1			25	25				
H8552	018	0	1	04	01	H8552_018_0	7	2	$30 OON Copayment Group	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H8552	018	0	1	04	01	H8552_018_0	7	1	30% OON Coinsurance Group	11	0111110010100110111100110000001100001	000000100000000000000000	2		2			2		2	1			30	30				
H8552	018	0	1	04	01	H8552_018_0	7	3	$40 Copayment Group	01	0000000100000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H8552	018	0	1	04	01	H8552_018_0	7	9	20% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8552	018	0	1	04	01	H8552_018_0	7	8	$55 OON Copayment Group	01	0000000001010000000000000000000000000		2		1	55.00	55.00	2		2	2								
H8552	018	0	1	04	01	H8552_018_0	7	7	$0 - 30% OON Group	01	0000000000000001000000000000010000000		2		1	0.00	0.00	2		2	1			30	30				
H8552	018	0	1	04	01	H8552_018_0	7	6	$0 Copayment	11	0000000000000000000000000000000001110	000000000000000010000000	2		1	0.00	0.00	2		2	2								
H8552	018	0	1	04	01	H8552_018_0	7	5	25% OON Coinsurance Group	01	0000000000000000000011000111000000000		2		2			2		2	1			25	25				
H8552	018	0	1	04	01	H8552_018_0	7	4	$200 Copayment Group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8552	801	0	1	04	01	H8552_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8552	801	0	1	04	01	H8552_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8552	802	0	1	04	01	H8552_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8552	802	0	1	04	01	H8552_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8552	803	0	1	04	01	H8552_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8552	803	0	1	04	01	H8552_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8604	001	0	1	04	01	H8604_001_0	9	2	Group 2	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H8604	001	0	1	04	01	H8604_001_0	9	3	Group 3	01	0000001000000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H8604	001	0	1	04	01	H8604_001_0	9	4	Group 4	11	0000000111111110000000100000000001001	000001000000000000001000	2		1	45.00	45.00	2		2	2								
H8604	001	0	1	04	01	H8604_001_0	9	1	Group 1	11	0111110000000000011111010000111010010	000000100000000010000000	2		2			2		2	1			20	20				
H8604	001	0	1	04	01	H8604_001_0	9	6	Group 6	10		000000000000000000000100	2		2			2		2	1			20	20				
H8604	001	0	1	04	01	H8604_001_0	9	7	Group 7	01	0000000000000001100000000000000100000		2		2			2		1	1	2		20	20		1	45.00	45.00
H8604	001	0	1	04	01	H8604_001_0	9	8	Group 8	01	0000000000000000000000000000000000100		2		1	20.00	45.00	2		1	2	2					1	20.00	45.00
H8604	001	0	1	04	01	H8604_001_0	9	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H8604	002	0	1	04	01	H8604_002_0	7	6	Group 6	10		000000000000000000000100	2		2			2		2	1			20	20				
H8604	002	0	1	04	01	H8604_002_0	7	7	Group 7	01	0000000000000001100000000000000100000		2		2			2		1	1	2		20	20		1	45.00	45.00
H8604	002	0	1	04	01	H8604_002_0	7	8	Group 8	01	0000000000000000000000000000000000100		2		1	20.00	45.00	2		1	2	2					1	20.00	45.00
H8604	002	0	1	04	01	H8604_002_0	7	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H8604	002	0	1	04	01	H8604_002_0	7	1	Group 1	11	0111110000000000011111010000111010010	000000100000000010000000	2		2			2		2	1			20	20				
H8604	002	0	1	04	01	H8604_002_0	7	2	Group 2	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H8604	002	0	1	04	01	H8604_002_0	7	3	Group 3	01	0000001000000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H8604	002	0	1	04	01	H8604_002_0	7	4	Group 4	11	0000000111111110000000100000000001001	000001000000000000001000	2		1	45.00	45.00	2		2	2								
H8604	003	0	1	04	01	H8604_003_0	8	2	Group 2	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H8604	003	0	1	04	01	H8604_003_0	8	3	Group 3	01	0000001000000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H8604	003	0	1	04	01	H8604_003_0	8	4	Group 4	11	0000000111111110000000100000000001001	000001000000000000001000	2		1	45.00	45.00	2		2	2								
H8604	003	0	1	04	01	H8604_003_0	8	8	Group 8	01	0000000000000000000000000000000000100		2		1	20.00	45.00	2		1	2	2					1	20.00	45.00
H8604	003	0	1	04	01	H8604_003_0	8	7	Group 7	01	0000000000000001100000000000000100000		2		2			2		1	1	2		20	20		1	45.00	45.00
H8604	003	0	1	04	01	H8604_003_0	8	6	Group 6	10		000000000000000000000100	2		2			2		2	1			20	20				
H8604	003	0	1	04	01	H8604_003_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H8604	003	0	1	04	01	H8604_003_0	8	1	Group 1	11	0111110000000000011111010000111010010	000000100000000010000000	2		2			2		2	1			20	20				
H8604	004	0	1	04	01	H8604_004_0	7	8	Group 8	01	0000000000000000000000000000000000100		2		1	20.00	45.00	2		1	2	2					1	20.00	45.00
H8604	004	0	1	04	01	H8604_004_0	7	7	Group 7	01	0000000000000001100000000000000100000		2		2			2		1	1	2		20	20		1	45.00	45.00
H8604	004	0	1	04	01	H8604_004_0	7	6	Group 6	10		000000000000000000000100	2		2			2		2	1			20	20				
H8604	004	0	1	04	01	H8604_004_0	7	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H8604	004	0	1	04	01	H8604_004_0	7	4	Group 4	11	0000000111111110000000100000000001001	000001000000000000001000	2		1	45.00	45.00	2		2	2								
H8604	004	0	1	04	01	H8604_004_0	7	3	Group 3	01	0000001000000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H8604	004	0	1	04	01	H8604_004_0	7	2	Group 2	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H8604	004	0	1	04	01	H8604_004_0	7	1	Group 1	11	0111110000000000011111010000111010010	000000100000000010000000	2		2			2		2	1			20	20				
H8604	005	0	1	04	01	H8604_005_0	10	2	Group 2	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H8604	005	0	1	04	01	H8604_005_0	10	3	Group 3	01	0000001000000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H8604	005	0	1	04	01	H8604_005_0	10	4	Group 4	11	0000000111111110000000100000000001001	000001000000000000001000	2		1	45.00	45.00	2		2	2								
H8604	005	0	1	04	01	H8604_005_0	10	1	Group 1	11	0111110000000000011111010000111010010	000000100000000010000000	2		2			2		2	1			20	20				
H8604	005	0	1	04	01	H8604_005_0	10	8	Group 8	01	0000000000000000000000000000000000100		2		1	20.00	45.00	2		1	2	2					1	20.00	45.00
H8604	005	0	1	04	01	H8604_005_0	10	7	Group 7	01	0000000000000001100000000000000100000		2		2			2		1	1	2		20	20		1	45.00	45.00
H8604	005	0	1	04	01	H8604_005_0	10	6	Group 6	10		000000000000000000000100	2		2			2		2	1			20	20				
H8604	005	0	1	04	01	H8604_005_0	10	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H8604	006	0	1	04	01	H8604_006_0	8	1	Group 1	11	0111110000000000011111010000111010010	000000100000000010000000	2		2			2		2	1			20	20				
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H8604	006	0	1	04	01	H8604_006_0	8	5	Group 5	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
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H8604	801	0	1	04	01	H8604_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
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H8634	001	0	1	04	01	H8634_001_0	13	2	$200 Copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8634	001	0	1	04	01	H8634_001_0	13	3	20% Coinsurance	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8634	001	0	1	04	01	H8634_001_0	13	4	0 Copay/ 0 Coinsurance	11	0000000000000000000000000000000100000	000000000000000110000000	2		2			2		2	2								
H8634	001	0	1	04	01	H8634_001_0	13	5	Vision Eye Exam	10		000000000000000000001000	1	40.00	2			2		2	2								
H8634	001	0	1	04	01	H8634_001_0	13	6	Vision Eyewear - Frames	10		000000000000000000000100	1	100.00	2			2		2	2								
H8634	001	0	1	04	01	H8634_001_0	13	7	Preventive Dental	10		000000000000000000100000	2		1	5.00	5.00	2		2	2								
H8634	001	0	1	04	01	H8634_001_0	13	8	Hearing Aids	10		000000000000000000000001	1	1000.00	2			2		2	2								
H8634	002	0	1	04	01	H8634_002_0	12	1	30% Coinsurance	11	0111111111111111111111110111011001111	000000000000000100000010	2		2			2		2	1			30	30				
H8634	002	0	1	04	01	H8634_002_0	12	8	Preventive Dental	10		000000000000000000100000	2		1	5.00	5.00	2		2	2								
H8634	002	0	1	04	01	H8634_002_0	12	2	$200 Copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H8634	002	0	1	04	01	H8634_002_0	12	3	20% Coinsurance	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
H8634	002	0	1	04	01	H8634_002_0	12	4	0 Copay/ 0 Coinsurance	11	0000000000000000000000000000000100000	000000000000000010000000	2		2			2		2	2								
H8634	002	0	1	04	01	H8634_002_0	12	5	Vision Eye Exam	10		000000000000000000001000	1	40.00	2			2		2	2								
H8634	002	0	1	04	01	H8634_002_0	12	6	Vision Eyewear - Frames	10		000000000000000000000100	1	100.00	2			2		2	2								
H8634	002	0	1	04	01	H8634_002_0	12	7	Hearing Aids	10		000000000000000000000001	1	1000.00	2			2		2	2								
H8634	801	0	1	04	01	H8634_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8634	801	0	1	04	01	H8634_801_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8634	802	0	1	04	01	H8634_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8634	802	0	1	04	01	H8634_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
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H8634	804	0	1	04	01	H8634_804_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8634	805	0	1	04	01	H8634_805_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8634	805	0	1	04	01	H8634_805_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8634	807	0	1	04	01	H8634_807_0	1	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H8634	807	0	1	04	01	H8634_807_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
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H8634	808	0	1	04	01	H8634_808_0	1	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
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H8707	003	0	1	04	01	H8707_003_0	6	9		10		000000000100000010000000	2		2			2		2	1			50	50				
H8707	003	0	1	04	01	H8707_003_0	6	8		01	0000000000000000000000000001000000000		2		2			2		2	1			40	40				
H8707	003	0	1	04	01	H8707_003_0	6	7		01	0000000000000000000000000110000000000		2		2			2		2	1			36	36				
H8707	003	0	1	04	01	H8707_003_0	6	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
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H8980	002	0	1	04	01	H8980_002_0	9	1	30% Coinsurance OON	11	0111001111011011111111010110111111111	000001100000000000001010	2		2			2		2	1			30	30				
H8980	002	0	1	04	01	H8980_002_0	9	2	40% Coinsurance OON	01	0000000000000000000000000001000000000		2		2			2		2	1			40	40				
H8980	002	0	1	04	01	H8980_002_0	9	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H8980	002	0	1	04	01	H8980_002_0	9	4	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	2								
H8980	002	0	1	04	01	H8980_002_0	9	5	Ambulance OON	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H8980	002	0	1	04	01	H8980_002_0	9	6	Gym OON - Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H8980	002	0	1	04	01	H8980_002_0	9	7	Cost Sharing 0%-30%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H8980	004	0	1	04	01	H8980_004_0	4	9	50% Dental Coinsurance	10		000000000000000000010000	2		2			1	100.00	2	1			50	50				
H8980	004	0	1	04	01	H8980_004_0	4	8	30% Dental Coinsurance (Non Medicare)	10		000000000000000000100000	2		2			1	100.00	2	1			30	30				
H8980	004	0	1	04	01	H8980_004_0	4	7	30% Coinsurance OON	01	0000000000000000000000000111100000000		2		2			2		2	1			30	30				
H8980	004	0	1	04	01	H8980_004_0	4	6	Hearing Aid OON	10		000000000000000000000001	2		2			2		2	1			50	50				
H8980	004	0	1	04	01	H8980_004_0	4	5	Gym OON - Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H8980	004	0	1	04	01	H8980_004_0	4	2	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H8980	004	0	1	04	01	H8980_004_0	4	3	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H8980	004	0	1	04	01	H8980_004_0	4	4	Ambulance OON	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
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H8980	004	0	1	04	01	H8980_004_0	4	10	Cost Sharing 0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H8980	004	0	1	04	01	H8980_004_0	4	1	20% Coinsurance OON	11	0111001111011011111111010000011111111	000001100000000000001010	2		2			2		2	1			20	20				
H8980	005	0	1	04	01	H8980_005_0	10	4	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	1			0	0				
H8980	005	0	1	04	01	H8980_005_0	10	5	Ambulance OON	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
H8980	005	0	1	04	01	H8980_005_0	10	6	Gym OON - Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
H8980	005	0	1	04	01	H8980_005_0	10	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H8980	005	0	1	04	01	H8980_005_0	10	8	50% Dental Coinsurance (Non Medicare)	10		000000000000000000010000	2		2			1	100.00	2	1			50	50				
H8980	005	0	1	04	01	H8980_005_0	10	10	30% Dental Coinsurance (Non Medicare)	10		000000000000000000100000	2		2			1	100.00	2	1			30	30				
H8980	005	0	1	04	01	H8980_005_0	10	1	20% Coinsurance OON	11	0111001111011011111111010000011111111	000001100000000000001010	2		2			2		2	1			20	20				
H8980	005	0	1	04	01	H8980_005_0	10	9	Cost Sharing 0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H8980	005	0	1	04	01	H8980_005_0	10	7	$0 Copay OON	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H8980	005	0	1	04	01	H8980_005_0	10	2	30% Coinsurance OON	01	0000000000000000000000000111100000000		2		2			2		2	1			30	30				
H8980	006	0	1	04	01	H8980_006_0	7	9	Preventative Services 0%-20%	01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
H8980	006	0	1	04	01	H8980_006_0	7	8	50% Dental Coinsurance (Non Medicare)	10		000000000000000000010000	2		2			1	100.00	2	1			50	50				
H8980	006	0	1	04	01	H8980_006_0	7	7	$0 Copay OON	10		000000000000000000000100	2		1	0.00	0.00	2		2	2								
H8980	006	0	1	04	01	H8980_006_0	7	6	Gym OON - Monthly Copay	10		000000000000000010000000	2		1	50.00	50.00	2		2	2								
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H8980	006	0	1	04	01	H8980_006_0	7	4	0% Coinsurance OON	01	0000010000000000000000000000000000000		2		2			2		2	2								
H8980	006	0	1	04	01	H8980_006_0	7	3	45% Coinsurance OON	01	0000100000100100000000100000000000000		2		2			2		2	1			45	45				
H8980	006	0	1	04	01	H8980_006_0	7	10	30% Dental Services (Non Medicare)	10		000000000000000000100000	2		2			1	100.00	2	1			30	30				
H8980	006	0	1	04	01	H8980_006_0	7	2	30% Coinsurance OON	01	0000000000000000000000000111100000000		2		2			2		2	1			30	30				
H8980	006	0	1	04	01	H8980_006_0	7	1	20% Coinsurance	11	0111001111011011111111010000011111111	000001100000000000001010	2		2			2		2	1			20	20				
H8980	801	0	1	04	01	H8980_801_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
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H8980	802	0	1	04	01	H8980_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H8980	802	0	1	04	01	H8980_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
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H9412	002	0	1	04	01	H9412_002_0	4	2	25% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			25	25				
H9412	002	0	1	04	01	H9412_002_0	4	1	$15 Copay Group	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	15.00	15.00	2		2	2								
H9412	002	0	1	04	01	H9412_002_0	4	3	$200 Copay group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H9412	002	0	1	04	01	H9412_002_0	4	4	$30 Copay Group	11	0000000001011000000000000001011101101	000001000000000010001010	2		1	30.00	30.00	2		2	2								
H9412	002	0	1	04	01	H9412_002_0	4	5	Hearing Aid Benefit	10		000000000000000000000001	1	1000.00	1	0.00	0.00	2		2	2								
H9412	002	0	1	04	01	H9412_002_0	4	6	30% Coinsurance Group	01	0000000000000000011000000000000000000		2		2			2		2	1			30	30				
H9412	002	0	1	04	01	H9412_002_0	4	7	20% Coinsurance Group	11	0111110110100111100111110111000000010	000000000000000010100000	2		2			2		2	1			20	20				
H9412	002	0	1	04	01	H9412_002_0	4	8	Routine Eyewear	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H9412	003	0	1	04	01	H9412_003_0	5	2	25% Coinsurance Group	01	0000000000000000000000000000100010000		2		2			2		2	1			25	25				
H9412	003	0	1	04	01	H9412_003_0	5	1	$15 Copay Group	11	0000001000000000000000000000000000000	000000000000000100000000	2		1	15.00	15.00	2		2	2								
H9412	003	0	1	04	01	H9412_003_0	5	3	$200 Copay group	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H9412	003	0	1	04	01	H9412_003_0	5	8	Routine Eyewear	10		000000000000000000000100	1	200.00	1	0.00	0.00	2		2	2								
H9412	003	0	1	04	01	H9412_003_0	5	7	20% Coinsurance Group	11	0111110110100111100111110111000000010	000000000000000010100000	2		2			2		2	1			20	20				
H9412	003	0	1	04	01	H9412_003_0	5	6	30% Coinsurance Group	01	0000000000000000011000000000000000000		2		2			2		2	1			30	30				
H9412	003	0	1	04	01	H9412_003_0	5	5	Hearing Aid Benefit	10		000000000000000000000001	1	1000.00	1	0.00	0.00	2		2	2								
H9412	003	0	1	04	01	H9412_003_0	5	4	$30 Copay Group	11	0000000001011000000000000001011101101	000001000000000010001010	2		1	30.00	30.00	2		2	2								
H9412	801	0	1	04	01	H9412_801_0	4	3	Partial Hospitalization	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
H9412	801	0	1	04	01	H9412_801_0	4	2	Medicare Covered Mental Health/Substance	01	0000000000100100000000100000000000000		2		1	40.00	40.00	2		2	2								
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H9412	802	0	1	04	01	H9412_802_0	4	2	Medicare Covered Mental Health/Substance	01	0000000000100100000000100000000000000		2		1	40.00	40.00	2		2	2								
H9412	802	0	1	04	01	H9412_802_0	4	1	OON Medicare Covered Services	01	0111011111011011111111111111111111111		2		2			2		2	1			20	20				
H9412	802	0	1	04	01	H9412_802_0	4	3	Partial Hospitalization	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
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H9503	001	0	1	04	01	H9503_001_0	5	6		11	0111111111111111111101100111001111101	000000000000000100000000	2		2			2		2	1			30	30				
H9503	001	0	1	04	01	H9503_001_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H9503	001	0	1	04	01	H9503_001_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H9503	001	0	1	04	01	H9503_001_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
H9503	001	0	1	04	01	H9503_001_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
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H9503	003	0	1	04	01	H9503_003_0	4	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H9503	003	0	1	04	01	H9503_003_0	4	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	30				
H9503	003	0	1	04	01	H9503_003_0	4	6		11	0111111111111111111101100111001111101	000000000000000100000000	2		2			2		2	1			30	30				
H9503	003	0	1	04	01	H9503_003_0	4	7		10		000000000110000010000000	2		2			2		2	1			50	50				
H9503	003	0	1	04	01	H9503_003_0	4	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
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H9503	008	0	1	04	01	H9503_008_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H9503	008	0	1	04	01	H9503_008_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	40				
H9503	008	0	1	04	01	H9503_008_0	5	6		01	0000000000000000000000000100000000000		2		2			2		2	1			30	30				
H9503	008	0	1	04	01	H9503_008_0	5	7		11	0111111111111111111101100011001111101	000000000000000100000000	2		2			2		2	1			40	40				
H9503	008	0	1	04	01	H9503_008_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H9503	008	0	1	04	01	H9503_008_0	5	8		10		000000000110000010000000	2		2			2		2	1			50	50				
H9503	009	0	1	04	01	H9503_009_0	5	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
H9503	009	0	1	04	01	H9503_009_0	5	8		10		000000000110000010000000	2		2			2		2	1			50	50				
H9503	009	0	1	04	01	H9503_009_0	5	7		11	0111111111111111111101100011001111101	000000000000000100000000	2		2			2		2	1			40	40				
H9503	009	0	1	04	01	H9503_009_0	5	6		01	0000000000000000000000000100000000000		2		2			2		2	1			30	30				
H9503	009	0	1	04	01	H9503_009_0	5	5		01	0000000000000000000010000000000000000		2		2			2		2	1			20	40				
H9503	009	0	1	04	01	H9503_009_0	5	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H9503	009	0	1	04	01	H9503_009_0	5	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
H9503	009	0	1	04	01	H9503_009_0	5	4		01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H9572	001	1	1	04	01	H9572_001_1	12	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	001	1	1	04	01	H9572_001_1	12	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	001	1	1	04	01	H9572_001_1	12	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	001	1	1	04	01	H9572_001_1	12	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	001	1	1	04	01	H9572_001_1	12	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	001	1	1	04	01	H9572_001_1	12	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	001	1	1	04	01	H9572_001_1	12	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	001	1	1	04	01	H9572_001_1	12	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	001	2	1	04	01	H9572_001_2	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	001	2	1	04	01	H9572_001_2	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	001	2	1	04	01	H9572_001_2	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	001	2	1	04	01	H9572_001_2	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	001	2	1	04	01	H9572_001_2	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	001	2	1	04	01	H9572_001_2	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	001	2	1	04	01	H9572_001_2	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	001	2	1	04	01	H9572_001_2	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	001	3	1	04	01	H9572_001_3	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	001	3	1	04	01	H9572_001_3	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	001	3	1	04	01	H9572_001_3	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	001	3	1	04	01	H9572_001_3	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	001	3	1	04	01	H9572_001_3	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	001	3	1	04	01	H9572_001_3	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	001	3	1	04	01	H9572_001_3	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	001	3	1	04	01	H9572_001_3	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	001	4	1	04	01	H9572_001_4	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	001	4	1	04	01	H9572_001_4	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	001	4	1	04	01	H9572_001_4	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	001	4	1	04	01	H9572_001_4	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	001	4	1	04	01	H9572_001_4	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	001	4	1	04	01	H9572_001_4	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	001	4	1	04	01	H9572_001_4	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	001	4	1	04	01	H9572_001_4	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	001	6	1	04	01	H9572_001_6	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	001	6	1	04	01	H9572_001_6	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	001	6	1	04	01	H9572_001_6	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	001	6	1	04	01	H9572_001_6	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	001	6	1	04	01	H9572_001_6	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	001	6	1	04	01	H9572_001_6	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	001	6	1	04	01	H9572_001_6	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	001	6	1	04	01	H9572_001_6	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	002	1	1	04	01	H9572_002_1	11	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	002	1	1	04	01	H9572_002_1	11	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	002	1	1	04	01	H9572_002_1	11	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	002	1	1	04	01	H9572_002_1	11	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	002	1	1	04	01	H9572_002_1	11	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	002	1	1	04	01	H9572_002_1	11	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	002	1	1	04	01	H9572_002_1	11	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	002	1	1	04	01	H9572_002_1	11	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	002	2	1	04	01	H9572_002_2	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	002	2	1	04	01	H9572_002_2	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	002	2	1	04	01	H9572_002_2	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	002	2	1	04	01	H9572_002_2	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	002	2	1	04	01	H9572_002_2	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	002	2	1	04	01	H9572_002_2	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	002	2	1	04	01	H9572_002_2	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	002	2	1	04	01	H9572_002_2	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	002	3	1	04	01	H9572_002_3	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	002	3	1	04	01	H9572_002_3	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	002	3	1	04	01	H9572_002_3	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	002	3	1	04	01	H9572_002_3	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	002	3	1	04	01	H9572_002_3	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	002	3	1	04	01	H9572_002_3	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	002	3	1	04	01	H9572_002_3	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	002	3	1	04	01	H9572_002_3	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	002	4	1	04	01	H9572_002_4	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	002	4	1	04	01	H9572_002_4	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	002	4	1	04	01	H9572_002_4	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	002	4	1	04	01	H9572_002_4	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	002	4	1	04	01	H9572_002_4	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	002	4	1	04	01	H9572_002_4	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	002	4	1	04	01	H9572_002_4	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	002	4	1	04	01	H9572_002_4	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	002	6	1	04	01	H9572_002_6	10	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	002	6	1	04	01	H9572_002_6	10	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	002	6	1	04	01	H9572_002_6	10	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	002	6	1	04	01	H9572_002_6	10	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	002	6	1	04	01	H9572_002_6	10	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	002	6	1	04	01	H9572_002_6	10	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	002	6	1	04	01	H9572_002_6	10	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	002	6	1	04	01	H9572_002_6	10	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	003	1	1	04	01	H9572_003_1	11	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	003	1	1	04	01	H9572_003_1	11	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			30	30				
H9572	003	1	1	04	01	H9572_003_1	11	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	003	1	1	04	01	H9572_003_1	11	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	003	1	1	04	01	H9572_003_1	11	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H9572	003	1	1	04	01	H9572_003_1	11	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H9572	003	1	1	04	01	H9572_003_1	11	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	003	1	1	04	01	H9572_003_1	11	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	003	2	1	04	01	H9572_003_2	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			30	30				
H9572	003	2	1	04	01	H9572_003_2	9	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	003	2	1	04	01	H9572_003_2	9	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	003	2	1	04	01	H9572_003_2	9	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H9572	003	2	1	04	01	H9572_003_2	9	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	003	2	1	04	01	H9572_003_2	9	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	003	2	1	04	01	H9572_003_2	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H9572	003	2	1	04	01	H9572_003_2	9	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	003	3	1	04	01	H9572_003_3	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			30	30				
H9572	003	3	1	04	01	H9572_003_3	9	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	003	3	1	04	01	H9572_003_3	9	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	003	3	1	04	01	H9572_003_3	9	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H9572	003	3	1	04	01	H9572_003_3	9	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	003	3	1	04	01	H9572_003_3	9	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	003	3	1	04	01	H9572_003_3	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H9572	003	3	1	04	01	H9572_003_3	9	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	003	4	1	04	01	H9572_003_4	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			30	30				
H9572	003	4	1	04	01	H9572_003_4	9	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	003	4	1	04	01	H9572_003_4	9	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	003	4	1	04	01	H9572_003_4	9	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	003	4	1	04	01	H9572_003_4	9	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H9572	003	4	1	04	01	H9572_003_4	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H9572	003	4	1	04	01	H9572_003_4	9	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	003	4	1	04	01	H9572_003_4	9	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	003	6	1	04	01	H9572_003_6	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			30	30				
H9572	003	6	1	04	01	H9572_003_6	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			30	30				
H9572	003	6	1	04	01	H9572_003_6	9	3	Hearing	11	0000000000000000000000000000000000001	000000000000000000000011	2		2			2		2	1			50	50				
H9572	003	6	1	04	01	H9572_003_6	9	4	Preventive Dental	10		000000000000000000100000	2		2			2		2	1			50	50				
H9572	003	6	1	04	01	H9572_003_6	9	5	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H9572	003	6	1	04	01	H9572_003_6	9	6	Supplemental Vision	10		000000000000000000001100	2		1	0.00	10.00	2		2	2								
H9572	003	6	1	04	01	H9572_003_6	9	7	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	003	6	1	04	01	H9572_003_6	9	8	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	004	1	1	04	01	H9572_004_1	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	004	1	1	04	01	H9572_004_1	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	004	1	1	04	01	H9572_004_1	9	3	Hearing	01	0000000000000000000000000000000000001		2		2			2		2	1			50	50				
H9572	004	1	1	04	01	H9572_004_1	9	4	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	004	1	1	04	01	H9572_004_1	9	5	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	004	1	1	04	01	H9572_004_1	9	6	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	004	2	1	04	01	H9572_004_2	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	004	2	1	04	01	H9572_004_2	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	004	2	1	04	01	H9572_004_2	9	3	Hearing	01	0000000000000000000000000000000000001		2		2			2		2	1			50	50				
H9572	004	2	1	04	01	H9572_004_2	9	6	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	004	2	1	04	01	H9572_004_2	9	5	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	004	2	1	04	01	H9572_004_2	9	4	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	004	3	1	04	01	H9572_004_3	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	004	3	1	04	01	H9572_004_3	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	004	3	1	04	01	H9572_004_3	9	5	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	004	3	1	04	01	H9572_004_3	9	4	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	004	3	1	04	01	H9572_004_3	9	3	Hearing	01	0000000000000000000000000000000000001		2		2			2		2	1			50	50				
H9572	004	3	1	04	01	H9572_004_3	9	6	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	004	4	1	04	01	H9572_004_4	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	004	4	1	04	01	H9572_004_4	9	6	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	004	4	1	04	01	H9572_004_4	9	5	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	004	4	1	04	01	H9572_004_4	9	4	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	004	4	1	04	01	H9572_004_4	9	3	Hearing	01	0000000000000000000000000000000000001		2		2			2		2	1			50	50				
H9572	004	4	1	04	01	H9572_004_4	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	004	6	1	04	01	H9572_004_6	9	1	Global coinsurance group	11	0111111111111111111111101000111001110	000000000000100110000000	2		2			2		2	1			40	40				
H9572	004	6	1	04	01	H9572_004_6	9	2	DME & Prosthetics	01	0000000000000000000000000110000000000		2		2			2		2	1			40	40				
H9572	004	6	1	04	01	H9572_004_6	9	3	Hearing	01	0000000000000000000000000000000000001		2		2			2		2	1			50	50				
H9572	004	6	1	04	01	H9572_004_6	9	4	Medicare Part B drugs	01	0000000000000000000000000000000010000		2		2			2		2	1			40	40				
H9572	004	6	1	04	01	H9572_004_6	9	5	Zero coinsurance/copay group	11	0000000000000000000000010001000100000	000000100000000000000000	2		2			2		2	2								
H9572	004	6	1	04	01	H9572_004_6	9	6	Bathroom Safety Bars	10		000000000100000000000000	1	100.00	2			2		2	2								
H9572	801	0	1	04	01	H9572_801_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9572	801	0	1	04	01	H9572_801_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9572	802	0	1	04	01	H9572_802_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9572	802	0	1	04	01	H9572_802_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9572	803	0	1	04	01	H9572_803_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9572	803	0	1	04	01	H9572_803_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9572	804	0	1	04	01	H9572_804_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9572	804	0	1	04	01	H9572_804_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9615	002	0	1	04	01	H9615_002_0	7	8	$600 Hearing Aid	10		000000000000000000000001	1	600.00	1	0.00	0.00	2		2	2								
H9615	002	0	1	04	01	H9615_002_0	7	9	$100 Eyewear	10		000000000000000000000100	1	100.00	1	0.00	0.00	2		2	2								
H9615	002	0	1	04	01	H9615_002_0	7	6	50% Coinsurance	10		000000001000000000000000	2		2			2		2	1			50	50				
H9615	002	0	1	04	01	H9615_002_0	7	5	$75 Copay	01	0000000000000000000000001000000000000		2		1	75.00	75.00	2		2	2								
H9615	002	0	1	04	01	H9615_002_0	7	4	$0 Copayment	11	0000000000000000000000010000111100000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H9615	002	0	1	04	01	H9615_002_0	7	7	$300 Dental	10		000000000000000000100000	1	300.00	1	0.00	0.00	2		2	2								
H9615	002	0	1	04	01	H9615_002_0	7	1	25% Coinsurance	11	0000010000000001111011000111000010010	000000000000000001000000	2		2			2		2	1			25	25				
H9615	002	0	1	04	01	H9615_002_0	7	3	$20 Copay	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H9615	002	0	1	04	01	H9615_002_0	7	2	$35 Copay	11	0111101011111110000100100000000001101	000000000000000000001010	2		1	35.00	35.00	2		2	2								
H9615	007	0	1	04	01	H9615_007_0	5	1	40% Coinsurance	11	0000010000000001111011000111000010010	000000000000000001000000	2		2			2		2	1			40	40				
H9615	007	0	1	04	01	H9615_007_0	5	2	$60 Copay	11	0111101011111110000100100000000001101	000000000000000000001010	2		1	60.00	60.00	2		2	2								
H9615	007	0	1	04	01	H9615_007_0	5	4	$0 Copayment	11	0000000000000000000000010000111100000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H9615	007	0	1	04	01	H9615_007_0	5	5	$125 Copay	01	0000000000000000000000001000000000000		2		1	125.00	125.00	2		2	2								
H9615	007	0	1	04	01	H9615_007_0	5	6	50% Coinsurance	10		000000001000000000000000	2		2			2		2	1			50	50				
H9615	007	0	1	04	01	H9615_007_0	5	3	$20 Copay	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H9615	008	0	1	04	01	H9615_008_0	6	4	$0 Copayment	11	0000000000000000000000010000111100000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H9615	008	0	1	04	01	H9615_008_0	6	5	$200 Copay	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H9615	008	0	1	04	01	H9615_008_0	6	1	40% Coinsurance	11	0000010000000001111011000111000010010	000000000000000001000000	2		2			2		2	1			40	40				
H9615	008	0	1	04	01	H9615_008_0	6	2	$60 Copay	11	0111101011111110000100100000000001101	000000000000000000001010	2		1	60.00	60.00	2		2	2								
H9615	008	0	1	04	01	H9615_008_0	6	3	$20 Copay	01	0000000100000000000000000000000000000		2		1	20.00	20.00	2		2	2								
H9615	802	0	1	04	01	H9615_802_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9615	802	0	1	04	01	H9615_802_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9615	807	0	1	04	01	H9615_807_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9615	807	0	1	04	01	H9615_807_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9670	004	0	1	04	01	H9670_004_0	9	4	$60 OON Copay	11	0000000001111100000000100000000001101	000001000000000000000000	2		1	60.00	60.00	2		2	2								
H9670	004	0	1	04	01	H9670_004_0	9	3	$40 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	40.00	40.00	2		2	2								
H9670	004	0	1	04	01	H9670_004_0	9	2	30% Coins - PCP/Spec Copay could apply	01	0000000000000001111100000000000000000		2		2			2		1	1	2		30	30		1	40.00	60.00
H9670	004	0	1	04	01	H9670_004_0	9	6	50% with $250 annual max	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H9670	004	0	1	04	01	H9670_004_0	9	7	50% OON	01	0000000000000000000000000111000010000		2		2			2		2	1			50	50				
H9670	004	0	1	04	01	H9670_004_0	9	5	OON Routine Vision	10		000000000000000000001100	2		1	0.00	0.00	2		2	2								
H9670	004	0	1	04	01	H9670_004_0	9	1	30% Coinsurance	11	0111110010000010000011011000111000010	000000100000000100000000	2		2			2		2	1			30	30				
H9670	004	0	1	04	01	H9670_004_0	9	8	50% Coins - PCP/Spec Copay could apply	01	0000000000000000000000000000000100000		2		2			2		1	1	2		50	50		1	40.00	60.00
H9670	801	0	1	04	01	H9670_801_0	10	1	20% coinsurance	11	0111110000000000000011011111101010010	000000100000000000010000	2		2			2		2	1			20	20				
H9670	801	0	1	04	01	H9670_801_0	10	2	20% Coins wPCP/Spec Copay	01	0000000000000001111100000000000100000		2		2			2		1	1	2		20	20		1	20.00	30.00
H9670	801	0	1	04	01	H9670_801_0	10	3	50% with $250 Annual Allowance	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H9670	801	0	1	04	01	H9670_801_0	10	4	50% coinsurance	10		000000000000000000000001	2		2			2		2	1			50	50				
H9670	801	0	1	04	01	H9670_801_0	10	6	$20 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	20.00	20.00	2		2	2								
H9670	801	0	1	04	01	H9670_801_0	10	7	$30 OON Copay	11	0000000011111110000000100000000001101	000001000000000000101010	2		1	30.00	30.00	2		2	2								
H9670	801	0	1	04	01	H9670_801_0	10	5	$0 OON Copay	11	0000000000000000000000000000010000000	000000000000000100001100	2		1	0.00	0.00	2		2	2								
H9670	802	0	1	04	01	H9670_802_0	9	1	20% coinsurance	11	0111110000000000000011011111101010010	000000100000000000010000	2		2			2		2	1			20	20				
H9670	802	0	1	04	01	H9670_802_0	9	2	20% Coins wPCP/Spec Copay	01	0000000000000001111100000000000100000		2		2			2		1	1	2		20	20		1	20.00	30.00
H9670	802	0	1	04	01	H9670_802_0	9	7	$30 OON Copay	11	0000000011111110000000100000000001101	000001000000000000101010	2		1	30.00	30.00	2		2	2								
H9670	802	0	1	04	01	H9670_802_0	9	6	$20 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	20.00	20.00	2		2	2								
H9670	802	0	1	04	01	H9670_802_0	9	5	$0 OON Copay	11	0000000000000000000000000000010000000	000000000000000100001100	2		1	0.00	0.00	2		2	2								
H9670	802	0	1	04	01	H9670_802_0	9	4	50% coinsurance	10		000000000000000000000001	2		2			2		2	1			50	50				
H9670	802	0	1	04	01	H9670_802_0	9	3	50% with $250 Annual Allowance	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H9670	803	0	1	04	01	H9670_803_0	9	3	50% with $250 Annual Allowance	10		000000000000000010000000	1	250.00	2			2		2	1			50	50				
H9670	803	0	1	04	01	H9670_803_0	9	2	20% Coins wPCP/Spec Copay	01	0000000000000001111100000000000100000		2		2			2		1	1	2		20	20		1	20.00	30.00
H9670	803	0	1	04	01	H9670_803_0	9	1	20% coinsurance	11	0111110000000000000011011111101010010	000000100000000000010000	2		2			2		2	1			20	20				
H9670	803	0	1	04	01	H9670_803_0	9	7	$30 OON Copay	11	0000000011111110000000100000000001101	000001000000000000101010	2		1	30.00	30.00	2		2	2								
H9670	803	0	1	04	01	H9670_803_0	9	6	$20 OON Copay	11	0000001100000000000000000000000000000	000010000000000000000000	2		1	20.00	20.00	2		2	2								
H9670	803	0	1	04	01	H9670_803_0	9	4	50% coinsurance	10		000000000000000000000001	2		2			2		2	1			50	50				
H9670	803	0	1	04	01	H9670_803_0	9	5	$0 OON Copay	11	0000000000000000000000000000010000000	000000000000000100001100	2		1	0.00	0.00	2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	2	$45 COPAY	01	0000000000000000000000000000000001001		2		1	45.00	45.00	2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	12	$75.00 ALLOWANCE	10		000000000000000000000100	2		2			2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	4	FITNESS	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	5	30%	01	0000000000000000001000000110000000000		2		2			2		2	1			30	30				
H9847	001	0	1	04	01	H9847_001_0	9	6	$200	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	7	25%	01	0000000000000001110100000000000000000		2		2			2		1	1	2		25	25		1	30.00	45.00
H9847	001	0	1	04	01	H9847_001_0	9	8	20%	11	0111110100000000000011110000100010010	000000100000000000000000	2		2			2		2	1			20	20				
H9847	001	0	1	04	01	H9847_001_0	9	9	ALLOWANCE $85.00	10		000000000000000000100000	2		2			2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	3	$55.00	01	0000000011111110000000000000000000100		2		1	55.00	55.00	2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	11	$0-20%	01	0000000000000000000000000001000000000		2		2			2		2	1			0	20				
H9847	001	0	1	04	01	H9847_001_0	9	10	Zero copay	11	0000000000000000000000000000011100000	000000000001000000001000	2		2			2		2	2								
H9847	001	0	1	04	01	H9847_001_0	9	1	$35 COPAY	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
H9847	005	0	1	04	01	H9847_005_0	10	3	FITNESS	10		000000000000000010000000	2		1	0.00	50.00	2		2	2								
H9847	005	0	1	04	01	H9847_005_0	10	1	COINSURANCE GROUP 20%	11	0000110000000000011011111000100010010	000000100000000000000000	2		2			2		2	1			20	20				
H9847	005	0	1	04	01	H9847_005_0	10	5	COPAY $49	01	0111000111111110000000000000000001101		2		1	49.00	49.00	2		2	2								
H9847	005	0	1	04	01	H9847_005_0	10	6	$40.00 COPAY	01	0000001000000000000000000000000000000		2		1	40.00	40.00	2		2	2								
H9847	005	0	1	04	01	H9847_005_0	10	7	$90.00 ALLOWANCE	10		000000000000000000000100	2		2			2		2	2								
H9847	005	0	1	04	01	H9847_005_0	10	8	100.00 ALLOWANCE	10		000000000000000000100000	2		2			2		2	2								
H9847	005	0	1	04	01	H9847_005_0	10	9	20% xray	01	0000000000000001000100000000000000000		2		2			2		1	1	2		20	20		1	30.00	49.00
H9847	005	0	1	04	01	H9847_005_0	10	4	25%	01	0000000000000000000000000110000000000		2		2			2		2	1			25	25				
H9847	005	0	1	04	01	H9847_005_0	10	10	25% lab	01	0000000000000000100000000000000000000		2		2			2		1	1	2		25	25		1	30.00	49.00
H9847	005	0	1	04	01	H9847_005_0	10	11	0%-20%	01	0000000000000000000000000001000000000		2		2			2		2	1			0	20				
H9847	005	0	1	04	01	H9847_005_0	10	2	ZERO COSTSHARE	11	0000000000000000000000000000011100000	000000000001000000001000	2		1	0.00	0.00	2		2	2								
H9847	801	0	1	04	01	H9847_801_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9847	801	0	1	04	01	H9847_801_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9847	802	0	1	04	01	H9847_802_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9847	802	0	1	04	01	H9847_802_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9847	803	0	1	04	01	H9847_803_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9847	803	0	1	04	01	H9847_803_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9847	804	0	1	04	01	H9847_804_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9847	804	0	1	04	01	H9847_804_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9847	805	0	1	04	01	H9847_805_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9847	805	0	1	04	01	H9847_805_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9847	806	0	1	04	01	H9847_806_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9847	806	0	1	04	01	H9847_806_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9947	001	0	1	04	01	H9947_001_0	7	1	$0	11	0000010000000000000000010000001101010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	10	Amubulance	01	0000000000000000000000001000000000000		2		1	175.00	175.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	9	Labs	01	0000000000000000100000000000000000000		2		1	40.00	40.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	8	Radiology	01	0000000000000001010100000000000000000		2		1	200.00	300.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	7	Mental Health	01	0000100000100100000000100000000000000		2		1	80.00	80.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	6	DME	01	0000000000000000000000000111000000000		2		2			2		2	1			30	30				
H9947	001	0	1	04	01	H9947_001_0	7	5	Specialist	01	0111000111010010000000000000000000001		2		1	45.00	45.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	3	Outpatient	01	0000000000000000000010000000000000000		2		1	30.00	45.00	2		2	1			25	25				
H9947	001	0	1	04	01	H9947_001_0	7	11	Part B Rx	01	0000000000000000000000000000000010000		2		2			2		2	1			30	30				
H9947	001	0	1	04	01	H9947_001_0	7	12	Preventive	01	0000000000000000000000000000010000000		2		1	0.00	45.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	13	Therapeutic Rad Services / ASC	01	0000000000000000001001000000000000000		2		2			2		2	1			25	25				
H9947	001	0	1	04	01	H9947_001_0	7	14	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	45.00	2		2	2								
H9947	001	0	1	04	01	H9947_001_0	7	2	20%	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
H9947	801	0	1	04	01	H9947_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9947	801	0	1	04	01	H9947_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9947	802	0	1	04	01	H9947_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9947	802	0	1	04	01	H9947_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9947	803	0	1	04	01	H9947_803_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
H9947	803	0	1	04	01	H9947_803_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9947	805	0	2	04	01	H9947_805_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
H9947	805	0	2	04	01	H9947_805_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R3175	003	0	1	31	11	R3175_003_0	8	2	Group 2	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
R3175	003	0	1	31	11	R3175_003_0	8	4	Group 4	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
R3175	003	0	1	31	11	R3175_003_0	8	3	Group 3	11	0000000000000000000000000000000000010	000000000100000010110000	2		1	0.00	0.00	2		2	2								
R3175	003	0	1	31	11	R3175_003_0	8	1	Group 1	11	0111111111111110000001111111001101101	000001100000000000000000	2		2			2		2	1			30	30				
R3175	003	0	1	31	11	R3175_003_0	8	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
R3175	801	0	1	31	11	R3175_801_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R3175	801	0	1	31	11	R3175_801_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R3175	802	0	1	31	11	R3175_802_0	2	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R3175	802	0	1	31	11	R3175_802_0	2	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R3332	001	0	1	31	11	R3332_001_0	8	4	Dialysis	01	0000000000000000000000000000100000000		2		2			2		2	1			20	50				
R3332	001	0	1	31	11	R3332_001_0	8	3	Ambulance	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R3332	001	0	1	31	11	R3332_001_0	8	2	Mental Health	01	0000100000100100000000100000000000000		2		1	40.00	40.00	2		2	2								
R3332	001	0	1	31	11	R3332_001_0	8	1	50% coinsurance	01	0111011111011011111111010111011111111		2		2			2		2	1			50	50				
R3444	008	0	1	31	11	R3444_008_0	5	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
R3444	008	0	1	31	11	R3444_008_0	5	2	Group 2	11	0000010000000000000000000000011100000	000001010100000010101110	2		1	0.00	0.00	2		2	2								
R3444	008	0	1	31	11	R3444_008_0	5	3	Group 3	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R3444	008	0	1	31	11	R3444_008_0	5	4	Group 4	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
R3444	008	0	1	31	11	R3444_008_0	5	5		01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
R3444	009	0	1	31	11	R3444_009_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	25.00	50.00
R3444	009	0	1	31	11	R3444_009_0	5	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
R3444	009	0	1	31	11	R3444_009_0	5	7	Group 7	11	0000001000001000000000000000000000000	000000000000000000001010	2		1	25.00	25.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
R3444	009	0	1	31	11	R3444_009_0	5	4	Group 4	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	2	Group 2	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
R3444	009	0	1	31	11	R3444_009_0	5	3	Group 3	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	12	Group 12	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
R3444	009	0	1	31	11	R3444_009_0	5	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
R3444	009	0	1	31	11	R3444_009_0	5	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
R3444	011	0	1	31	11	R3444_011_0	5	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
R3444	011	0	1	31	11	R3444_011_0	5	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
R3444	011	0	1	31	11	R3444_011_0	5	2	Group 2	11	0000010000000000000000000000011100000	000001010000000010101110	2		1	0.00	0.00	2		2	2								
R3444	011	0	1	31	11	R3444_011_0	5	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
R3444	011	0	1	31	11	R3444_011_0	5	4	Group 4	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	8	Group 8	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
R3444	012	0	1	31	11	R3444_012_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	30.00	50.00
R3444	012	0	1	31	11	R3444_012_0	5	2	Group 2	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
R3444	012	0	1	31	11	R3444_012_0	5	14	Group 14	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	30.00	30.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	12	Group 12	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	11	Group 11	11	0000000000000000000000010001011100110	000000100000000110000100	2		1	0.00	0.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	10	Group 10	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
R3444	012	0	1	31	11	R3444_012_0	5	7	Group 7	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	5	Group 5	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
R3444	012	0	1	31	11	R3444_012_0	5	1	Group 1	11	0111000011011010000000000000000001101	000001000000000000000000	2		1	50.00	50.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	3	Group 3	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
R3444	012	0	1	31	11	R3444_012_0	5	4	Group 4	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	7	Group 7	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	6	Group 6	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	9	Group 9	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	8	Group 8	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
R5287	001	0	1	31	11	R5287_001_0	5	5	Group 5	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	4	Group 4	01	0000000000000000000010000000000000000		2		1	14.00	21.00	2		2	1			40	40				
R5287	001	0	1	31	11	R5287_001_0	5	3	Group 3	01	0000000000000001111100000000000000000		2		1	14.00	21.00	2		1	1	2		40	40		1	40.00	70.00
R5287	001	0	1	31	11	R5287_001_0	5	2	Group 2	11	0000000000000000000001000011001100010	000000000000000100000000	2		2			2		2	1			40	40				
R5287	001	0	1	31	11	R5287_001_0	5	14	Group 14	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	13	Group 13	01	0000000000001000000000000000000000000		2		1	40.00	70.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	12	Group 12	01	0000001000000000000000000000000000000		2		1	40.00	40.00	2		2	2								
R5287	001	0	1	31	11	R5287_001_0	5	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
R5287	001	0	1	31	11	R5287_001_0	5	10	Group 10	01	0000010000000000000000000100000010000		2		2			2		2	1			50	50				
R5287	001	0	1	31	11	R5287_001_0	5	1	Group 1	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	70.00	70.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	7	Group 7	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	1	Group 1	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	70.00	70.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	9	Group 9	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	8	Group 8	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
R5287	002	0	1	31	11	R5287_002_0	4	10	Group 10	01	0000010000000000000000000100000010000		2		2			2		2	1			50	50				
R5287	002	0	1	31	11	R5287_002_0	4	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
R5287	002	0	1	31	11	R5287_002_0	4	12	Group 12	01	0000001000000000000000000000000000000		2		1	40.00	40.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	13	Group 13	01	0000000000001000000000000000000000000		2		1	40.00	70.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	2	Group 2	11	0000000000000000000001000011001100010	000000000000000100000000	2		2			2		2	1			40	40				
R5287	002	0	1	31	11	R5287_002_0	4	6	Group 6	01	0000000000000000000000001000000000000		2		1	300.00	300.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	5	Group 5	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
R5287	002	0	1	31	11	R5287_002_0	4	4	Group 4	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			40	40				
R5287	002	0	1	31	11	R5287_002_0	4	3	Group 3	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		40	40		1	40.00	70.00
R5287	003	0	1	31	11	R5287_003_0	8	7	Group 7	01	0000000000000001111100000000000000000		2		2			2		1	1	1	30	0	30	30	2		
R5287	003	0	1	31	11	R5287_003_0	8	6	Group 6	10		000000010000000000000000	2		2			2		2	1			75	75				
R5287	003	0	1	31	11	R5287_003_0	8	5	Group 5	10		000000000000000000100000	2		1	40.00	40.00	2		2	2								
R5287	003	0	1	31	11	R5287_003_0	8	4	Group 4	11	0000000000000000000000000000000000010	000000000100000000000100	2		1	0.00	0.00	2		2	2								
R5287	003	0	1	31	11	R5287_003_0	8	3	Group 3	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
R5287	003	0	1	31	11	R5287_003_0	8	2	Group 2	01	0000000000000000000010000000010000000		2		2			2		2	1			0	30				
R5287	003	0	1	31	11	R5287_003_0	8	1	Group 1	11	0111111111111110000001111111001111101	000001100000000000001000	2		2			2		2	1			30	30				
R5342	001	0	1	31	11	R5342_001_0	6	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
R5342	001	0	1	31	11	R5342_001_0	6	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
R5342	001	0	1	31	11	R5342_001_0	6	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	60.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
R5342	001	0	1	31	11	R5342_001_0	6	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			30	30				
R5342	001	0	1	31	11	R5342_001_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		30	30		1	35.00	60.00
R5342	001	0	1	31	11	R5342_001_0	6	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			30	30				
R5342	001	0	1	31	11	R5342_001_0	6	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
R5342	001	0	1	31	11	R5342_001_0	6	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	60.00	60.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	10	Group 10	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	1	Group 1	01	0000001000000000000000000000000000000		2		1	35.00	35.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	11	Group 11	01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
R5342	002	0	1	31	11	R5342_002_0	5	9	Group 9	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
R5342	002	0	1	31	11	R5342_002_0	5	8	Group 8	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	7	Group 7	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	6	Group 6	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	5	Group 5	01	0000000000000000000010000000000000000		2		1	13.00	21.00	2		2	1			30	30				
R5342	002	0	1	31	11	R5342_002_0	5	12	Group 12	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
R5342	002	0	1	31	11	R5342_002_0	5	13	Group 13	01	0000000000001000000000000000000000000		2		1	35.00	60.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	14	Group 14	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	2	Group 2	11	0111000111010010000000000000000001101	000001000000000000001010	2		1	60.00	60.00	2		2	2								
R5342	002	0	1	31	11	R5342_002_0	5	3	Group 3	11	0000000000000000000001000011001110010	000000000000000100000000	2		2			2		2	1			30	30				
R5342	002	0	1	31	11	R5342_002_0	5	4	Group 4	01	0000000000000001111100000000000000000		2		1	13.00	21.00	2		1	1	2		30	30		1	35.00	60.00
R5342	801	0	1	31	11	R5342_801_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R5342	801	0	1	31	11	R5342_801_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R5342	802	0	1	31	11	R5342_802_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R5342	802	0	1	31	11	R5342_802_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R5342	803	0	1	31	11	R5342_803_0	3	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R5342	803	0	1	31	11	R5342_803_0	3	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R5826	001	0	1	31	11	R5826_001_0	6	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	30				
R5826	001	0	1	31	11	R5826_001_0	6	4		01	0000000000000000000000000100100000000		2		2			2		2	1			20	20				
R5826	001	0	1	31	11	R5826_001_0	6	5		01	0000000000000000000010000000000010000		2		2			2		2	1			20	30				
R5826	001	0	1	31	11	R5826_001_0	6	6		11	0111111111111111111101100011001101101	000000000000000100000000	2		2			2		2	1			30	30				
R5826	001	0	1	31	11	R5826_001_0	6	7		10		000000000010000010000000	2		2			2		2	1			50	50				
R5826	001	0	1	31	11	R5826_001_0	6	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
R5826	001	0	1	31	11	R5826_001_0	6	2		01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
R5826	002	0	1	31	11	R5826_002_0	3	6		10		000000000000000000010000	2		2			2		2	1			50	55				
R5826	002	0	1	31	11	R5826_002_0	3	1		11	0000000000000000000000010000000000010	000000100000000000001000	2		1	0.00	0.00	2		2	2								
R5826	002	0	1	31	11	R5826_002_0	3	2		01	0000000000000000000000001000000000000		2		1	225.00	225.00	2		2	2								
R5826	002	0	1	31	11	R5826_002_0	3	3		01	0000000000000000000000000000010000000		2		2			2		2	1			0	20				
R5826	002	0	1	31	11	R5826_002_0	3	4		11	0111111111111111111111100111101111101	000000000000000100000000	2		2			2		2	1			20	20				
R5826	002	0	1	31	11	R5826_002_0	3	5		10		000000000110000010100000	2		2			2		2	1			50	50				
R5826	003	0	1	31	11	R5826_003_0	4	15		10		000000000110000010110000	2		2			2		2	1			50	50				
R5826	003	0	1	31	11	R5826_003_0	4	2		01	0000000000000000100000000000000000100		2		1	0.00	45.00	2		2	2								
R5826	003	0	1	31	11	R5826_003_0	4	3		01	0111001100000000000000000000000000000		2		1	15.00	15.00	2		2	2								
R5826	003	0	1	31	11	R5826_003_0	4	4		01	0000000001001000000000000000000000000		2		1	15.00	45.00	2		2	2								
R5826	003	0	1	31	11	R5826_003_0	4	5		01	0000000010000010000100000000000000000		2		1	15.00	50.00	2		2	2								
R5826	003	0	1	31	11	R5826_003_0	4	6		01	0000000000000000010000000000000000000		2		1	150.00	225.00	2		1	2	2					1	15.00	45.00
R5826	003	0	1	31	11	R5826_003_0	4	7		01	0000000000000000000001001000000000000		2		1	225.00	225.00	2		2	2								
R5826	003	0	1	31	11	R5826_003_0	4	8		01	0000100000100100000000000000000000000		2		1	40.00	40.00	2		2	2								
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R5826	003	0	1	31	11	R5826_003_0	4	9		01	0000000000010000000000000000000001001		2		1	45.00	45.00	2		2	2								
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R5826	003	0	1	31	11	R5826_003_0	4	11		01	0000010000000000001000000010100010000		2		2			2		2	1			20	20				
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R5941	007	0	1	31	11	R5941_007_0	7	2	Therapeutic radiological services	01	0000000000000000001000000000000000000		2		2			2		1	1	2		20	20		1	30.00	45.00
R5941	007	0	1	31	11	R5941_007_0	7	13	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	45.00	2		2	2								
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R5941	007	0	1	31	11	R5941_007_0	7	11	20%	11	0000000000000000000000000000100010000	000000000000000000100000	2		2			2		2	1			20	20				
R5941	007	0	1	31	11	R5941_007_0	7	10	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
R5941	007	0	1	31	11	R5941_007_0	7	1	$0	11	0000010000000000000000010000001101010	000000100000000010001100	2		1	0.00	0.00	2		2	2								
R5941	007	0	1	31	11	R5941_007_0	7	9	Labs	01	0000000000000000100000000000000000000		2		1	25.00	25.00	2		1	2	2					1	30.00	45.00
R5941	007	0	1	31	11	R5941_007_0	7	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
R5941	007	0	1	31	11	R5941_007_0	7	5	Specialist	11	0111000111010010000000000000000000001	000000000000000000000010	2		1	45.00	45.00	2		2	2								
R5941	007	0	1	31	11	R5941_007_0	7	6	DME/ASC	01	0000000000000000000001000111000000000		2		2			2		2	1			30	30				
R5941	007	0	1	31	11	R5941_007_0	7	7	Mental Health	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
R5941	007	0	1	31	11	R5941_007_0	7	8	Radiology	01	0000000000000001010100000000000000000		2		2			2		1	1	2		30	30		1	30.00	45.00
R5941	007	0	1	31	11	R5941_007_0	7	3	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	30.00	45.00	2		2	1			30	30				
R5941	008	0	1	31	11	R5941_008_0	8	2	Therapeutic radiological services	01	0000000000000000001000000000000000000		2		2			2		1	1	2		20	20		1	30.00	45.00
R5941	008	0	1	31	11	R5941_008_0	8	13	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	45.00	2		2	2								
R5941	008	0	1	31	11	R5941_008_0	8	12	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	45.00	2		2	2								
R5941	008	0	1	31	11	R5941_008_0	8	11	20%	11	0000000000000000000000000000100010000	000000000000000000100000	2		2			2		2	1			20	20				
R5941	008	0	1	31	11	R5941_008_0	8	10	Ambulance	01	0000000000000000000000001000000000000		2		1	95.00	95.00	2		2	2								
R5941	008	0	1	31	11	R5941_008_0	8	1	$0	11	0000010000000000000000010000001101010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R5941	008	0	1	31	11	R5941_008_0	8	3	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	30.00	45.00	2		2	1			30	30				
R5941	008	0	1	31	11	R5941_008_0	8	9	Labs	01	0000000000000000100000000000000000000		2		1	20.00	20.00	2		1	2	2					1	30.00	45.00
R5941	008	0	1	31	11	R5941_008_0	8	8	Radiology	01	0000000000000001010100000000000000000		2		2			2		1	1	2		25	25		1	30.00	45.00
R5941	008	0	1	31	11	R5941_008_0	8	7	Mental Health	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
R5941	008	0	1	31	11	R5941_008_0	8	6	DME/ASC	01	0000000000000000000001000111000000000		2		2			2		2	1			30	30				
R5941	008	0	1	31	11	R5941_008_0	8	5	Specialist	11	0111000111010010000000000000000000001	000000000000000000000010	2		1	45.00	45.00	2		2	2								
R5941	008	0	1	31	11	R5941_008_0	8	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	1	$0	11	0000010000000000000000010000001101010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	10	Ambulance	01	0000000000000000000000001000000000000		2		1	150.00	150.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	11	20%	01	0000000000000000000000000000100010000		2		2			2		2	1			20	20				
R5941	009	0	1	31	11	R5941_009_0	8	12	Preventive Services	01	0000000000000000000000000000010000000		2		1	0.00	50.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	13	Eye Exams	01	0000000000000000000000000000000000100		2		1	0.00	50.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	2	Therapeutic Radiological Services	01	0000000000000000001000000000000000000		2		2			2		1	1	2		20	20		1	30.00	50.00
R5941	009	0	1	31	11	R5941_009_0	8	9	Labs	01	0000000000000000100000000000000000000		2		1	20.00	20.00	2		1	2	2					1	30.00	50.00
R5941	009	0	1	31	11	R5941_009_0	8	7	Mental Health	01	0000100000100100000000100000000000000		2		1	50.00	50.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	6	DME/ASC	01	0000000000000000000001000111000000000		2		2			2		2	1			30	30				
R5941	009	0	1	31	11	R5941_009_0	8	5	Specialist	11	0111000111010010000000000000000000001	000000000000000000000010	2		1	50.00	50.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	4	PCP	01	0000001000001000000000000000000000000		2		1	30.00	30.00	2		2	2								
R5941	009	0	1	31	11	R5941_009_0	8	3	Outpatient Hospital	01	0000000000000000000010000000000000000		2		1	30.00	50.00	2		2	1			30	30				
R5941	009	0	1	31	11	R5941_009_0	8	8	Radiology	01	0000000000000001010100000000000000000		2		2			2		1	1	2		30	30		1	30.00	50.00
R6801	008	0	1	31	11	R6801_008_0	6	3	Group 3	11	0000010000000000000000000000011100000	000001010100000010101110	2		1	0.00	0.00	2		2	2								
R6801	008	0	1	31	11	R6801_008_0	6	2	Group 2	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
R6801	008	0	1	31	11	R6801_008_0	6	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
R6801	008	0	1	31	11	R6801_008_0	6	5	Group 5	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R6801	008	0	1	31	11	R6801_008_0	6	4	Group 4	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
R6801	009	0	1	31	11	R6801_009_0	5	14	Gourp 14	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
R6801	009	0	1	31	11	R6801_009_0	5	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	10.00	10.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	5	Group 5	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	7	Group 7	10		000000000000000000000001	2		1	340.00	390.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
R6801	009	0	1	31	11	R6801_009_0	5	13	Group 13	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
R6801	009	0	1	31	11	R6801_009_0	5	12	Group 12	01	0000000000000000000010000000000000000		2		1	14.00	15.00	2		2	1			20	20				
R6801	009	0	1	31	11	R6801_009_0	5	11	Group 11	11	0000000000010000000000010001011100110	000000110000000010000100	2		1	0.00	0.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	10	Group 10	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	1	Group 1	11	0111000011001010000000000000000001101	000001000000000000000000	2		1	45.00	45.00	2		2	2								
R6801	009	0	1	31	11	R6801_009_0	5	9	Group 9	01	0000000000000001111100000000000000000		2		1	14.00	15.00	2		1	1	2		20	20		1	10.00	45.00
R6801	011	0	1	31	11	R6801_011_0	5	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
R6801	011	0	1	31	11	R6801_011_0	5	2	Group 2	11	0000010000000000000000000000011100000	000000010000000010111110	2		1	0.00	0.00	2		2	2								
R6801	011	0	1	31	11	R6801_011_0	5	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
R6801	011	0	1	31	11	R6801_011_0	5	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
R6801	011	0	1	31	11	R6801_011_0	5	4	Group 4	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	14	Gruop 14	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
R6801	012	0	1	31	11	R6801_012_0	5	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
R6801	012	0	1	31	11	R6801_012_0	5	4	Group 4	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	5	Group 5	01	0000000000000001111100000000000000000		2		1	14.00	15.00	2		1	1	2		20	20		1	15.00	45.00
R6801	012	0	1	31	11	R6801_012_0	5	6	Group 6	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	7	Group 7	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	8	Group 8	10		000000000000000000000001	2		1	340.00	390.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	9	Group 9	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
R6801	012	0	1	31	11	R6801_012_0	5	12	Group 12	11	0000000000000000000000010001011100110	000000100000000110000100	2		1	0.00	0.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	11	Group 11	01	0000000000000000000010000000000000000		2		1	14.00	15.00	2		2	1			20	20				
R6801	012	0	1	31	11	R6801_012_0	5	10	Group 10	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	15.00	15.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	1	Group 1	11	0111000011011010000000000000000001101	000001000000000000000000	2		1	45.00	45.00	2		2	2								
R6801	012	0	1	31	11	R6801_012_0	5	13	Group 13	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R7439	001	0	1	31	11	R7439_001_0	10	1	Group 1 -30%	01	0111111111111111111111100111100011101		2		2			2		2	1			30	30				
R7439	001	0	1	31	11	R7439_001_0	10	2	Group 2 - $0	11	0000000000000000000000010000011100010	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R7439	001	0	1	31	11	R7439_001_0	10	3	Group 3 - $200	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
R7439	003	0	1	31	11	R7439_003_0	9	1	Group 1 - 30%	11	0111111111111111111111100111100011101	000000000000000000001000	2		2			2		2	1			30	30				
R7439	003	0	1	31	11	R7439_003_0	9	2	Group 2 - $0	11	0000000000000000000000010000011100010	000000100000000010000100	2		1	0.00	0.00	2		2	2								
R7439	003	0	1	31	11	R7439_003_0	9	3	Group 3 - $200	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
R7439	006	0	1	31	11	R7439_006_0	8	1	Group 1 - 30%	11	0111111111111111111111100111100011101	000000000000000000001000	2		2			2		2	1			30	30				
R7439	006	0	1	31	11	R7439_006_0	8	3	Group 3 - $200	01	0000000000000000000000001000000000000		2		1	200.00	200.00	2		2	2								
R7439	006	0	1	31	11	R7439_006_0	8	2	Group 2 - $0	11	0000000000000000000000010000011100010	000000100000000010000100	2		1	0.00	0.00	2		2	2								
R7439	801	0	1	31	11	R7439_801_0	5	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R7439	801	0	1	31	11	R7439_801_0	5	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R7439	802	0	1	31	11	R7439_802_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R7439	802	0	1	31	11	R7439_802_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R7439	805	0	1	31	11	R7439_805_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R7439	805	0	1	31	11	R7439_805_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R7439	806	0	1	31	11	R7439_806_0	4	2		01	0111101111111111111111111111101111111		2		2			2		2	1			20	20				
R7439	806	0	1	31	11	R7439_806_0	4	1		01	0000010000000000000000000000010000000		2		2			2		2	1			0	0				
R7444	001	0	1	31	11	R7444_001_0	6	11	Group 11	01	0000000000000000000010000000000000000		2		1	14.00	14.00	2		2	1			40	40				
R7444	001	0	1	31	11	R7444_001_0	6	2	Group 2	11	0000000000000000000000010000000000000	000000100000000010000000	2		1	0.00	0.00	2		2	2								
R7444	001	0	1	31	11	R7444_001_0	6	9	Group 9	01	0000000000000000000000000000010000000		2		2			2		2	1			0	40				
R7444	001	0	1	31	11	R7444_001_0	6	4	Group 4	01	0000000000000000000000000000100000000		2		2			2		2	1			20	20				
R7444	001	0	1	31	11	R7444_001_0	6	5	Group 5	01	0000000000000001111100000000000000000		2		1	14.00	14.00	2		1	1	1	40	40	40	40	2		
R7444	001	0	1	31	11	R7444_001_0	6	6	Group 6	01	0000000000100100000000100000000000000		2		1	35.00	45.00	2		2	2								
R7444	001	0	1	31	11	R7444_001_0	6	7	Group 7	01	0000100000000000000000000000000000000		2		1	75.00	75.00	2		2	2								
R7444	001	0	1	31	11	R7444_001_0	6	8	Grroup 8	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R7444	001	0	1	31	11	R7444_001_0	6	10	Group 10	10		000000000000000000000001	2		1	390.00	450.00	2		2	2								
R7444	001	0	1	31	11	R7444_001_0	6	1	Group 1	11	0111001111011010000001000011001111111	000001000000000100001010	2		2			2		2	1			40	40				
R7444	001	0	1	31	11	R7444_001_0	6	3	Group 3	01	0000010000000000000000000100000000000		2		2			2		2	1			50	50				
R9896	008	0	1	31	11	R9896_008_0	6	2	Group 2	11	0000010000000000000000000000011100000	000001010100000010101110	2		1	0.00	0.00	2		2	2								
R9896	008	0	1	31	11	R9896_008_0	6	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
R9896	008	0	1	31	11	R9896_008_0	6	4	Group 4	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R9896	008	0	1	31	11	R9896_008_0	6	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
R9896	008	0	1	31	11	R9896_008_0	6	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
R9896	009	0	1	31	11	R9896_009_0	6	12	Group 12	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	11	Group 11	11	0000000000010000000000010001011100010	000000110000000010000100	2		1	0.00	0.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	10	Group 10	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
R9896	009	0	1	31	11	R9896_009_0	6	1	Group 1	11	0111000011000010000000000000000001001	000001000000000000000000	2		1	50.00	50.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	5	Group 5	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	6	Group 6	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	7	Group 7	01	0000000000000000000010000000000000000		2		1	12.00	15.00	2		2	1			20	20				
R9896	009	0	1	31	11	R9896_009_0	6	8	Group 8	01	0000000000000000000001000010100010000		2		2			2		2	1			20	20				
R9896	009	0	1	31	11	R9896_009_0	6	9	Group 9	01	0000000000000001111100000000000000000		2		1	12.00	15.00	2		1	1	2		20	20		1	25.00	50.00
R9896	009	0	1	31	11	R9896_009_0	6	13	Group 13	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	14	Group 14	01	0000000000000000000000000000000000100		2		1	0.00	50.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	15	Group 15	01	0000000000001000000000000000000000000		2		1	25.00	50.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	2	Group 2	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	4	Group 4	11	0000001000000000000000000000000000000	000000000000000000001010	2		1	25.00	25.00	2		2	2								
R9896	009	0	1	31	11	R9896_009_0	6	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
R9896	012	0	1	31	11	R9896_012_0	6	9	Group 9	01	0000000000000000000010000000000000000		2		1	13.00	15.00	2		2	1			20	20				
R9896	012	0	1	31	11	R9896_012_0	6	8	Group 8	01	0000000000000000000001000011100010000		2		2			2		2	1			20	20				
R9896	012	0	1	31	11	R9896_012_0	6	7	Group 7	01	0000000000000000000000000100000000000		2		2			2		2	1			40	40				
R9896	012	0	1	31	11	R9896_012_0	6	6	Group 6	01	0000000000000001111100000000000000000		2		1	13.00	15.00	2		1	1	2		20	20		1	30.00	50.00
R9896	012	0	1	31	11	R9896_012_0	6	5	Group 5	11	0000000100000000000000000000000000000	000000000000000000100000	2		1	20.00	20.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	4	Group 4	11	0000001000001000000000000000000000000	000000000000000000000010	2		1	30.00	30.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	3	Group 3	01	0000010000000000000000000000000000000		2		2			2		2	1			50	50				
R9896	012	0	1	31	11	R9896_012_0	6	2	Group 2	01	0000000000100100000000100000000000000		2		1	30.00	40.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	15	Group 15	01	0000000000000000000000000000000000100		2		1	0.00	50.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	14	Group 14	10		000000000000000000001000	2		1	25.00	25.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	13	Group 13	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	12	Group 12	01	0000000000000000000000001000000000000		2		1	250.00	250.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	11	Group 11	11	0000000000000000000000010001011100010	000000100000000110000100	2		1	0.00	0.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	10	Group 10	01	0000100000000000000000000000000000000		2		1	55.00	55.00	2		2	2								
R9896	012	0	1	31	11	R9896_012_0	6	1	Group 1	11	0111000011011010000000000000000001001	000001000000000000000000	2		1	50.00	50.00	2		2	2								
R9896	021	0	1	31	11	R9896_021_0	5	2	Group 2	11	0000010000000000000000000000011100000	000000010000000010111110	2		1	0.00	0.00	2		2	2								
R9896	021	0	1	31	11	R9896_021_0	5	3	Group 3	01	0000000000000000000000000000000000100		2		2			2		2	1			0	20				
R9896	021	0	1	31	11	R9896_021_0	5	4	Group 4	10		000000000000000000000001	2		1	330.00	380.00	2		2	2								
R9896	021	0	1	31	11	R9896_021_0	5	5	Group 5	01	0000000000000001111100000000000000000		2		2			2		1	1	1	20	20	20	20	2		
R9896	021	0	1	31	11	R9896_021_0	5	1	Group 1	01	0111101111111110000011111111100011011		2		2			2		2	1			20	20				
